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OBJECTIVE: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. METHODS: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60-78 years) and 62 younger PTSD patients (19-58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. RESULTS: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). CONCLUSION: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
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BACKGROUND: Complex PTSD (CPTSD) has been incorporated in the 11th edition of the International Classification of Diseases (ICD-11) as a mental health condition distinct from PTSD. OBJECTIVE: The objective of the current study is to determine whether individuals classified as having CPTSD can benefit from an intensive trauma-focused treatment, resulting in decreased PTSD and CPTSD symptoms, and loss of diagnoses. METHOD: Patients diagnosed with PTSD (N = 308) took part in an intensive 8-day treatment programme combining prolonged exposure, EMDR therapy, psycho-education, and physical activity. The treatment was not phase-based in that it did not contain a stabilization phase or skill training prior to therapy. CPTSD diagnosis was assessed by means of the International Trauma Questionnaire (ITQ) and PTSD diagnosis was assessed with both the ITQ and CAPS-5. Treatment response was measured with the CAPS-5, PCL-5, and ITQ. RESULTS: Symptoms of both PTSD and CPTSD significantly decreased from pre- to post-treatment resulting in a significant loss of CAPS-5 based PTSD (74.0%) and ITQ-based PTSD and CPTSD diagnoses (85.0% and 87.7%, respectively). No adverse events occurred in terms of suicides, suicide attempts, or hospital admissions. CONCLUSIONS: The results are supportive of the notion that the majority of patients classified as having CPTSD strongly benefit from an intensive trauma-focused treatment for their PTSD.
Antecedentes: El TEPT complejo (TEPT-C) se ha incorporado en la 11ª edición de la Clasificación Internacional de Enfermedades (CIE-11) como una condición de salud mental distinta del TEPT.Objetivo: El objetivo del presente estudio es determinar si las personas clasificadas como con TEPT-C pueden beneficiarse de un tratamiento intensivo centrado en el trauma, lo que resulta en una disminución de los síntomas de TEPT y TEPT-C y la pérdida de diagnóstico de TEPT.Método: Los pacientes diagnosticados con TEPT (N = 308) participaron en un programa de tratamiento intensivo de 8 días que combina exposición prolongada, terapia EMDR, psicoeducación y actividad física. El tratamiento no se dividió en fases, ya que no contenía una fase de estabilización o entrenamiento de habilidades antes de la terapia. El diagnóstico de TEPT-C se evaluó mediante el Cuestionario Internacional de Trauma (ITQ por sus siglas en ingles) y el diagnóstico de TEPT se evaluó tanto con el ITQ como con CAPS-5. La respuesta al tratamiento se midió con CAPS-5, PCL-5 e ITQ.Resultados: los síntomas de TEPT y TEPT-C disminuyeron significativamente del pretratamiento al postratamiento, lo que resultó en una pérdida significativa del diagnóstico de TEPT basado en CAPS-5 (74.0%) y diagnósticos de TEPT y TEPT-C basados en ITQ (85.0 y 87.7%, respectivamente). No se produjeron eventos adversos en términos de suicidios, intentos de suicidio o ingresos hospitalarios.Conclusiones: Los resultados apoyan la noción de que la mayoría de los pacientes clasificados con TEPT-C se benefician significativamente de un tratamiento intensivo centrado en el trauma para su TEPT.
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OBJECTIVE: Investigating the influence of the sequence in which two evidence-based trauma-focused treatments are offered to PTSD-patients. METHODS: PTSD-patients were treated using an intensive eight-day treatment program, combining Prolonged Exposure (PE) and EMDR therapy. Forty-four patients received a PE session in the morning and an EMDR session in the afternoon, while 62 patients received the reversed sequence (EMDR followed by PE). Outcome measures were PTSD symptom severity and subjective experiences. RESULTS: Patients who received PE first and EMDR second showed a significantly greater reduction in PTSD symptoms. Patients preferred this sequence and valued the treatment sessions as significantly more helpful compared to patients in the EMDR-first condition. CONCLUSION: The results of this explorative study are supportive of the notion that PE and EMDR therapy can be successfully combined, and that sequence matters. First applying PE sessions before EMDR sessions resulted in better treatment outcome, and better subjective patient's evaluations in terms of treatment helpfulness and preference.