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Long-term treatment gains of a brief exposure-based treatment for PTSD.

ABSTRACT: BACKGROUND:Written exposure therapy (WET) is a 5-session PTSD treatment that may address barriers in treatment for posttraumatic stress disorder (PTSD) given its brevity and tolerability. A recent study found outcomes for WET were non-inferior to outcomes from Cognitive Processing Therapy (CPT) through 36 weeks from first treatment session (Sloan, Marx, Lee, & Resick, 2018); the current study examined whether treatment gains were maintained through 60 weeks from first session, and also evaluated both treatments' effect on depressive symptoms. METHODS:The study enrolled 126 individuals with PTSD randomized to WET or CPT. Assessments were conducted at baseline and 6, 12, 24, 36, and 60 weeks following the first treatment session. PTSD diagnosis and symptom severity were determined via the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), and depression symptoms were assessed using the Beck Depression Inventory-2. RESULTS:WET remained non-inferior to CPT through the 60 week assessment; the groups had a difference of less than 3 points in their total CAPS-5 scores, and within-condition effects on PTSD were large (WET d = 1.23; CPT d = 1.38). Both treatments significantly reduced depressive symptoms over the 60 week study, with the CPT group experiencing a more rapid decrease. The between-condition effect of treatment on depression was small (d = .19). CONCLUSIONS:WET is a treatment that is non-inferior to CPT with regard to PTSD symptoms, with treatment effects that are long-lasting. Additionally, both WET and CPT demonstrated substantial effects on depressive symptoms. WET should be considered a good option for PTSD treatment.

SUBMITTER: Thompson-Hollands J

PROVIDER: S-EPMC6168424 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Long-term treatment gains of a brief exposure-based treatment for PTSD.

Thompson-Hollands Johanna J Marx Brian P BP Lee Daniel J DJ Resick Patricia A PA Sloan Denise M DM

Depression and anxiety 20180824 10

<h4>Background</h4>Written exposure therapy (WET) is a 5-session PTSD treatment that may address barriers in treatment for posttraumatic stress disorder (PTSD) given its brevity and tolerability. A recent study found outcomes for WET were non-inferior to outcomes from Cognitive Processing Therapy (CPT) through 36 weeks from first treatment session (Sloan, Marx, Lee, & Resick, 2018); the current study examined whether treatment gains were maintained through 60 weeks from first session, and also e ...[more]

PMID: 30144228

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Project description:Dementia affects 47 million individuals worldwide, and assuming the status quo is projected to rise to 150 million by 2050. Prevention of age-related cognitive impairment in older persons with lifestyle interventions continues to garner evidence but whether this can combat underlying neurodegeneration is unknown. The Study of Mental Activity and Resistance Training (SMART) trial has previously reported within-training findings; the aim of this study was to investigate the long-term neurostructural and cognitive impact of resistance exercise in Mild Cognitive Impairment (MCI). For the first time we show that hippocampal subareas particularly susceptible to volume loss in Alzheimer's disease (AD) are protected by resistance exercise for up to one year after training. One hundred MCI participants were randomised to one of four training groups: (1) Combined high intensity progressive resistance and computerised cognitive training (PRT+CCT), (2) PRT+Sham CCT, (3) CCT+Sham PRT, (4) Sham physical+sham cognitive training (SHAM+SHAM). Physical, neuropsychological and MRI assessments were carried out at baseline, 6 months (directly after training) and 18 months from baseline (12 months after intervention cessation). Here we report neuro-structural and functional changes over the 18-month trial period and the association with global cognitive and executive function measures. PRT but not CCT or PRT+CCT led to global long-term cognitive improvements above SHAM intervention at 18-month follow-up. Furthermore, hippocampal subfields susceptible to atrophy in AD were protected by PRT revealing an elimination of long-term atrophy in the left subiculum, and attenuation of atrophy in left CA1 and dentate gyrus when compared to SHAM+SHAM (p = 0.023, p = 0.020 and p = 0.027). These neuroprotective effects mediated a significant portion of long-term cognitive benefits. By contrast, within-training posterior cingulate plasticity decayed after training cessation and was unrelated to long term cognitive benefits. Neither general physical activity levels nor fitness change over the 18-month period mediated hippocampal trajectory, demonstrating that enduring hippocampal subfield plasticity is not a simple reflection of post-training changes in fitness or physical activity participation. Notably, resting-state fMRI analysis revealed that both the hippocampus and posterior cingulate participate in a functional network that continued to be upregulated following intervention cessation. Multiple structural mechanisms may contribute to the long-term global cognitive benefit of resistance exercise, developing along different time courses but functionally linked. For the first time we show that 6 months of high intensity resistance exercise is capable of not only promoting better cognition in those with MCI, but also protecting AD-vulnerable hippocampal subfields from degeneration for at least 12 months post-intervention. These findings emphasise the therapeutic potential of resistance exercise; however, future work will need to establish just how long-lived these outcomes are and whether they are sufficient to delay dementia.

Dataset Information

Long-term treatment gains of a brief exposure-based treatment for PTSD.

Publications

Long-term treatment gains of a brief exposure-based treatment for PTSD.

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