Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples? Journal of Traumatic Stress, 18(5), 425-436

Boston University, Boston, Massachusetts, United States
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2005; 18(5):425-36. DOI: 10.1002/jts.20050
Source: PubMed


The authors review sample composition and enrollment data for 34 studies cited in the International Society for Traumatic Stress Studies (ISTSS) 2000 Practice Guidelines as meeting the Level A U.S. Agency for Health Care Policy and Research (AHCPR) classification for treatment of adult posttraumatic stress disorder (PTSD), and compare data from more recent research. Findings reveal that many published reports omitted vital data including exclusion criteria and rates, demographics, and trauma exposure history. Moreover, severe comorbid psychopathology, a common feature of treatment-seeking individuals with PTSD, emerged as the predominant reason for exclusion across studies. Subsequently published studies exhibited improved reporting of sample characteristics and demonstrated comparable outcomes despite inclusion of more diverse trauma exposure samples. Findings indicate the need for future efficacy research to adopt more comprehensive reporting requirements and to test the applicability of validated treatments to individuals suffering from as yet unstudied combinations of PTSD and prevalent comorbid disorders.

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Available from: Bessel van der Kolk, Jan 04, 2014
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    • "Women with a history of childhood maltreatment were recruited between May 2008 and July 2010 from rural and university-area prenatal clinics via clinicianor self-referral. Consistent with norms for trials of PTSD interventions (Spinazzola, Blaustein, & van der Kolk, 2005), exclusion criteria addressed safety and included active psychotic disorders, untreated substance abuse, past year suicide attempts, intimate partner or parent abuse not addressed by social services, or high-risk pregnancy conditions requiring perinatologist care, psychotropic medication, and current engagement in long-term individual psychotherapy, but not completed therapy. "
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    ABSTRACT: To test the effectiveness of a trauma-specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes. Quasi-experimental study comparing women from a single-group, pretest-posttest pilot intervention study with women matched from a prospective observational study. Rural and university-based prenatal clinics. Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants. Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self-study program supported by weekly phone tutoring sessions with a health professional. The National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience. Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding. This trauma-specific intervention reaches and benefits pregnant women with a history of childhood maltreatment.
    Full-text · Article · Apr 2014 · Journal of Obstetric Gynecologic & Neonatal Nursing
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    • "These treatments should be the first-line psychological treatment for PTSD [25-27]. Unfortunately, people with a psychotic disorder are often excluded from PTSD treatment efficacy research [28,29]. Therefore, not much is known about the generalizability of PE or EMDR efficacy to people with psychotic disorders [30]. "
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    ABSTRACT: BackgroundTrauma contributes to psychosis and in psychotic disorders post-traumatic stress disorder (PTSD) is often a comorbid disorder. A problem is that PTSD is underdiagnosed and undertreated in people with psychotic disorders. This study’s primary goal is to examine the efficacy and safety of prolonged exposure and eye movement desensitization and reprocessing (EMDR) for PTSD in patients with both psychotic disorders and PTSD, as compared to a waiting list. Secondly, the effects of both treatments are determined on (a) symptoms of psychosis, in particular verbal hallucinations, (b) depression and social performance, and (c) economic costs. Thirdly, goals concern links between trauma exposure and psychotic symptomatology and the prevalence of exposure to traumatic events, and of PTSD. Fourthly predictors, moderators, and mediators for treatment success will be explored. These include cognitions and experiences concerning treatment harm, credibility and burden in both participants and therapists.Methods/DesignA short PTSD-screener assesses the possible presence of PTSD in adult patients (21- to 65- years old) with psychotic disorders, while the Clinician Administered PTSD Scale interview will be used for the diagnosis of current PTSD. The M.I.N.I. Plus interview will be used for diagnosing lifetime psychotic disorders and mood disorders with psychotic features. The purpose is to include consenting participants (N = 240) in a multi-site single blind randomized clinical trial. Patients will be allocated to one of three treatment conditions (N = 80 each): prolonged exposure or EMDR (both consisting of eight weekly sessions of 90 minutes each) or a six-month waiting list. All participants are subjected to blind assessments at pre-treatment, twomonths post treatment, and six monthspost treatment. In addition, participants in the experimental conditions will have assessments at mid treatment and at 12 months follow-up.DiscussionThe results from the post treatment measurement can be considered strong empirical indicators of the safety and effectiveness of prolonged exposure and EMDR. The six-month and twelve-month follow-up data have the potential of reliably providing documentation of the long-term effects of both treatments on the various outcome variables. Data from pre-treatment and midtreatment can be used to reveal possible pathways of change.Trial registrationTrial registration: ISRCTN79584912
    Full-text · Article · May 2013 · Trials
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    • "therapies for PTSD, it is comparable to treatment studies for PTSD with comorbid disorders (37%Á62%; Spinazzola et al., 2005)*suggesting that the complexity of the clinical picture may have led to a higher drop-out. However, the drop-out rate was also higher than in comparable studies (i.e., PTSD efficacy studies with refugees in western psychiatric settings) by Paunovic and O ¨ st (2001; drop-out 20%) and Hinton et al. (2004, 2005; drop-out 0%). "

    Full-text · Dataset · Mar 2013
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