Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents.
ABSTRACT Our objective in the present study was to examine the temporal sequencing of posttraumatic and depressive symptoms during prolonged exposure therapy for posttraumatic stress disorder (PTSD) among children and adolescents.
Participants were 73 children and adolescents (56.2% female) between the ages of 8 and 18. Participants completed self-report measures of posttraumatic stress and depression prior to every session. Measures included the Child PTSD Symptom Scale, Beck Depression Inventory, and Children's Depression Inventory.
Multilevel mediational analyses indicated reciprocal relations during treatment: Changes in posttraumatic symptoms led to changes in depressive symptoms and vice versa. Posttraumatic symptoms accounted for 64.1% of the changes in depression, whereas depressive symptoms accounted for 11.0% of the changes in posttraumatic stress.
Prolonged exposure therapy may work primarily by reducing posttraumatic stress, which in turn reduces depression.
SourceAvailable from: Melanie Harned[Show abstract] [Hide abstract]
ABSTRACT: Prolonged exposure (PE) is an effective psychological treatment for patients who suffer from PTSD. The majority of PTSD patients have comorbid psychiatric disorders, and some clinicians are hesitant to use PE with comorbid patients because they believe that comorbid conditions may worsen during PE. In this article, we reviewed the evidence for this question: what are the effects of PE on comorbid symptoms and associated symptomatic features? We reviewed findings from 18 randomized controlled trials of PE that assessed the most common comorbid conditions (major depression, anxiety disorders, substance use disorders, personality disorders, and psychotic disorders) and additional symptomatic features (suicidality, dissociation, negative cognitions, negative emotions, and general health and work/social functioning). Although systematic research is not available for all comorbid populations, the existing research indicates that comorbid disorders and additional symptomatic features either decline along with the PTSD symptoms or do not change as a result of PE. Therefore, among the populations that have been studied to date, there is no empirical basis for excluding PTSD patients from PE due to fear of increases in comorbid conditions or additional symptomatic features. Limitations of the existing research and recommendations for future research are also discussed.Current Psychiatry Reports 03/2015; 17(3):549. DOI:10.1007/s11920-015-0549-1 · 3.05 Impact Factor
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ABSTRACT: Law enforcement officers are often reported to frequently abuse alcohol due to occupational stress. However, few studies have examined alcohol use among U.S. police officers. This study investigated the prevalence of alcohol use and the relation between alcohol use and amount of subjective work-related traumatic distress, work-related but nontraumatic stress, personal relationship stress, posttraumatic stress disorder (PTSD) symptoms, depression, and age among law enforcement officers (N = 193) working in a midwestern state. Multiple regression analyses showed that greater subjective posttraumatic distress and PTSD avoidance symptoms were the most significant predictors of greater alcohol use among officers. Implications for practice are discussed.Journal of Loss and Trauma 03/2013; 18(5). DOI:10.1080/15325024.2012.719340 · 1.03 Impact Factor
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ABSTRACT: Objective: We examined comorbid disorders' prevalence, their impact on abstinence, and the impact of depressive symptoms on abstinence and of abstinence on depressive symptoms. Method: A randomized controlled trial's data on outcomes from treating cocaine dependence were used. It compared abstinence-contingent housing and work to contingency management plus behavioral day treatment. Regardless of original trial arm assignment, groups of participants with no additional Axis I disorders (n = 87) and 1 or more additional Axis I disorders (n = 113) were compared for abstinence. Changes in depression symptoms, measured by the Beck Depression Inventory, were analyzed as a function of 4 cohorts of increased consecutive weeks abstinent. An autoregressive cross-lagged path model examined reciprocal relationships between depression and abstinence. Results: Most prevalent additional disorders were depressive disorders, followed by anxiety disorders. Additional disorders did not significantly affect abstinence. Cohorts with more abstinence were linearly related to lower depression symptoms. The cross-lagged model showed that longer abstinence predicted decreases in depressive symptoms at 6 months. However, depressive symptoms did not predict changes in abstinence. Conclusions: Our study adds to others that have found an effective treatment targeted at specific problems such as substance abuse, social anxiety disorder, and posttraumatic stress disorder that may have the side benefit of reducing depression. Additionally, we find that depression does not interfere with effective substance abuse treatment for cocaine dependency. This may be the 1st formal analysis comparing the ability of cocaine abstinence to predict future depressive symptoms versus depressive symptoms to predict future cocaine abstinence. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Journal of Consulting and Clinical Psychology 10/2014; 83(1). DOI:10.1037/a0037960 · 4.85 Impact Factor