points on the Clinician-Administered PTSD Scale in the par-oxetine group and 30 points in the placebo group. As thesenumbers suggest, the amount of improvement was greater inthe paroxetine group. At 10 weeks, patients who received par-oxetine were more likely to achieve remission too: 42% versus17% of those who received placebo. The groups had similar decreases in depression, but the paroxetine group had greater improvement in quality of life. After PE ended, 26 patients en-tered a 12-week maintenance phase in which they continued toreceive their assigned medication. There were no differencesbetween groups during this phase, which suggests that theplacebo group caught up to the paroxetine group. However, itis difficult to draw definitive conclusions because the mainte-nance sample was self-selected and also smaller than thesample in the original study. Replicating the findings in a larger,more diverse sample of trauma survivors would help cliniciansand patients determine whether combined treatment should beused more often. Read more...http://dx.doi.org/10.1176/ appi.ajp.2011.11020321
Schneier, F. R., Neria, Y., Pavlicova, M., Hembree, E., Suh, E. J., Am-sel, L., & Marshall, R. D. (2012).Combined prolonged exposure ther-apy and paroxetine for PTSD related to the world trade center attack: Arandomized controlled trial.
American Journal of Psychiatry, 169
, 80-88. PILOTS ID: 37261
Prolonged exposure for Veterans with mild tomoderate TBI
we reported on a studyfrom the Cincinnati VAMC showing that Veterans with mild,moderate, or severe traumatic brain injury and PTSD canbenefit from Cognitive Processing Therapy. Preliminary find-ings from a study on Prolonged Exposure provide additionalsupport for the use of evidence-based treatments for PTSDamong Veterans with TBI. The study used a clinical sample of 10 male OEF/OIF Veterans treated in outpatient OEF/OIF,polytrauma, and PTSD clinics at 2 VA Medical Centers. Allpatients had a documented history of TBI, ongoing cognitivedeficits, and current diagnosis of PTSD. Based on a compre-hensive TBI evaluation, 6 of the patients met criteria for mildTBI and 4 for moderate TBI. Modifications to the standard PEprotocol included increased structure (e.g., mid-week phonecontact), use of memory-enhancing strategies (e.g., electroniccalendars), and extending session length by 30 minutes. Theaverage number of sessions was 13.4. Reductions in PTSDand depression symptoms were significant and large (PCL:
=3.64; Beck Depression Inventory-II:
= 1.82), with 9 out of 10Veterans no longer meeting criteria for PTSD based on a PCLof
50 at posttreatment. Whether the Veterans would haveimproved just as much without the treatment modifications isunknown. However, the study clearly shows that prolongedexposure with minimal procedural enhancements is feasible for treating PTSD and depression in Veterans with TBI. Readmore...http://dx.doi.org/10.1097/HTR.0b013e31823cd01f
Wolf, G. K., Strom, T. Q., Kehle, S. M., & Eftekhari, A. (2012).A pre-liminary examination of prolonged exposure therapy with Iraq and Af-ghanistan veterans with a diagnosis of posttraumatic stress disorder and mild to moderate traumatic brain injury.
Journal of Head TraumaRehabilitation, 27
, 26-32. PILOTS ID: 37922
Efficacy of group therapy for PTSD
Group therapy is frequently used to treat PTSD patients in VAand non-VA settings. Literature reviews of this approach sug-gest positive outcomes but no rigorous meta-analysis of theresearch had been done, until now. Results of the new studywere mixed. A team led by the National Center for PTSD atthe Boston VAMC indentified randomized controlled trials of outpatient group therapy for either PTSD or trauma survivors.The final sample of 16 was limited to studies that included aPTSD-related symptom measure and sufficient information tocalculate an effect size. The investigators adjusted effect sizesto statistically account for the effect of group clustering for the13 studies that had failed to do so (omitting this correction canyield an overestimate of the treatment effect). The overall pre-post effect size was .71, which is smaller than the 1.0-1.5 typi-cally observed in studies of individual therapy. The between-group effect size was small (
= .24); effect sizes were greater when group treatment was compared with wait-list (
= .56)versus active treatment conditions (
= .09). No studies com-pared group therapy with individual therapy or examined treat-ments such as group Cognitive Processing Therapy. The find-ings suggest that group therapies for PTSD (69% of whichwere cognitive behavioral therapy) are better than no treatmentin reducing PTSD but comparable to other active group treat-ments such as supportive therapy and less effective than indi-vidual therapy. When interpreting these results it is importantto remember that the investigators examined PTSD outcomesonly. The findings of limited benefit may not generalize toother important outcomes. Read more...http:// www.ptsd.va.gov/professional/articles/article-pdf/id37918.pdf
Sloan, D. M., Feinstein, B. A., Gallagher, M. W., Beck, J. G., & Keane,T. M. (2011, November 7).Efficacy of Group Treatment for Posttrau-matic Stress Disorder Symptoms: A Meta-Analysis.
Psychological Trauma: Theory, Research, Practice, and Policy
. Advance online publi-cation. PILOTS ID: 37918
Decreasing use of benzodiazepines amongVeterans with PTSD
Benzodiazepines are often prescribed for immediate relief of anxiety and insomnia. Lack of evidence for their efficacy as atreatment for PTSD and possible long-term harms led the VAand DoD to specifically recommend against benzodiazepineuse in the2010 Clinical Practice Guideline for PTSD. A recentanalysis of VA national administrative data reveals that pre-scribing practices are heading in the right direction but at aslow pace. Investigators linked inpatient and outpatient en-counter datasets with prescription records from fiscal years1999 through 2009. During this time, the number of Veterans