Article

Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents

Department of Psychology, Boston University, 648 Beacon St., Boston, MA 02215, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 06/2011; 79(3):421-5. DOI: 10.1037/a0023318
Source: PubMed

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.

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Available from: Eva Gilboa-Schechtman, Dec 24, 2013
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    • "For example, reduction in social anxiety symptoms was found to mediate 91% of reduction in depression , whereas depression mediated only 6% of reduction in social anxiety symptoms (Moscovitch, Hofmann, Suvak, & In-Albon, 2005). Similarly, reduction in posttraumatic stress disorder (PTSD) symptoms has been found to mediate between 64% (Aderka, Foa, Applebaum, Shafran, & Gilboa-Schechtman, 2011) and 80% (Aderka, Gillihan, McLean, & Foa, 2013) of subsequent reduction in depression, whereas changes in depression mediated only 11% (Aderka et al., 2011) and 45% (Aderka et al., 2013) of subsequent PTSD changes, respectively. "
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    ABSTRACT: The current study examines the temporal relationship between changes in obsessive-compulsive symptoms and changes in depressive symptoms during exposure and response prevention (EX/RP) therapy for obsessive-compulsive disorder (OCD). Participants were 40 adults (53% female) who received EX/RP in a randomized controlled trial comparing serotonin reuptake inhibitor (SRI) augmentation strategies. Participants completed clinician-administered assessments of OCD (Yale-Brown Obsessive Compulsive Scale) and depressive symptoms (Hamilton Depression Rating Scale) every four weeks from baseline to 32-week follow-up. Lagged multilevel mediational analyses indicated that change in OCD symptoms accounted for 65% of subsequent change in depressive symptoms. In contrast, change in depressive symptoms only partially mediated subsequent change in OCD symptoms, accounting for 20% of the variance in outcome. These data indicate that reductions in co-morbid depressive symptoms during EX/RP for OCD are largely driven by reductions in obsessive-compulsive symptoms. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Behaviour Research and Therapy
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    • "However, it seems that changes in posttraumatic symptoms and depressive symptoms are more closely linked in adult populations than in pediatric ones. In the present study, 80.3% of changes in depressive symptoms were accounted for by posttraumatic symptoms, compared to 64.1% among youths, and 45.0% of changes in posttraumatic symptoms were accounted for by changes in depressive symptoms, compared to 11.0% among youths (Aderka et al., 2011). This discrepancy may be the result of developmental differences, or differences in types of trauma experienced and time since the trauma. "
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    ABSTRACT: Objective: In the present study, we examined the relationship between posttraumatic and depressive symptoms during prolonged exposure (PE) treatment with and without cognitive restructuring (CR) for the treatment of posttraumatic stress disorder (PTSD). Method: Female assault survivors (N = 153) with PTSD were randomized to either PE alone or PE with added CR (PE/CR). During treatment, bi-weekly self-report measures of posttraumatic and depressive symptoms were administered. Results: Multilevel mediational analyses indicated that during PE, changes in posttraumatic symptoms accounted for 80.3% of changes in depressive symptoms, whereas changes in depressive symptoms accounted for 45.0% of changes in posttraumatic symptoms. During PE/CR, changes in posttraumatic symptoms accounted for 59.6% of changes in depressive symptoms, and changes in depressive symptoms accounted for 50.7% of changes in posttraumatic symptoms. Conclusions: This pattern of results suggests that PE primarily affects posttraumatic symptoms, which in turn affect depressive symptoms. In contrast, PE/CR results in a more reciprocal relationship between posttraumatic and depressive symptoms.
    Full-text · Article · Jan 2013 · Journal of Consulting and Clinical Psychology
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    • "Finally, there may be a reciprocal relationship between changes in PTSD and depression in PE. Post-traumatic symptoms account for more variance of the change in depression than vice versa, suggesting that PE may work primarily by reducing posttraumatic stress, which in turn reduces depression (Aderka, Foa, Applebaum, Shafran, & Gilboa-Schechtman, 2011). Taken together, evidence across randomized trials of PE consistently shows improvement in depression, and clinical improvement in PTSD occurs even for those who have higher pre-treatment depression severity. "
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    ABSTRACT: Although prolonged exposure (PE) has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.
    Full-text · Article · Jul 2012 · European Journal of Psychotraumatology
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