12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity.

BACKGROUND: Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. METHODS: All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. RESULTS: The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46-60% of patients achieved recovery with respect to PTSD symptoms, and that 44-48% no longer met diagnostic criteria for PTSD. CONCLUSIONS: Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. TRIAL REGISTRATION: The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.

Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity.

Background: Intensive outpatient treatment could be a promising option for patients with post-traumatic stress disorder (PTSD). Objective: The aim of the study was to test the effectiveness of an eight-day (two-week) intensive treatment for PTSD within a public health care setting (open trial design). Method: Eighty-nine patients were offered the choice between intensive treatment and spaced individual treatment, of which 34 (38.2%) chose the intensive format. Patients were assessed with self-report batteries and interviews at pre-treatment, start of treatment, post-treatment and three-month follow-up. Each day consisted of individual Prolonged Exposure therapy, Eye Movement Desensitization and Reprocessing therapy, group psychoeducation, and physical activity. Therapists rotated between patients. Results: Between 55 and 62% of the patients showed a clinically significant change (recovery) in symptoms of PTSD, and the effect sizes were large (d = 1.38-1.52). Patients also showed reduction in symptoms of depression and anxiety, along with improved well-being and interpersonal functioning. Changes in social and work functioning were more ambiguous. There were no dropouts, attendance was high, and patients were highly satisfied with the treatment. Conclusions: The intensive programme was an attractive and effective treatment option for patients with PTSD.

Antecedentes: El tratamiento ambulatorio intensivo podría ser una opción prometedora para los pacientes con trastorno de estrés postraumático (TEPT).Objetivo: El objetivo del estudio fue probar la efectividad de un tratamiento intensivo de 8 días (2 semanas) para el TEPT dentro de un entorno de atención de salud pública (diseño de ensayo abierto).Método: Se ofreció a 89 pacientes elegir entre tratamiento intensivo y tratamiento individual espaciado, de los cuales 34 (38,2%) eligieron el formato intensivo. Los pacientes fueron evaluados con baterías de autoinforme y entrevistas antes del tratamiento, al inicio del tratamiento, después del tratamiento y a los 3 meses de seguimiento. Cada día consistió en terapia de exposición prolongada individual, terapia de reprocesamiento y desensibilización por movimientos oculares, psicoeducación grupal y actividad física. Los terapeutas rotaron entre los pacientes.Resultados: Entre el 55-62% de los pacientes mostraron un cambio clínicamente significativo (recuperación) en los síntomas del TEPT, y los tamaños del efecto fueron grandes (d = 1,38­1,52). Los pacientes también mostraron una reducción en los síntomas de depresión y ansiedad, junto con mejoría en bienestar y funcionamiento interpersonal. Los cambios en el funcionamiento social y laboral fueron más ambiguos. No hubo abandonos, la asistencia fue alta y los pacientes estaban altamente satisfechos con el tratamiento.Conclusiones: El programa intensivo fue una opción de tratamiento atractiva y efectiva para pacientes con TEPT.

Intensive outpatient treatment for post-traumatic stress disorder: a thematic analysis of patient experience.

Background: Intensive treatments have shown encouraging results in the treatment of several psychological disorders, including post-traumatic stress disorder (PTSD). However, qualitative studies on patient experiences with intensive treatment for PTSD remain scarce. Objective: The aim of this study was to explore patient experiences with an intensive, outpatient treatment for PTSD and to discover important factors behind treatment feasibility. Method: Eight participants were recruited from two groups of patients having completed the intensive treatment programme. Semi-structured qualitative interviews were conducted, and data sets were analysed using thematic analysis. Results: The main result indicated that patients experienced the treatment as very demanding, but still worth the effort in terms of reducing symptoms. The intensity was valued as useful. Participants emphasized the sense of unity with other participants as well as physical activity as important factors for completion of the treatment programme. The rotation of therapists was also highlighted as important for treatment efficacy. Conclusions: This study provides insights into what the patients experienced and emphasized as important aspects of treatment and essential factors for completing treatment. The main conclusions were that all of the patients evaluated the treatment as demanding, but the reward of reduced symptoms made it worthwhile. The high frequency of therapy sessions and the therapist rotation were reported to counteract avoidance and increase the patients' commitment to therapy. Physical activity and unity in the group were highlighted as essential for treatment feasibility. HIGHLIGHTS: • High treatment intensity enabled increased focus and adherence, and reduced avoidance. Therapist rotation led to heightened intensity and new learning experiences.• Physical activity and sense of unity through group elements were reported as important factors for treatment feasibility.