Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial).

Background: New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives: This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods: Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions: This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration: This trial is registered in the Netherlands Trial Register (Trial NL9120).

Antecedentes: Se han desarrollado para personas con TEPT nuevos programas de tratamiento intensivos centrados en trauma (TFT por sus siglas en inglés) que incorporan actividad física. Sin embargo, la contribución única de la actividad física dentro de estos programas de TFT intensivos nunca se ha investigado de manera controlada.Objetivos: Este ensayo controlado aleatorizado investigará la efectividad de la actividad física agregada a un programa intensivo de TFT. Además, el estudio tiene como objetivo investigar los mecanismos subyacentes de los efectos de la actividad física sobre el cambio en los síntomas de TEPT.Métodos: Las personas con TEPT serán asignadas en forma aleatoria a dos condiciones: una actividad física o una condición de control activo no físico. Todos los participantes recibirán la misma TFT intensiva que durará 8 días dentro de dos semanas consecutivas, en las que se combinarán diariamente la exposición prolongada y las sesiones de terapia EMDR y psicoeducación. La cantidad de actividad física diferirá según la condición. Mientras que la condición de actividad física induce actividades físicas diarias de moderada intensidad, en la condición de control activo no físico no se prescribe actividad física, sino que se realiza una mezcla controlada de tareas guiadas (creativa). Las dos medidas de resultado primarias son el cambio en los síntomas de TEPT antes y después del tratamiento y a los seis meses de seguimiento, medidos con la Escala de TEPT administrada por el clínico (CAPS-5) y la Lista de verificación de TEPT del DSM-5 (PCL-5). Adicionalmente, los problemas del sueño autoinformados, los síntomas depresivos, la regulación de emociones, los síntomas disociativos y la sensibilidad a la ansiedad se medirán como potenciales mecanismos subyacentes.Conclusiones: Este estudio contribuirá al campo de la investigación de las estrategias de potenciación para el tratamiento del TEPT al investigar la efectividad de la actividad física agregada a la TFT intensiva.Registro de ensayo: este ensayo esta registrado en el Registro de ensayos de los Países Bajos (ensayo NL 9120).

The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder.

Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

Antecedentes: generalmente se recomienda tener precaución al aplicar un tratamiento centrado en el trauma a las personas con trastorno de estrés postraumático (TEPT) y trastorno de personalidad límite comórbido (TPL).Objetivo: Investigar los efectos de un programa de tratamiento breve, intensivo y directo centrado en el trauma para personas con TEPT sobre la gravedad de los síntomas de TPL.Métodos: los participantes (n = 72) con TEPT grave (87.5% tenían una o más comorbilidades; 52.8% cumplieron los criterios para el subtipo disociativo de TEPT) debido a múltiples traumas (por ejemplo, 90.3% abuso sexual) participaron en un programa intensivo de ocho días de tratamiento centrado en el trauma, consistente en EMDR, terapia de exposición prolongada (PE), actividad física y psicoeducación. El tratamiento no incluyó ninguna forma de estabilización (por ejemplo, entrenamiento de regulación emocional) antes de la terapia centrada en el trauma. Las evaluaciones se realizaron antes y después del tratamiento (Lista de síntomas límite, BSL-23; severidad de los síntomas de TEPT, Escala de TEPT administrada por clínicos para DSM-5, CAPS-5) y durante los ocho días de tratamiento (Lista de verificación de TEPT, PCL-5).Resultados: el tratamiento resultó en una disminución significativa de los síntomas de TPL (d de Cohen = 0.70). De los 35 pacientes con un tamizaje positivo de TPL en el pretratamiento, el 32,7% perdió su tamizaje positivo en el postratamiento. No ocurrieron eventos adversos ni abandonos durante el período de tiempo del estudio, y ninguno de los pacientes experimentó deterioro de los síntomas en respuesta al tratamiento.Conclusión: Los resultados sugieren que un tratamiento intensivo centrado en el trauma es un tratamiento factible y seguro para pacientes con TEPT con síntomas clínicamente elevados de TPL, y que los síntomas de TLP disminuyen junto con los síntomas de TEPT.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder.

Background: There is room for improvement regarding the treatment of severe post-traumatic stress disorder (PTSD). Intensifying treatment to increase patient retention is a promising development. Objective: The aim of this study was to determine the effectiveness of an intensive trauma-focused treatment programme over 8 days for individuals suffering from severe PTSD. Method: Treatment was provided for 347 PTSD patients (70% women; mean age = 38.32 years, SD = 11.69) and consisted of daily sessions of prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy (16 sessions in total), physical activity, and psycho-education. All participants had experienced multiple traumas, including sexual abuse (74.4%), and suffered from multiple comorbidities (e.g. 87.5% had a mood disorder). Suicidal ideation was frequent (73.9%). PTSD symptom severity was assessed by both clinician-rated [Clinician Administered PTSD Scale (CAPS)] and self-report [PTSD Symptom Scale Self Report (PSS-SR) and Impact of Event Scale (IES)] inventories. For a subsample (n = 109), follow-up data at 6 months were available. Results: A significant decline in symptom severity was found (e.g. CAPS intention-to-treat sample Cohen's d = 1.64). At post-treatment, 82.9% showed a clinically meaningful response and 54.9% a loss of diagnosis. Dropout was very low (2.3%). Conclusions: Intensive trauma-focused treatment programmes including prolonged exposure, EMDR therapy, and physical activity can be effective for patients suffering from severe PTSD and are associated with low dropout rates.

Antecedentes: Hay un margen de mejora con respecto al tratamiento del trastorno de estrés postraumático severo (TEPT). Intensificar el tratamiento para aumentar la retención de paciente es un desarrollo prometedor.Objetivo: Determinar la efectividad de un programa de tratamiento intensivo centrado en trauma durante 8 días para personas que presentan TEPT severo.Método: Se proporcionó tratamiento a 347 pacientes con TEPT (70,0% mujeres, edad media = 38,32 años, DE = 11,69) y consistió en sesiones diarias de exposición prolongada y terapia EMDR (16 sesiones en total), actividad física, y psico-educación. Todos los participantes habían experimentado múltiples traumas, incluido abuso sexual (74,4%), y padecían múltiples comorbilidades (por ejemplo, 87,5% trastorno anímico). La ideación suicida fue frecuente (73,9%). La gravedad de los síntomas de TEPT fue evaluada tanto por el clínico con inventarios calificados (CAPS) como por auto-reporte (PSS-SR y IES). Para una submuestra (N=109) se dispuso de datos de seguimiento a los seis meses.Resultados: Se encontró una disminución significativa en la gravedad de los síntomas (por ejemplo, en la muestra CAPS ITT d = 1,64 de Cohen). En el post tratamiento, el 82,9% mostró una respuesta clínicamente significativa y el 54,9% una pérdida del diagnóstico. El abandono fue muy bajo (2,3%).Conclusiones: Los programas intensivos de tratamientos centrados en trauma, incluido la terapia de exposición prolongada, la terapia EMDR y la actividad física, pueden ser efectivos para los pacientes que sufren de trastorno de estrés postraumático severo y se asocian con bajas tasas de abandono.

Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.

This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments.

Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders.

BACKGROUND: In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown METHOD: In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points. RESULTS: Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged. CONCLUSIONS: In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.