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Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to P...

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Autores principales: Oprel, Danielle A. C., Hoeboer, Chris M., Schoorl, Maartje, de Kleine, Rianne A., Cloitre, Marylene, Wigard, Ingrid G., van Minnen, Agnes, van der Does, Willem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500700/
https://www.ncbi.nlm.nih.gov/pubmed/34630934
http://dx.doi.org/10.1080/20008198.2020.1851511
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author Oprel, Danielle A. C.
Hoeboer, Chris M.
Schoorl, Maartje
de Kleine, Rianne A.
Cloitre, Marylene
Wigard, Ingrid G.
van Minnen, Agnes
van der Does, Willem
author_facet Oprel, Danielle A. C.
Hoeboer, Chris M.
Schoorl, Maartje
de Kleine, Rianne A.
Cloitre, Marylene
Wigard, Ingrid G.
van Minnen, Agnes
van der Does, Willem
author_sort Oprel, Danielle A. C.
collection PubMed
description Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity. Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen’s d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t(135) = −2.85, p = .005, d = .49) but not clinician-assessed symptoms (t(135) = −1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t(135) = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t(135) = −2.77, p = .006, Cohen’s d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions. Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes. The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113
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spelling pubmed-85007002021-10-09 Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial Oprel, Danielle A. C. Hoeboer, Chris M. Schoorl, Maartje de Kleine, Rianne A. Cloitre, Marylene Wigard, Ingrid G. van Minnen, Agnes van der Does, Willem Eur J Psychotraumatol Clinical Research Article Background: It is unclear whether the evidence-based treatments for PTSD are as effective in patients with CA-PTSD. Objective: We aimed to investigate the effectiveness of three variants of prolonged exposure therapy. Method: We recruited adults with CA-PTSD. Participants were randomly assigned to Prolonged Exposure (PE; 16 sessions in 16 weeks), intensified Prolonged Exposure (iPE; 12 sessions in 4 weeks followed by 2 booster sessions) or a phase-based treatment, in which 8 sessions of PE were preceded by 8 sessions of Skills Training in Affective and Interpersonal Regulation (STAIR+PE; 16 sessions in 16 weeks). Assessments took place in week 0 (baseline), week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. The primary outcome was clinician-rated PTSD symptom severity. Results: We randomly assigned 149 patients to PE (48), iPE (51) or STAIR+PE (50). All treatments resulted in large improvements in clinician assessed and self-reported PTSD symptoms from baseline to 1-year follow-up (Cohen’s d > 1.6), with no significant differences among treatments. iPE led to faster initial symptom reduction than PE for self-report PTSD symptoms (t(135) = −2.85, p = .005, d = .49) but not clinician-assessed symptoms (t(135) = −1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t(135) = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t(135) = −2.77, p = .006, Cohen’s d = .48) STAIR+PE did not result in significantly more improvement from baseline to 1-year follow-up on the secondary outcome emotion regulation, interpersonal problems and self-esteem compared to PE and iPE. Dropout rates did not differ significantly between conditions. Conclusions: Variants of exposure therapy are tolerated well and lead to large improvements in patients with CA-PTSD. Intensifying treatment may lead to faster improvement but not to overall better outcomes. The trial is registered at the clinical trial registry, number NCT03194113, https://clinicaltrials.gov/ct2/show/NCT03194113 Taylor & Francis 2021-01-15 /pmc/articles/PMC8500700/ /pubmed/34630934 http://dx.doi.org/10.1080/20008198.2020.1851511 Text en © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Research Article
Oprel, Danielle A. C.
Hoeboer, Chris M.
Schoorl, Maartje
de Kleine, Rianne A.
Cloitre, Marylene
Wigard, Ingrid G.
van Minnen, Agnes
van der Does, Willem
Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title_full Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title_fullStr Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title_full_unstemmed Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title_short Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial
title_sort effect of prolonged exposure, intensified prolonged exposure and stair+prolonged exposure in patients with ptsd related to childhood abuse: a randomized controlled trial
topic Clinical Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500700/
https://www.ncbi.nlm.nih.gov/pubmed/34630934
http://dx.doi.org/10.1080/20008198.2020.1851511
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