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

Autor: Willem van der Does, Rianne A. de Kleine, Marylene Cloitre, Chris M. Hoeboer, Danielle A.C. Oprel, Agnes van Minnen, Maartje Schoorl, Ingrid G Wigard
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
强化治疗
聚焦创伤治疗
Pediatrics
medicine.medical_specialty
trauma-focused treatment
RC435-571
Implosive Therapy
tratamiento intensificado
behavioral disciplines and activities
exposición prolongada
law.invention
Stress Disorders
Post-Traumatic
Experimental Psychopathology and Treatment
tratamiento centrado en el trauma
Randomized controlled trial
law
mental disorders
medicine
Humans
In patient
Child
STAIR (en su sigla en inglés)
Childhood abuse
intensified treatment
Psychiatry
Clinical Research Article
childhood trauma
trauma infantil
business.industry
Adult Survivors of Child Abuse
CA-PTSD
STAIR
Posttraumatic stress disorder
童年期创伤
延长暴露
Prolonged exposure
Treatment Outcome
创伤后应激障碍
prolonged exposure
Trastorno de estrés postraumático
Self Report
business
TEPT-AI
Research Article
Zdroj: European journal of psychotraumatology, 12(1), 1-13
European Journal of Psychotraumatology, 12, 1
European Journal of Psychotraumatology, 12(1). TAYLOR & FRANCIS LTD
European Journal of Psychotraumatology, 12
European Journal of Psychotraumatology
article-version (VoR) Version of Record
European Journal of Psychotraumatology, Vol 12, Iss 1 (2021)
ISSN: 2000-8198
Popis: 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 (t135 = −2.85, p = .005, d = .49) but not clinician-assessed symptoms (t135 = −1.65, p = .10) and faster initial symptom reduction than STAIR+PE for self-reported (t135 = −4.11, p < .001, d = .71) and clinician-assessed symptoms (t135 = −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
Summary HIGHLIGHTS • Childhood abuse-related PTSD can be effectively treated with (variants of) exposure therapy. • STAIR+PE and intensified PE did not improve treatment outcomes compared to PE.• Intensified PE showed faster symptom improvement.
Databáze: OpenAIRE
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