Changes in comorbid depression following intensive trauma-focused treatment for PTSD and complex PTSD.

BACKGROUND: The extent to which intensive trauma-focused treatment for individuals with post-traumatic stress disorder (PTSD) is also effective in treating comorbid major depressive disorder (MDD) remains unclear. OBJECTIVE: The purpose of the present study was to test the hypothesis that brief intensive trauma-focused therapy for PTSD is associated with significant reductions in depressive symptoms and loss of diagnostic status of MDD. METHODS: A total of 334 adult patients with PTSD (189 patients who were also diagnosed with MDD) underwent a brief intensive trauma-focused treatment programme consisting of EMDR therapy, prolonged exposure, physical activity, and psychoeducation. At pre-treatment, post-treatment and 6-month follow-up, severity and diagnostic status of PTSD and MDD were assessed. A linear mixed model was used to analyze changes in the severity of PTSD and depressive symptoms, whereas a generalized linear mixed model was used to determine changes in the MDD diagnostic status. RESULTS: Treatment resulted in a significant and strong decrease of PTSD and MDD symptoms at post-treatment (d = 2.34 and 1.22, respectively), and at 6-month follow-up (d = 1.67 and 0.73, respectively). The proportion of patients fulfilling the diagnostic status of MDD changed from 57% at pre-treatment to 33% at the 6-month follow-up. Although the initial response to treatment did not differ between patients with and without comorbid MDD, for both groups a significant relapse in depressive symptoms was found after six months, which could be explained almost entirely by the presence of CPTSD at baseline. CONCLUSIONS: The results support the notion that brief, intensive trauma-focused treatment is highly effective for individuals with PTSD and comorbid MDD. Because patients with CPTSD are vulnerable to relapse in depressive symptoms, this target group may require additional treatment.

Intensive trauma-focused treatment (ITFT) of PTSD proved to be associated with a significant decrease in comorbid MDD.Comorbid MDD did not moderate the effect of ITFT for PTSD.Presence of Complex PTSD was predictive of relapse of MDD symptoms 6 months later.

The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD.

Background: Individuals with posttraumatic stress disorder (PTSD) often experience sexual disturbances. Objective: To determine whether intensive trauma-focused treatment is associated with an improvement in sexual functioning (i.e., sexual satisfaction and sexual desire) in individuals with PTSD. Method: In total, 227 patients with PTSD (68.7% women, mean age = 40.97) participated in an intensive eight-day trauma-focused treatment program consisting of prolonged exposure, eye movement and desensitization and reprocessing (EMDR) therapy, physical activity, and psychoeducation. Patients were assessed (i.e., Clinician Administered PTSD Scale and Sexual Functioning Questionnaire) pre- and post-treatment and at 6-months follow-up. Results: Sexual satisfaction and sexual desire increased significantly associated with trauma-focused treatment from pre-treatment to 6-months follow-up, albeit the effect sizes were small (Cohen's d = 0.39 and 0.17, respectively). Although men reported greater overall sexual desire than women, sexual functioning improved after treatment in both men and women. Furthermore, those with remission of PTSD reported greater sexual functioning post-treatment and at 6-months follow-up, than those without remission. However, changes in PTSD symptoms associated with treatment were not predictive of the level of sexual satisfaction or sexual desire 6 months after treatment. Conclusion: The results of this uncontrolled study suggest that intensive treatment for PTSD can have beneficial effects on sexual satisfaction and desire in both men and women; however, this may not necessarily be due to a decrease in PTSD symptoms.

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial.

Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.

Prevalence of painful temporomandibular disorders, awake bruxism and sleep bruxism among patients with severe post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is associated with painful temporomandibular disorder (TMD) and may be part of the aetiology of awake bruxism (AB) and sleep bruxism (SB). Investigating the associations between PTSD symptoms on the one hand, and painful TMD, AB and SB on the other, can help tailoring treatment to the needs of this patient group. OBJECTIVES: The aim of this study was to investigate the associations between PTSD symptoms and painful TMD, AB and SB among patients with PTSD, focusing on prevalence, symptom severity and the influence of trauma history on the presence of painful TMD, AB and SB. METHODS: Individuals (N = 673) attending a specialised PTSD clinic were assessed (pre-treatment) for painful TMD (TMD pain screener), AB and SB (Oral Behaviours Checklist), PTSD symptoms (Clinician-Administered PTSD Scale) and type of traumatic events (Life Events Checklist). RESULTS: Painful TMD, AB and SB were more prevalent among patients with PTSD (28.4%, 48.3% and 40.1%, respectively) than in the general population (8.0%, 31.0% and 15.3%, respectively; all p's < .001). PTSD symptom severity was found to be significantly, but poorly, associated with the severity of painful TMD (rs  = .126, p = .001), AB (rs  = .155, p < .001) and SB (rs  = .084, p = .029). Patients who had been exposed to sexual assault were more likely to report AB than patients who had not. Similarly, exposure to physical violence was associated with increased odds for SB. CONCLUSION: Patients with severe PTSD are more likely to experience painful TMD, AB or SB, whereas type of traumatic event can be of influence. These findings can contribute to selecting appropriate treatment modalities when treating patients with painful TMD, AB and SB.

Cardiorespiratory fitness as protection against the development of memory intrusions: A prospective trauma analogue study.

Intrusive and distressing memories are at the core of post-traumatic stress disorder (PTSD). Since cardiorespiratory fitness (CRF) has been linked with improved mental health, emotion regulation, and memory function, CRF may, by promoting these capabilities, protect against the development of intrusions after trauma. We investigated the CRF-intrusion relationship and its potential mediators in 115 healthy individuals, using a trauma film to induce intrusions. As potential mediators, we assessed indices of pre-trauma mental health such as heart rate variability, subjective and psychobiological peri-traumatic responses, and memory. Critically, results showed that higher CRF was related to fewer intrusions, but no mediators emerged for the CRF-intrusion relationship. These results indicate that individuals displaying higher CRF are less prone to develop traumatic memory intrusions. Future studies may want to investigate whether promoting fitness prior to possible trauma exposure can boost resilience against the development of debilitating re-experiencing symptoms of PTSD.

Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth.

Background: Home-based psychotherapy delivered via telehealth has not been investigated in the context of intensive trauma-focused treatment for individuals with severe or Complex posttraumatic stress disorder (PTSD). Objective: To examine the feasibility, safety and effectiveness of an intensive treatment programme containing prolonged exposure, EMDR therapy, physical activities and psycho-education, delivered via home-based telehealth. Method: The treatment was carried out within four consecutive days during the outbreak of the COVID-19 pandemic. The sample consisted of six (four female) patients suffering from severe or Complex PTSD resulting from exposure to multiple traumatic events, mostly during early childhood. Four of them fulfilled the diagnostic criteria of complex PTSD. Outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ). Results: CAPS-5 and PCL-5 scores decreased significantly from pre- to post-treatment (Cohen's ds 1.04 and 0.93), and from post-treatment to follow-up (Cohen's ds 0.92 and 1.24). Four of the six patients lost their PTSD or Complex PTSD diagnostic status. No patient dropped out, no personal adverse events and no reliable symptom worsening occurred. Conclusions: The results suggest that intensive, trauma-focused treatment of severe or Complex PTSD delivered via home-based telehealth is feasible, safe and effective, and can be a viable alternative to face-to-face delivered intensive trauma-focused treatment.

Antecedentes: La psicoterapia desde la casa entregada por medio de telesalud no ha sido investigada en el contexto del tratamiento intensivo centrado en el trauma para individuos con trastorno de estrés postraumático (TEPT) severo o Complejo.Objetivo: Examinar la factibilidad, seguridad y efectividad de un programa de tratamiento intensivo que contiene exposición prolongada, terapia EMDR, actividades físicas y psicoeducación, entregadas por medio de telesalud desde el hogar.Método: El tratamiento fue llevado a cabo dentro de cuatro días consecutivos durante el brote de la pandemia del COVID-19. La muestra consistió de seis pacientes (cuatro mujeres) que sufrían de TEPT severo o Complejo como resultado de la exposición a eventos traumáticos múltiples, la mayoría durante la infancia temprana. Cuatro de ellos cumplieron con los criterios diagnósticos del TEPT complejo. Las medidas de resultado fueron la Escala de TEPT Administrada por el Médico para el DSM-5 (CAPS-5 en su sigla en inglés), la Lista de Chequeo para el TEPT (PCL-5 en su sigla en inglés), y el Cuestionario Internacional de Trauma (ITQ en su sigla en inglés).Resultados: Los puntajes de CAPS-5 y PCL-5 disminuyeron significativamente desde el pre al postratamiento (ds de Cohen 1.04 y 0.93), y desde el postratamiento al seguimiento (ds de Cohen 0.92 y 1.24). Cuatro de los seis pacientes perdieron su estado diagnóstico de TEPT o TEPT Complejo. Ningún paciente abandonó el tratamiento, no hubo hubo eventos personales adversos y no hubo empeoramiento confiable de los síntomas.Conclusiones: Los resultados sugieren que el tratamiento intensivo centrado en el trauma de TEPT severo o Complejo entregado por medio de telesalud desde la casa es factible, seguro y efectivo, y puede ser una alternativa viable al tratamiento intensivo centrado en el trauma entregado en persona.

Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults.

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).

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme.

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.

The effects of symptom overreporting on PTSD treatment outcome.

BACKGROUND: It is often assumed that individuals with posttraumatic stress disorder (PTSD) who overreport their symptoms should be excluded from trauma-focused treatments. OBJECTIVE: To investigate the effects of a brief, intensive trauma-focused treatment programme for individuals with PTSD who are overreporting symptoms. METHODS: Individuals (n = 205) with PTSD participated in an intensive trauma-focused treatment programme consisting of EMDR and prolonged exposure (PE) therapy, physical activity and psycho-education. Assessments took place at pre- and post-treatment (Structured Inventory of Malingered Symptomatology; SIMS, Clinician Administered PTSD Scale for DSM-5; CAPS-5). RESULTS: Using a high SIMS cut-off of 24 or above, 14.1% (n = 29) had elevated SIMS scores (i.e. 'overreporters'). The group of overreporters showed significant decreases in PTSD-symptoms, and these treatment results did not differ significantly from other patients. Although some patients (35.5%) remained overreporters at post-treatment, SIMS scores decreased significantly during treatment. CONCLUSION: The results suggest that an intensive trauma-focused treatment not only is a feasible and safe treatment for PTSD in general, but also for individuals who overreport their symptoms.

Antecedentes: Generalmente se asume que individuos con trastorno de Estrés Postraumático (TEPT) que sobre-informan sus síntomas debiesen ser excluidos de tratamientos centrados en el trauma.Objetivo: Investigar los efectos de un programa de tratamiento centrado en el trauma breve e intensivo en individuos con TEPT que sobre-informan síntomas.Métodos: Individuos (n=205) con TEPT participaron en un programa de tratamiento intensivo centrado en el trauma, consistente en EMDR y terapia de exposición prolongada (PE por sus siglas en inglés), actividad física y Psicoeducación. Se realizaron evaluaciones pre y post tratamiento (Inventario Estructurado de Sintomatología Simulada SIMS, Escala de TEPT para el DSM-5 administrada por el Clínico CAPS-5)Resultados: Usando un corte en el inventario SIMS de 24 o mayor, 14.1% (n=29) tenía elevados puntajes SIMS (es decir, los 'sobre-informadores'). El grupo de sobre-informadores mostró un descenso significativo en los síntomas de TEPT, y estos resultados de tratamiento no fueron significativamente diferentes al del resto de los pacientes. Aunque algunos pacientes (35.5%) se mantuvieron sobre-informadores posterior al tratamiento, los puntajes SIMS disminuyeron significativamente durante el tratamiento.Conclusión: Los resultados sugieren que un tratamiento intensivo centrado en el trauma no es solo factible y seguro para el TEPT en general, sino que también para individuos que sobre-informan sus síntomas.

Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD.

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.

Improvements in cardiorespiratory fitness are not significantly associated with post-traumatic stress disorder symptom reduction in intensive treatment.

Background: Physical activity has been found to have positive effects on symptoms of post-traumatic stress disorder (PTSD). However, the importance and role of cardiorespiratory fitness (CRF) in relation to PTSD treatment outcome is not yet clear. Objective: The purpose of the present study was to test the hypothesis that CRF would increase following intensive trauma-focused treatment (TFT) of PTSD augmented with physical activity, and that improved CRF would be associated with a significant decline in PTSD symptoms. Method: One hundred-eight individuals with severe PTSD (72% women; mean age = 40.44, SD = 11.55) were enrolled in an intensive TFT programme of 8 days within 2 consecutive weeks that consisted of daily prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR) therapy and 6 hours of physical activity each day. CRF levels were assessed at baseline and post-treatment with a 6-Minute Walk Test (6MWT) and, in a subsample, with a submaximal ergometer test (PWC75%/kg). Severity of PTSD symptoms was measured with the PTSD Symptom Scale-Self Report (PSS-SR). Results: A significant increase in CRF from pre- to post-treatment and a significant decrease of PTSD-symptoms was found. However, CRF difference scores were not associated with treatment outcome. Conclusions: Although individuals with PTSD may show an increase in CRF following an intensive TFT programme augmented with physical activity and a decrease of PTSD-symptoms, the current findings do not support the notion that treatment outcome is related to CRF.

Antecedentes: Se ha encontrado que la actividad física tiene efectos positivos sobre los síntomas del trastorno de estrés postraumático (TEPT). Sin embargo, la importancia y el papel de la actividad física cardiorrespiratoria (cardiorespiratory fitness, CFR) en relación con el resultado del tratamiento del TEPT aún no está claro.Objetivo: El propósito del presente estudio fue probar la hipótesis de que la CFR mejoraría después del tratamiento intensivo de TEPT centrado-en-el-trauma (TFT) potenciado con actividad física, y que la CFR optimizado se asociaría con una disminución significativa de los síntomas del TEPT.Método: Ciento ocho individuos con TEPT severo (72% mujeres; edad media = 40.44, DE = 11.55) se inscribieron en un programa intensivo de TFT de 8 días dentro de 2 semanas consecutivas que consistió en exposición diaria prolongada (PE), Terapia de Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) y 6 horas de actividad física cada día. Los niveles de CRF se evaluaron al inicio y después del tratamiento con una prueba de caminata de 6 minutos (6MWT) y, en una submuestra, con una prueba de ergómetro submáxima (PWC75%/kg). La gravedad de los síntomas de TEPT se midió con el Informe de Escala de Síntomas del TEPT (PSS-SR). Resultados: Se encontró un aumento significativo en la CFR desde antes y hasta después del tratamiento y una disminución significativa de los síntomas de TEPT. Sin embargo, las puntuaciones de diferencia de CRF no se asociaron con el resultado del tratamiento.Conclusiones: Aunque las personas con TEPT pueden mostrar un aumento en el CFR después de un programa intensivo de TFT potenciado con actividad física y una disminución de los síntomas de TEPT, los hallazgos actuales no respaldan la noción de que el resultado del tratamiento está relacionado con la CFR.