A Pilot Study of Interpersonal Psychotherapy for Posttraumatic Stress Disorder
ABSTRACT This article describes pilot testing of interpersonal psychotherapy adapted for posttraumatic stress disorder (PTSD). Unlike most psychotherapies for PTSD, interpersonal psychotherapy is not exposure-based, focusing instead on interpersonal sequelae of trauma.
Fourteen consecutively enrolled subjects with chronic PTSD (DSM-IV) from various traumas received an open, 14-week interpersonal psychotherapy trial.
Treatment was well tolerated: 13 subjects (93%) completed therapy. After 14 weeks, 12 of 14 subjects no longer met diagnostic criteria for PTSD, 69% responded (50% Clinician Administered PTSD Scale score decrement), and 36% remitted (score < or =20). Thirteen subjects reported declines in PTSD symptoms across all three symptom clusters. Depressive symptoms, anger reactions, and interpersonal functioning also improved.
Treating interpersonal sequelae of PTSD appears to improve other symptom clusters. Interpersonal psychotherapy may be an efficacious alternative for patients who refuse repeated exposure to past trauma. This represents an exciting extension of interpersonal psychotherapy to an anxiety disorder.
- SourceAvailable from: Claudia Rafful
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- "In other cases, such as exposure-based approaches to PTSD or other anxiety disorders, dropout may occur because of patients' difficulty tolerating treatment procedures [43e45]. Preliminary data suggest that alternative treatment approaches [e.g., interpersonal psychotherapy (IPT)] based on different mechanisms of action may help to improve both retention and outcomes for these patients . Studies comparing the effectiveness of exposure and prevention of response therapy vs. IPT are ongoing (R01 MH079078: PI, Markowitz). "
ABSTRACT: A large body of comparative effectiveness research (CER) focuses on the use of observational and quasi-experimental approaches. We sought to examine the use of clinical trials as a tool for CER, particularly in mental health. Examination of three ongoing randomized clinical trials in psychiatry addressing issues that would pose difficulties for nonexperimental CER methods. Existing statistical approaches to nonexperimental data appear insufficient to compensate for biases that may arise when the pattern of missing data cannot be properly modeled such as when there are no standards for treatment, when affected populations have limited access to treatment, or when there are high rates of treatment dropout. Clinical trials should retain an important role in CER, particularly in cases of high disorder prevalence, large expected effect sizes, difficult-to-reach populations, or when examining sequential treatments or stepped-care algorithms. Progress in CER on mental health will require careful consideration of appropriate selection between clinical trials and nonexperimental designs and on allocation of research resources to optimally inform key treatment decisions for each patient.Journal of clinical epidemiology 08/2013; 66(8 Suppl):S29-36. DOI:10.1016/j.jclinepi.2013.02.013 · 5.48 Impact Factor
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- "However, at least with regard to attrition, this intervention appears to have no advantage over CBT (Siev & Chambless, 2007). Preliminary evidence also suggests interpersonal psychotherapy, an additional intervention not requiring repeated fear confrontation, is effective for the treatment of PTSD (Bleiberg & Markowitz, 2005), though it has not been researched extensively. It is not yet clear whether cognitive therapy, applied relaxation, and interpersonal psychotherapy are in fact less aversive than exposure therapy, at least as measured by differences in refusal and attrition rates. "
ABSTRACT: Evaluations of psychotherapy have traditionally focused on symptom reduction as the primary standard by which their value is determined. This has contributed to the appearance of equivalence between many therapies that may differ considerably in complexity, feasibility, amount of homework and therapist contact required, expected cost, speed of symptom decline, and transdiagnostic utility. In the current paper, I make the case that these are fundamental features related to quality that should be considered in psychotherapy development, randomized controlled trials, and dissemination efforts. Empirically supported treatments for different disorders are evaluated based on these criteria, and special consideration is given to cognitive-behavioral treatments for anxiety disorders. Specific recommendations for a quality-oriented clinical research agenda are also provided.Behavior therapy 09/2012; 43(3):468-81. DOI:10.1016/j.beth.2010.12.007 · 2.85 Impact Factor
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- "This RCT compares three disparate manualized psychotherapies delivered over 14 weeks for patients with chronic PTSD: Prolonged Exposure (PE; Foa and Rothbaum, 1998), Relaxation Therapy (RT; Jacobsen, 1938), and Interpersonal Psychotherapy (IPT; Weissman et al., 2007; Bleiberg and Markowitz, 2005). PE reconstructs a detailed trauma narrative and provides in vivo and imaginal exposure to trauma reminders. "
ABSTRACT: Clinical trials of psychotherapy require diagnostic homogeneity, which implies a convergence of clinical presentations. Yet research study patients present diversely, and patients who do not fit a treatment paradigm may greatly complicate delivery of the study psychotherapy. The research literature has not addressed this issue. The authors use case illustrations of three psychotherapies--Prolonged Exposure, Relaxation Therapy, and Interpersonal Psychotherapy--from an ongoing psychotherapy outcome trial of posttraumatic stress disorder to describe psychotherapeutic responses to complex, "atypical" patients who strain standard treatment paradigms. Therapists required flexibility, and occasionally deviations from strict protocol, in treating heterodox patients. Such heterogeneity of presentation may have implications for psychotherapy outcome in research trials. Despite lack of discussion in the literature, many trials may face such issues.The Journal of nervous and mental disease 07/2012; 200(7):594-7. DOI:10.1097/NMD.0b013e31825bfaf4 · 1.81 Impact Factor