Chronic Posttraumatic Stress Disorder
Conditions
Keywords
PTSD, Posttraumatic Stress Disorder, Exposure Therapy, Prolonged Exposure, Fear Memory Retrieval, Compound extinction, Deepened extinction, Psychotherapy
Brief summary
This study is investigating a new brief psychotherapy for post-traumatic stress disorder (PTSD) which, modifies an already proven psychotherapy for PTSD by adding two new components and modifying several others. The goal of the study is to determine whether this experimental treatment outperforms the well-established standard treatment.
Detailed description
This study is investigating a new brief psychotherapy for post-traumatic stress disorder (PTSD) which, modifies an already proven psychotherapy for PTSD by adding two new components and modifying several others. The goal of the study is to determine whether this experimental treatment outperforms the well-established standard treatment. Individuals between the ages of 18-65 with chronic PTSD are randomly assigned to one of three psychotherapy conditions: (a) brief enhanced exposure therapy; (b) standard prolonged exposure therapy; and (c) delayed standard exposure therapy. All study participants undergo a phone and face-to-face screening assessment to determine study eligibility and baseline (pretreatment-Week 0) symptom severity. Upon completing treatment, participants undergo three additional assessment visits (Week 6, Week 10, and Week 22). During each of these outcome assessment visits, participants complete a structured clinical interview and a battery of computer-administered questionnaires.
Interventions
BEHAVIORALRevisiting the Trauma memories
Patient engages in repeated revisiting of their trauma memory under the guidance of the therapist for about 40 minutes. During each revisiting trial the patient closes their eyes and verbally describes the trauma and the feeling and thoughts experienced during the trauma.
BEHAVIORALProcessing the trauma memories
The patient and therapist discuss the patient's experience during the trauma revisiting with the goal of helping the patient gain alternative perspectives of the trauma.
BEHAVIORALPsychoeducation
Through patient handouts and didactic instruction, the patient learns about the common reactions to trauma and the rationale for exposure therapy.
BEHAVIORALTrauma Memory Retrieval Trial
Prior to the start of Imaginal Exposure, the patient is asked to recall a threatening element of their trauma memory for 1 minute. This is followed by a 30-minute rest-period prior to beginning imaginal exposure.
BEHAVIORALExposure to video clips related to the patient's trauma
Patient is seated in front of a computer monitor and instructed to view a 30-min looped video clip that thematically resembles the patient's trauma.
BEHAVIORALBreathing retraining
Patient is seated comfortably in a chair and instructed to breathe slowly and deeply in a relaxed manner.
BEHAVIORALExposure Homework
Therapist assists the patient in identifying trauma-related situations/activities that the patient is avoiding and encourages the patient to begin to confront these situations between sessions.
BEHAVIORALCompound extinction
The patient repeatedly confronts the truama-related media clip while simultaneously listening to their own trauma script through headphones.
Sponsors
University of Pennsylvania
University of Texas at Austin
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
1. Current primary PTSD diagnosis based on DSM-IV criteria, with a minimum duration of 12 weeks since the traumatic event. 2. Between the age of 18 and 65. 3. Medication status stable for at least 6 weeks
Exclusion criteria
1. Current diagnosis of schizophrenia, delusional disorder, or organic mental disorder as defined by the DSM-IV. 2. Current diagnosis of bipolar disorder, depression with psychotic features, or depression severe enough to require immediate psychiatric treatment (i.e., serious suicide risk with intent and plan). 3. Current diagnosis of alcohol or substance dependence within the 3 previous months. 4. Unwilling or unable to discontinue current trauma-focused psychotherapy. 5. Ongoing intimate relationship with the perpetrator (in assault-related PTSD cases). 6. Other severe acute or chronic medical or psychiatric condition that, in the judgment of the Medical Director, would make the participant inappropriate for entry.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in PTSD symptom severity | Weeks 6, 10, 22 | PTSD Symptom Scale - Interview Version |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in depression symptom severity | Weeks 6, 10, 22. | Quick Inventory of Depressive Symptomatology - Self-Report |
| Change from baseline in trauma-related cognitions | Weeks 6, 10, 22. | Post-Traumatic Cognitions Inventory - Self-Report |
| Change from baseline in general physical and psychological health | Weeks 6, 10, 22 | Medical Outcomes Study Short Form 36, Version 2 - Self-report |
| Change from baseline in work, social/leisure activities, and family/home life functioning | Weeks 6, 10, 22. | Sheehan Disability Scale - Self-report |
Countries
United States
Outcome results
None listed