Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-23T00:29:36.316Z Has data issue: false hasContentIssue false
  • English
  • Français

The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel

Published online by Cambridge University Press:  17 September 2018

Lily A. Brown ,
Joshua D. Clapp ,
Joshua J. Kemp ,
Jeffrey S. Yarvis ,
Katherine A. Dondanville ,
Brett T. Litz ,
Jim Mintz ,
John D. Roache ,
Stacey Young-McCaughan  and
Alan L. Peterson
...Show all authors
Lily A. Brown*
Affiliation:
Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N, Philadelphia, PA 19104,USA
Joshua D. Clapp
Affiliation:
University of Wyoming, Laramie, WY, USA
Joshua J. Kemp
Affiliation:
Warren Alpert Medical School, Providence, RI, USA
Jeffrey S. Yarvis
Affiliation:
Carl R. Darnall Army Medical Center, Fort Hood, Texas,USA
Katherine A. Dondanville
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Brett T. Litz
Affiliation:
VA Boston Healthcare System and Boston University School of Medicine, Boston, MA,USA
Jim Mintz
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
John D. Roache
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Stacey Young-McCaughan
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Alan L. Peterson
Affiliation:
University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX,USA
Edna B. Foa
Affiliation:
University of Pennsylvania, Philadelphia, PA,USA
*
Author for correspondence: Lily A. Brown, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).

Methods

Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.

Results

Five classes, namely rapid responder (7–17%), steep linear responder (14–22%), gradual responder (30–34%), non-responder (27–33%), and symptom exacerbation (7–13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.

Conclusions

Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.

Keywords

Active duty militaryposttraumatic stress disorderpresent-centered therapyprolonged exposurePTSD
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 12 , September 2019 , pp. 1980 - 1989
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aderka, IM, Appelbaum-Namdar, E, Shafran, N and Gilboa-Schechtman, E (2011) Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 79, 441–446.Google Scholar
Akaike, H (1987) Factor analysis and AIC. Psychometrika 52, 317–332.Google Scholar
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. text rev. Washington, DC: American Psychiatric Association.Google Scholar
Asparouhov, T and Muthen, B (2014) Auxiliary variables in mixture modeling: using the BCH method in Mplus to estimate a distal outcome model and an arbitrary second model. Mplus web notes: No. 21. Retrieved from http://www.statmodel.com/examples/webnote.shtml.Google Scholar
Bakk, Z and Vermunt, JK (2016) Robustness of stepwise latent class modeling with continuous distal outcomes. Structural Equation Modeling: A Multidisciplinary Journal 23, 20–31.Google Scholar
Beck, AT, Steer, RA and Brown, GK (1996) Manual for the Beck Depression Inventory-II. San Antonio, Texas: The Psychological Corporation.Google Scholar
Brady, F, Warnock-Parkes, E, Barker, C and Ehlers, A (2015) Early in-session predictors of response to trauma-focused cognitive therapy for posttraumatic stress disorder. Behaviour Research and Therapy 75, 40–47.Google Scholar
Brown, LA, Zandberg, LJ and Foa, EB (in press). Mechanisms of change in prolonged exposure therapy for PTSD: implications for clinical practice. Journal of Psychotherapy Integration.Google Scholar
Clapp, JD, Kemp, JJ, Cox, KS and Tuerk, PW (2016) Patterns of change in response to prolonged exposure: implications for treatment outcome. Depression and Anxiety, 33, 807–815.Google Scholar
Clark, SL and Muthen, B (2009) Relating latent class analysis results to variables not included in the analysis. Retrieved from http://www.statmodel.com/download/relatinglca.pdf.Google Scholar
Cusack, K, Jonas, DE, Forneris, CA, Wines, C, Sonis, J, Middleton, JC, Feltner, C, Brownley, KA, Olmsted, KR, Greenblatt, A, Weil, A and Gaynes, BN (2016) Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clinical Psychology Review 43, 128–141.Google Scholar
Doane, LS, Feeny, NC and Zoellner, LA (2010) A preliminary investigation of sudden gains in exposure therapy for PTSD. Behaviour Research and Therapy 48, 555–560.Google Scholar
Eftekhari, A, Ruzek, JI, Crowley, JJ, Rosen, CS, Greenbaum, MA and Karlin, BE (2013) Effectiveness of national implementation of prolonged exposure therapy in veterans affairs care. JAMA Psychiatry 70, 949–955.Google Scholar
Foa, EB and Tolin, DF (2000) Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. Journal of Traumatic Stress 13, 181–191.Google Scholar
Foa, EB, Riggs, DS, Dancu, CV and Rothbaum, BO (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459–473.10.1002/jts.2490060405Google Scholar
Foa, EB, Tolin, DF, Ehlers, A, Clark, DM and Orsillo, SM (1999) The posttraumatic cognitions inventory (PTCI): development and validation. Psychological Assessment 11, 303–314.Google Scholar
Foa, EB, Zoellner, LA, Feeny, NC, Hembree, EA and Alvarez-Conrad, J (2002) Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology 70, 1022–1028.Google Scholar
Foa, EB, McLean, CP, Capaldi, S and Rosenfield, D (2013) Prolonged exposure vs supportive counseling for sexual abuse-related PTSD in adolescent girls: a randomized clinical trial. Journal of the American Medical Association 310, 2650–2657.Google Scholar
Foa, EB, McLean, CP, Zang, Y, Rosenfield, D, Yadin, E, Yarvis, JS, Mintz, J, Young-McCaughan, S, Borah, EV, Dondanville, KA, Fina, BA, Hall-Clark, BN, Lichner, T, Litz, BT, Roache, J, Wright, EC, Peterson AL for the STRONG STAR Consortium (2018) Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present centered therapy on PTSD severity in military personnel: a randomized clinical trial. Journal of the American Medical Association 319, 354–364.Google Scholar
Goodman, LA (2002) Latent class analysis: the empirical study of latent types, latent variables, and latent structures. In Hagenaars, JA and McCutcheon, AL (eds), Applied Latent Class Analysis. Cambridge, United Kingdom: Cambridge University Press, pp. 3–55.Google Scholar
Howell, DC (2010) Statistical methods for psychology, 7th Edn. Belmont, CA: Wadsworth.Google Scholar
Jacobson, NS and Truax, P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.Google Scholar
Joesch, JM, Golinelli, D, Sherbourne, CD, Sullivan, G, Stein, MB, Craske, MG and Roy-Byrne, PP (2013) Trajectories of change in anxiety severity and impairment during and after treatment with evidence-based treatment for multiple anxiety disorders in primary care. Depression and Anxiety 30, 1099–1106.Google Scholar
Jun, JJ, Zoellner, LA and Feeny, NC (2013) Sudden gains in prolonged exposure and sertraline for chronic PTSD. Depression and Anxiety 30, 607–613.Google Scholar
Karlin, BE, Ruzek, JI, Chard, KM, Eftekhari, A, Monson, CM, Hembree, EA, Resick, PA and Foa, EB (2010) Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. Journal of Trauamatic Stress 23, 663–673.Google Scholar
Kelly, KA, Rizvi, SL, Monson, CM and Resick, PA (2009) The impact of sudden gains in cognitive behavioral therapy for posttraumatic stress disorder. Journal of Traumatic Stress 22, 287–293.Google Scholar
Larsen, SE, Wiltsey Stirman, S, Smith, BN and Resick, PA (2016) Symptom exacerbations in trauma-focused treatments: associations with treatment outcome and non-completion. Behaviour Research and Therapy 77, 68–77.10.1016/j.brat.2015.12.009Google Scholar
Loerinc, AG, Meuret, AE, Twohig, MP, Rosenfield, D, Bluett, EJ and Craske, MG (2015) Response rates for CBT for anxiety disorders: need for standardized criteria. Clinical Psychology Review 42, 72–82.Google Scholar
Lubke, G and Muthén, BO (2007) Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters. Structural Equation Modeling: A Multidisciplinary Journal 14, 26–47.Google Scholar
Muthén, LK and Muthén, BO (2012) Mplus User's Guide, 7th Edn. Los Angeles, CA: Muthén & Muthén.Google Scholar
Nishith, P, Resick, PA and Griffin, MG (2002) Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 70, 880–886.Google Scholar
Nylund, KL, Asparouhov, T and Muthén, BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal, 14, 535–569.Google Scholar
Orinstein, AJ, Urcelay, GP and Miller, RR (2010) Expanding the intertrial interval during extinction: response cessation and recovery. Behavior Therapy 41, 14–29.Google Scholar
Raftery, AE (1995) Bayesian model selection in social research. Sociological Methodology 25, 111–163.Google Scholar
Ramaswamy, V, Desarbo, WS, Reibstein, DJ and Robinson, WT (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Marketing Science 12, 103–124.Google Scholar
Schnurr, PP, Friedman, MJ, Engel, CC, Foa, EB, Shea, MT, Chow, BK, Resick, PA, Thurston, V, Orsillo, SM, Haug, R, Turner, C and Bernardy, N (2007) Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. Journal of the American Medical Association 297, 820–830.Google Scholar
Schumm, JA, Walter, KH and Chard, K (2013) Latent class differences explain variability in PTSD symptom changes during cognitive processing therapy for veterans. Psychological Trauma: Theory, Research, Practice, and Policy 5, 536–544.Google Scholar
Suris, A, Link-Malcolm, J, Chard, K, Ahn, C and North, C (2013) A randomized clinical trial of cognitive processing therapy for veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress 26, 28–37.Google Scholar
Urcelay, GP, Wheeler, DS and Miller, RR (2009) Spacing extinction trials alleviates renewal and spontaneous recovery. Learning and Behavior 37, 60–73.Google Scholar
U.S. Department of Veterans Affairs (2008) Uniform Mental Health Services in VA Medical Centers and Clinics (VHA Handbook 1160.01). Washington, DC: Author.Google Scholar
Weathers, F, Litz, BT, Herman, DS, Huska, JA and Keane, TM (1993, October). The PTSD Checklist (PCL): Reliability, validity and diagnostic utility. Paper presented at the 9th Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.Google Scholar