Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts
Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2018-01-01
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| Series: | European Journal of Psychotraumatology |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20008198.2018.1425574 |
| _version_ | 1797954592522108928 |
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| author | Lotte Hendriks Rianne A. de Kleine Theo G. Broekman Gert-Jan Hendriks Agnes van Minnen |
| author_facet | Lotte Hendriks Rianne A. de Kleine Theo G. Broekman Gert-Jan Hendriks Agnes van Minnen |
| author_sort | Lotte Hendriks |
| collection | DOAJ |
| description | Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe. |
| first_indexed | 2024-04-10T23:19:49Z |
| format | Article |
| id | doaj.art-64482efbf2bd4fb7b802167c91f883a1 |
| institution | Directory Open Access Journal |
| issn | 2000-8066 |
| language | English |
| last_indexed | 2024-04-10T23:19:49Z |
| publishDate | 2018-01-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | European Journal of Psychotraumatology |
| spelling | doaj.art-64482efbf2bd4fb7b802167c91f883a12023-01-12T15:31:29ZengTaylor & Francis GroupEuropean Journal of Psychotraumatology2000-80662018-01-019110.1080/20008198.2018.14255741425574Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attemptsLotte Hendriks0Rianne A. de Kleine1Theo G. Broekman2Gert-Jan Hendriks3Agnes van Minnen4Institution for Integrated Mental Health Care Pro PersonaInstitution for Integrated Mental Health Care Pro PersonaBureau BêtaInstitution for Integrated Mental Health Care Pro PersonaInstitution for Integrated Mental Health Care Pro PersonaBackground: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 × 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p < .001) that persisted during the three- and six-month follow-ups with large effect sizes (Cohen’s d > 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.http://dx.doi.org/10.1080/20008198.2018.1425574(complex) ptsdtreatment outcome(prolonged) exposureintensive treatmentpredictorsresponse patterns |
| spellingShingle | Lotte Hendriks Rianne A. de Kleine Theo G. Broekman Gert-Jan Hendriks Agnes van Minnen Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts European Journal of Psychotraumatology (complex) ptsd treatment outcome (prolonged) exposure intensive treatment predictors response patterns |
| title | Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts |
| title_full | Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts |
| title_fullStr | Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts |
| title_full_unstemmed | Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts |
| title_short | Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts |
| title_sort | intensive prolonged exposure therapy for chronic ptsd patients following multiple trauma and multiple treatment attempts |
| topic | (complex) ptsd treatment outcome (prolonged) exposure intensive treatment predictors response patterns |
| url | http://dx.doi.org/10.1080/20008198.2018.1425574 |
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