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Does trauma-focused exposure therapy exacerbate symptoms among patients with comorbid PTSD and substance use disorders?

Published online by Cambridge University Press:  23 April 2019

Cynthia L. Lancaster ,
Daniel F. Gros ,
Michael C. Mullarkey ,
Christal L. Badour ,
Therese K. Killeen ,
Kathleen T. Brady  and
Sudie E. Back
Cynthia L. Lancaster*
Affiliation:
Department of Psychology, University of Nevada Reno, Reno, NV, USA
Daniel F. Gros
Affiliation:
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA Mental Health Service, Ralph H. Johnson Veteran’s Affairs Medical Center, Charleston, SC, USA
Michael C. Mullarkey
Affiliation:
Department of Psychology, University of Texas, Austin, TX, USA
Christal L. Badour
Affiliation:
Department of Psychology, University of Kentucky, Lexington, KY, USA
Therese K. Killeen
Affiliation:
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
Kathleen T. Brady
Affiliation:
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
Sudie E. Back
Affiliation:
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA Mental Health Service, Ralph H. Johnson Veteran’s Affairs Medical Center, Charleston, SC, USA
*
*Corresponding author. Email: [email protected]
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Abstract

Background: Although exposure-based therapy is a well-established, effective treatment for post-traumatic stress disorder (PTSD), some practitioners report reluctance to implement it due to concerns that it may exacerbate symptoms of PTSD and commonly comorbid disorders, such as substance use disorders (SUD).

Aim: This study compared the exacerbation of psychological symptoms among participants with comorbid PTSD and SUD who received either SUD treatment alone or SUD treatment integrated with exposure therapy for PTSD.

Method: Participants (N = 71) were treatment-seeking, military Veterans with comorbid PTSD and SUD who were randomized to 12 individual sessions of either (1) an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE); or (2) a non-exposure-based, SUD-only treatment (Relapse Prevention; RP). We examined between-group differences in the frequency of statistically reliable exacerbations of PTSD, SUD and depression symptoms experienced during treatment.

Results: At each of the 12 sessions, symptom exacerbation was minimal and generally equally likely in either treatment group. However, an analysis of treatment completers suggests that RP participants experienced slightly more exacerbations of PTSD symptoms during the course of treatment.

Conclusions: This study is the first to investigate symptom exacerbation throughout trauma-focused exposure therapy for individuals with comorbid PTSD and SUD. Results add to a growing literature which suggests that trauma-focused, exposure-based therapy does not increase the risk of symptom exacerbation relative to non-exposure-based therapy.

Keywords

combined treatmentdepressionpost-traumatic stress disordersubstance usetherapy outcomeVeteran
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 1 , January 2020 , pp. 38 - 53
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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