Posttraumatic stress disorder and depression residual symptoms among veterans and service members who completed a 3-week cognitive processing therapy-based intensive treatment program.

OBJECTIVE: While previous studies have documented that evidence-based treatments for posttraumatic stress disorder (PTSD) are efficacious, treatment completers often continue to experience residual symptoms. However, no studies to date have assessed residual symptoms following intensive treatment programs (ITPs) for PTSD, which combine evidence-based PTSD treatment along with adjunctive interventions. The present study examined residual symptoms of PTSD and depression in 482 veterans and service members who completed a 3-week Cognitive Processing Therapy-based ITP. METHOD: Residual symptoms were examined at posttreatment and 3 months following ITP completion. Frequency analyses and logistic regressions were conducted to discern the presence of residual symptoms among (a) the total sample and (b) participants who did and did not experience clinically meaningful change in PTSD symptom severity over the course of treatment. RESULTS: Study results indicated that the majority of participants (80%-87%) reported some PTSD and depression residual symptoms at ITP completion, which commonly continued to be endorsed at 3 months following ITP completion. At both treatment completion and 3 months following treatment, participants who experienced clinically meaningful changes during the ITP exhibited statistically lower odds of PTSD and depression residual symptoms as compared to participants who did not experience clinically meaningful changes. However, regardless of whether clinically meaningful changes in PTSD symptoms were experienced, participants most commonly endorsed residual symptoms in the hyperarousal cluster of PTSD and general depression symptoms at high rates. CONCLUSIONS: Findings suggest the need to further examine functional impairment and coping skill use associated with these long-standing residual symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A case series examining PTSD and depression symptom reductions over the course of a 2-week virtual intensive PTSD treatment program for veterans.

OBJECTIVE: Evidence-based treatments for posttraumatic stress disorder (PTSD) can be effectively delivered over telehealth. There are, however, no studies that examine the effectiveness of delivering evidence-based treatments for PTSD in an intensive format via telehealth. Telehealth may be well-suited as a delivery modality because it may address barriers specific to intensive treatments. METHOD: To address this gap, we report on a case series of ten consecutively enrolled veterans (60% male; mean age 42.3, SD = 6.3) who participated in a virtual 2-week, cognitive processing therapy (CPT)-based intensive program. RESULTS: All (100%) participants completed treatment and reported large reductions in PTSD and depression symptoms pre- to posttreatment (Hedge's gws = 2.83 and gws = 1.97, respectively), pre- to 3-month follow-up (Hedge's gws = .99 and gws = 1.24, respectively), as well as very high satisfaction. CONCLUSIONS: Results of this case series suggest that evidence-based treatments for PTSD can be effectively delivered in intensive formats over telehealth and lay the foundation for more rigorously designed and larger scale research comparing virtual to in-person delivered intensive PTSD treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do morally injurious experiences and index events negatively impact intensive PTSD treatment outcomes among combat veterans?

Background: It has been suggested that current frontline posttraumatic stress disorder (PTSD) treatments are not effective for the treatment of moral injury and that individuals who have experienced morally injurious events may respond differently to treatment than those who have not. However, these claims have yet to be empirically tested. Objective: This study evaluated the rates of morally injurious event exposure and morally injurious index trauma and their impact on PTSD (PCL-5) and depression symptom (PHQ-9) reductions during intensive PTSD treatment. Method: Data from 161 USA military combat service members and veterans (91.3% male; mean age = 39.94 years) who participated in a 3-week Cognitive Processing Therapy (CPT)-based intensive PTSD treatment programme (ITP) was utilized. Morally injurious event exposure was established via the Moral Injury Event Scale (MIES). Index traumas were also coded by the treating clinician. Linear mixed effects regression analyses were conducted to examine if differences in average effects or trends over the course of treatment existed between veterans with morally injurious event exposure or index trauma and those without. Results: Rates of morally injurious event exposure in this treatment sample were high (59.0%-75.2%). Morally injurious event exposure and the type of index trauma did not predict changes in symptom outcomes from the ITP and veterans reported large reductions in PTSD (d = 1.35-1.96) and depression symptoms (d = 0.95-1.24) from pre- to post-treatment. Non-inferiority analyses also demonstrated equivalence across those with and without morally injurious event exposure and index events. There were no significant gender differences. Conclusions: The present study suggests that PTSD and depression in military veterans with morally injurious event exposure histories may be successfully treated via a 3-week CPT-based ITP.

Antecedentes: Se ha sugerido que los tratamientos actuales de primera línea para el trastorno de estrés postraumático (TEPT) no son efectivos para el tratamiento del daño moral y que las personas que han experimentado eventos moralmente dañinos pueden responder de manera diferente al tratamiento que las que no lo han hecho. Sin embargo, estas afirmaciones aún no se han probado empíricamente.Objetivo: Este estudio evaluó las tasas de exposición a eventos moralmente dañinos y trauma índice moralmente dañino y su impacto en las reducciones de síntomas del TEPT (PCL-5) y de depresión (PHQ-9) durante el tratamiento intensivo para TEPT.Método: Se utilizaron datos de 161 miembros y veteranos del servicio militar de combate de los Estados Unidos (91,3% hombres; edad promedio = 39,94 años) que participaron en un programa de tratamiento intensivo de TEPT (ITP en su sigla en inglés) basado en la Terapia de procesamiento cognitivo (CPT en su sigla en inglés) durante 3 semanas. La exposición a eventos moralmente dañinos se estableció mediante la Escala de eventos de daño moral (MIES en su sigla en inglés). Los traumas índice también fueron codificados por el médico tratante. Se llevaron a cabo análisis de regresión de efectos mixtos lineales para examinar si existían diferencias en los efectos promedio o las tendencias durante el curso de tratamiento en los veteranos con exposición a eventos moralmente perjudiciales o trauma índice y los que no.Resultados: Las tasas de exposición a eventos moralmente dañinos en esta muestra de tratamiento fueron altas (59,0% −75,2%). La exposición a eventos moralmente dañinos y el tipo de trauma índice no predijeron cambios en los resultados de los síntomas de la ITP y los veteranos reportaron grandes reducciones en los síntomas de TEPT (d = 1.35-1.96) y de depresión (d = 0.95-1.24) entre el pre- y post- tratamiento. Los análisis de no inferioridad también demostraron equivalencia entre aquellos con y sin exposición a eventos moralmente dañinos y eventos índice. No hubo diferencias de género significativas.Conclusiones: El presente estudio sugiere que el TEPT y la depresión en los veteranos militares con antecedentes de exposición a eventos moralmente dañinos pueden tratarse con éxito mediante un IPT basado en CPT de 3 semanas.

A placebo-controlled pilot study of a wearable morning bright light treatment for probable PTSD.

BACKGROUND: Evidence-based treatments for post-traumatic stress disorder (PTSD) have poor uptake and remission rates, suggesting that alternative treatments are needed. Morning bright light may be an effective treatment for PTSD given its established effects on mood and sleep, however, there are no published trials. METHODS: We conducted a placebo-controlled pilot trial of a wearable light device, the Re-timer®, for individuals with probable PTSD. Individuals were randomly assigned to the active Re-timer® (n = 9) or a placebo Re-timer® dimmed with neutral density filters (n = 6). Participants self-administered the treatment at home 1 hr each morning over 4 weeks. PTSD and depression symptoms were assessed at pre- and post-treatment. RESULTS: The Re-timer® was well tolerated and the perceived benefit was high, though treatment adherence was only moderate. Those in the active group were more likely to achieve a minimal clinically important change in PTSD and depression symptoms and had larger symptom reductions than those in the placebo group CONCLUSIONS: A wearable morning light treatment was acceptable and feasible for patients with probable PTSD. This study provides initial proof-of-concept that light treatment can improve PTSD. A larger trial is warranted to establish treatment efficacy. NCT#: 03513848.