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[PMID]:29362795
[Au] Autor:Foa EB; McLean CP; Zang Y; Rosenfield D; Yadin E; Yarvis JS; Mintz J; Young-McCaughan S; Borah EV; Dondanville KA; Fina BA; Hall-Clark BN; Lichner T; Litz BT; Roache J; Wright EC; Peterson AL; STRONG STAR Consortium
[Ad] Endereço:Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
[Ti] Título:Effect of Prolonged Exposure Therapy Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD Symptom Severity in Military Personnel: A Randomized Clinical Trial.
[So] Source:JAMA;319(4):354-364, 2018 01 23.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Effective and efficient treatment is needed for posttraumatic stress disorder (PTSD) in active duty military personnel. Objective: To examine the effects of massed prolonged exposure therapy (massed therapy), spaced prolonged exposure therapy (spaced therapy), present-centered therapy (PCT), and a minimal-contact control (MCC) on PTSD severity. Design, Setting, and Participants: Randomized clinical trial conducted at Fort Hood, Texas, from January 2011 through July 2016 and enrolling 370 military personnel with PTSD who had returned from Iraq, Afghanistan, or both. Final follow-up was July 11, 2016. Interventions: Prolonged exposure therapy, cognitive behavioral therapy involving exposure to trauma memories/reminders, administered as massed therapy (n = 110; 10 sessions over 2 weeks) or spaced therapy (n = 109; 10 sessions over 8 weeks); PCT, a non-trauma-focused therapy involving identifying/discussing daily stressors (n = 107; 10 sessions over 8 weeks); or MCC, telephone calls from therapists (n = 40; once weekly for 4 weeks). Main Outcomes and Measures: Outcomes were assessed before and after treatment and at 2-week, 12-week, and 6-month follow-up. Primary outcome was interviewer-assessed PTSD symptom severity, measured by the PTSD Symptom Scale-Interview (PSS-I; range, 0-51; higher scores indicate greater PTSD severity; MCID, 3.18), used to assess efficacy of massed therapy at 2 weeks posttreatment vs MCC at week 4; noninferiority of massed therapy vs spaced therapy at 2 weeks and 12 weeks posttreatment (noninferiority margin, 50% [2.3 points on PSS-I, with 1-sided α = .05]); and efficacy of spaced therapy vs PCT at posttreatment. Results: Among 370 randomized participants, data were analyzed for 366 (mean age, 32.7 [SD, 7.3] years; 44 women [12.0%]; mean baseline PSS-I score, 25.49 [6.36]), and 216 (59.0%) completed the study. At 2 weeks posttreatment, mean PSS-I score was 17.62 (mean decrease from baseline, 7.13) for massed therapy and 21.41 (mean decrease, 3.43) for MCC (difference in decrease, 3.70 [95% CI,0.72 to 6.68]; P = .02). At 2 weeks posttreatment, mean PSS-I score was 18.03 for spaced therapy (decrease, 7.29; difference in means vs massed therapy, 0.79 [1-sided 95% CI, -∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment was 18.88 for massed therapy (decrease, 6.32) and 18.34 for spaced therapy (decrease, 6.97; difference, 0.55 [1-sided 95% CI, -∞ to 2.05; P = .03 for noninferiority]). At posttreatment, PSS-I scores for PCT were 18.65 (decrease, 7.31; difference in decrease vs spaced therapy, 0.10 [95% CI, -2.48 to 2.27]; P = .93). Conclusions and Relevance: Among active duty military personnel with PTSD, massed therapy (10 sessions over 2 weeks) reduced PTSD symptom severity more than MCC at 2-week follow-up and was noninferior to spaced therapy (10 sessions over 8 weeks), and there was no significant difference between spaced therapy and PCT. The reductions in PTSD symptom severity with all treatments were relatively modest, suggesting that further research is needed to determine the clinical importance of these findings. Trial Registration: clinicaltrials.gov Identifier: NCT01049516.
[Mh] Termos MeSH primário: Terapia Implosiva/métodos
Militares/psicologia
Psicoterapia/métodos
Transtornos de Estresse Pós-Traumáticos/terapia
[Mh] Termos MeSH secundário: Adulto
Campanha Afegã de 2001-
Feminino
Seres Humanos
Guerra do Iraque 2003-2011
Modelos Lineares
Masculino
Índice de Gravidade de Doença
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21242


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[PMID]:27771572
[Au] Autor:Rapee RM; Jones MP; Hudson JL; Malhi GS; Lyneham HJ; Schneider SC
[Ad] Endereço:Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia. Electronic address: Ron.Rapee@mq.edu.au.
[Ti] Título:d-Cycloserine does not enhance the effects of in vivo exposure among young people with broad-based anxiety disorders.
[So] Source:Behav Res Ther;87:225-231, 2016 12.
[Is] ISSN:1873-622X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Use of the partial NMDA receptor agonist d-Cycloserine (DCS) to increase extinction to feared cues among anxious adults has shown mixed, although overall positive effects. Few studies have extended this effect to youth and none have addressed young people with broad-based anxiety such as separation anxiety, social anxiety, or generalised anxiety. In the current trial 51 children and adolescents with diagnosed anxiety disorders, aged 7-14 years received four sessions of graduated, experimenter-led, in vivo exposure to a hierarchy of feared cues relevant to their primary fear. They were randomly allocated to receive either 50 mg of DCS or a matched placebo capsule in a fully double-blind design. Both groups showed large reductions across sessions in their primary fear according to both parent and child report, but there were no significant differences between conditions at any session. The results are consistent with most studies to date of DCS-augmented exposure in young people.
[Mh] Termos MeSH primário: Transtornos de Ansiedade/tratamento farmacológico
Transtornos de Ansiedade/terapia
Ciclosserina/uso terapêutico
Terapia Implosiva
[Mh] Termos MeSH secundário: Adolescente
Criança
Terapia Combinada
Método Duplo-Cego
Feminino
Seres Humanos
Masculino
Nootrópicos/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Nootropic Agents); 95IK5KI84Z (Cycloserine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180203
[Lr] Data última revisão:
180203
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:28686823
[Au] Autor:Zoellner LA; Telch M; Foa EB; Farach FJ; McLean CP; Gallop R; Bluett EJ; Cobb A; Gonzalez-Lima F
[Ad] Endereço:Department of Psychology, Box 351525, University of Washington, Seattle, WA 98195. zoellner@uw.edu.
[Ti] Título:Enhancing Extinction Learning in Posttraumatic Stress Disorder With Brief Daily Imaginal Exposure and Methylene Blue: A Randomized Controlled Trial.
[So] Source:J Clin Psychiatry;78(7):e782-e789, 2017 Jul.
[Is] ISSN:1555-2101
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The memory-enhancing drug methylene blue (MB) administered after extinction training improves fear extinction retention in rats and humans with claustrophobia. Robust findings from animal research, in combination with established safety and data showing MB-enhanced extinction in humans, provide a foundation to extend this work to extinction-based therapies for posttraumatic stress disorder (PTSD) such as prolonged exposure (PE). METHODS: Patients with chronic PTSD (DSM-IV-TR; N = 42) were randomly assigned to imaginal exposure plus MB (IE + MB), imaginal exposure plus placebo (IE + PBO), or waitlist (WL/standard PE) from September 2011 to April 2013. Following 5 daily, 50-minute imaginal exposure sessions, 260 mg of MB or PBO was administered. Waitlist controls received PE following 1-month follow-up. Patients were assessed using the independent evaluator-rated PTSD Symptom Scale-Interview version (primary outcome), patient-rated PTSD, trauma-related psychopathology, and functioning through 3-month follow-up. RESULTS: Both IE + MB and IE + PBO showed strong clinical gains that did not differ from standard PE at 3-month follow-up. MB-augmented exposure specifically enhanced independent evaluator-rated treatment response (number needed to treat = 7.5) and quality of life compared to placebo (effect size d = 0.58). Rate of change for IE + MB showed a delayed initial response followed by accelerated recovery, which differed from the linear pattern seen in IE + PBO. MB effects were facilitated by better working memory but not by changes in beliefs. CONCLUSIONS: The findings provide preliminary efficacy for a brief IE treatment for PTSD and point to the potential utility of MB for enhancing outcome. Brief interventions and better tailoring of MB augmentation strategies, adjusting for observed patterns, may have the potential to reduce dropout, accelerate change, and improve outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01188694.
[Mh] Termos MeSH primário: Extinção Psicológica/efeitos dos fármacos
Terapia Implosiva/métodos
Azul de Metileno/uso terapêutico
Psicoterapia Breve/métodos
Transtornos de Estresse Pós-Traumáticos/psicologia
Transtornos de Estresse Pós-Traumáticos/terapia
[Mh] Termos MeSH secundário: Adulto
Doença Crônica
Terapia Combinada
Feminino
Seguimentos
Seres Humanos
Entrevista Psicológica
Masculino
Meia-Idade
Pacientes Desistentes do Tratamento/psicologia
Qualidade de Vida/psicologia
Transtornos de Estresse Pós-Traumáticos/diagnóstico
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
T42P99266K (Methylene Blue)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE


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[PMID]:28394217
[Au] Autor:McLay RN; Baird A; Webb-Murphy J; Deal W; Tran L; Anson H; Klam W; Johnston S
[Ad] Endereço:1 San Diego County Mental Health , San Diego, California.
[Ti] Título:A Randomized, Head-to-Head Study of Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder.
[So] Source:Cyberpsychol Behav Soc Netw;20(4):218-224, 2017 Apr.
[Is] ISSN:2152-2723
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Virtual reality exposure therapy (VRET) is one of the few interventions supported by randomized controlled trials for the treatment of combat-related posttraumatic stress disorder (PTSD) in active duty service members. A comparative effectiveness study was conducted to determine if virtual reality technology itself improved outcomes, or if similar results could be achieved with a control exposure therapy (CET) condition. Service members with combat-related PTSD were randomly selected to receive nine weeks of VRET or CET. Assessors, but not therapists, were blinded. PTSD symptom improvement was assessed one week and 3 months after the conclusion of treatment using the clinician-administered PTSD scale (CAPS). A small crossover component was included. Results demonstrated that PTSD symptoms improved with both treatments, but there were no statistically significant differences between groups. Dropout rates were higher in VRET. Of those who received VRET, 13/42 (31%) showed >30% improvement on the CAPS, versus 16/43 (37%) who received CET. Three months after treatment, >30% improvement was seen in 10/33 (30%) of VRET participants and 12/33 (36%) in CET. Participants who crossed over (n = 11) showed no statistically significant improvements in a second round of treatment, regardless of condition. This study supported the utility of exposure therapy for PTSD, but did not support additional benefit by the inclusion of virtual reality.
[Mh] Termos MeSH primário: Distúrbios de Guerra/terapia
Terapia Implosiva/métodos
Transtornos de Estresse Pós-Traumáticos/terapia
Veteranos/psicologia
Terapia de Exposição à Realidade Virtual/métodos
[Mh] Termos MeSH secundário: Adulto
Distúrbios de Guerra/psicologia
Feminino
Seres Humanos
Masculino
Método Simples-Cego
Transtornos de Estresse Pós-Traumáticos/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170608
[Lr] Data última revisão:
170608
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170411
[St] Status:MEDLINE
[do] DOI:10.1089/cyber.2016.0554


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[PMID]:28373222
[Au] Autor:Gega L
[Ad] Endereço:Lina Gega, PhD, RMN, EMB650, Reader in Mental Health, Mental Health and Addiction Research Group (MHARG), Department of Health Sciences & Hull York Medical School, University of York, Alcuin Research Resource Centre, Heslington, York YO10 5DD, UK. Email: lina.gega@york.ac.uk.
[Ti] Título:The virtues of virtual reality in exposure therapy.
[So] Source:Br J Psychiatry;210(4):245-246, 2017 Apr.
[Is] ISSN:1472-1465
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Virtual reality can be more effective and less burdensome than real-life exposure. Optimal virtual reality delivery should incorporate direct dialogues with a therapist, discourage safety behaviours, allow for a mismatch between virtual and real exposure tasks, and encourage self-directed real-life practice between and beyond virtual reality sessions.
[Mh] Termos MeSH primário: Terapia Implosiva/métodos
Interface Usuário-Computador
[Mh] Termos MeSH secundário: Seres Humanos
Terapia Implosiva/instrumentação
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1192/bjp.bp.116.193300


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[PMID]:28282427
[Au] Autor:Bürkner PC; Bittner N; Holling H; Buhlmann U
[Ad] Endereço:Institute of Psychology, University of Münster, Münster, Germany.
[Ti] Título:D-cycloserine augmentation of behavior therapy for anxiety and obsessive-compulsive disorders: A meta-analysis.
[So] Source:PLoS One;12(3):e0173660, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The present meta-analysis investigates whether the antibiotic D-cycloserine (DCS), a partial agonist at the glutamatergic N-methyl-D-aspartate receptor, can augment the effect of behavior therapy in humans with anxiety and obsessive-compulsive disorders. METHOD: A keyword-based computer search was conducted using common electronic databases. Only studies investigating the effect of DCS in humans with anxiety and obsessive-compulsive disorders were included, resulting in 23 studies with a combined sample size of 1314 patients. Effect sizes were coded as Hedges' g and SMCC, the latter also incorporating differences in pre-treatment values. Bayesian multilevel meta-analysis was applied to take dependencies of effect sizes obtained from the same study into account. RESULTS: While previous meta-analyses found small to moderate improvements, the current results including the most recent research indicate that the overall effect of DCS is very small and almost indistinguishable from zero (g = -0.12, CI = [-0.27, 0.02]; SMCC = -0.10, CI = [-0.29, 0.07]). Slightly larger effects were found for social anxious patients. Further, study quality and year of publication were relevant moderators, with higher quality / more recent studies reported smaller effects of DCS. CONCLUSIONS: These findings raise the question of the usefulness of DCS as an augmentation of exposure therapy for anxiety and obsessive-compulsive disorders. At least, it seems to be less promising than initially thought. The fact that study quality was inversely related to the reported effect sizes underlines the importance of high quality primary research in order to avoid over-estimation of treatment effects in clinical psychology.
[Mh] Termos MeSH primário: Transtornos de Ansiedade/terapia
Ciclosserina/uso terapêutico
Terapia Implosiva/métodos
Transtorno Obsessivo-Compulsivo/terapia
[Mh] Termos MeSH secundário: Transtornos de Ansiedade/tratamento farmacológico
Teorema de Bayes
Seres Humanos
Transtorno Obsessivo-Compulsivo/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
95IK5KI84Z (Cycloserine)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170311
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0173660


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[PMID]:28270329
[Au] Autor:Cooper AA; Kline AC; Graham B; Bedard-Gilligan M; Mello PG; Feeny NC; Zoellner LA
[Ad] Endereço:PTSD Treatment and Research Program, Case Western Reserve University. Electronic address: aac82@case.edu.
[Ti] Título:Homework "Dose," Type, and Helpfulness as Predictors of Clinical Outcomes in Prolonged Exposure for PTSD.
[So] Source:Behav Ther;48(2):182-194, 2017 Mar.
[Is] ISSN:1878-1888
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Homework is often viewed as central to prolonged exposure (PE) for posttraumatic stress disorder (PTSD), but its relationship with treatment outcome is not well understood. We evaluated homework type, dose, and patients' perceptions of helpfulness as predictors of symptom change and posttreatment outcomes in PE. Patients with chronic PTSD received PE in a randomized clinical trial. Independent evaluators assessed PTSD severity at pre- and posttreatment. Patients reported homework adherence and perceived helpfulness at the beginning of each session, separately for in vivo and imaginal exposure assignments. These variables were examined as predictors of change in PTSD symptoms, PTSD remission, and good end-state functioning (GESF; low PTSD, depression, and anxiety) at posttreatment. Higher imaginal homework adherence predicted greater symptom improvement between sessions and across treatment, as well as twice the odds of achieving remission and GESF. Patients who were at least moderately adherent to imaginal homework assignments (two or more times a week) reported more symptom gains than those who were least adherent but did not differ from those who were most adherent. In vivo adherence was not consistently associated with better outcome, perhaps due to heterogeneity in form and function of weekly assignments. Higher ratings of helpfulness of both types of homework predicted greater symptom improvement from pre- to posttreatment and between sessions. Overall, imaginal exposure homework may complement in-session exposures by enhancing key change processes, though perfect adherence is not necessary. Patients' perceptions of helpfulness may reflect buy-in or perceived match between homework completion and functional impairment. Clinically, in addition to targeting adherence to homework assignments, querying about perceived helpfulness and adjusting assignments appropriately may help augment clinical gains.
[Mh] Termos MeSH primário: Terapia Comportamental/métodos
Terapia Implosiva/métodos
Transtornos de Estresse Pós-Traumáticos/terapia
[Mh] Termos MeSH secundário: Adulto
Ansiedade/terapia
Depressão/terapia
Feminino
Seres Humanos
Masculino
Meia-Idade
Transtornos de Estresse Pós-Traumáticos/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE


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[PMID]:28270327
[Au] Autor:Kumpula MJ; Pentel KZ; Foa EB; LeBlanc NJ; Bui E; McSweeney LB; Knowles K; Bosley H; Simon NM; Rauch SA
[Ad] Endereço:Clement J. Zablocki VA Medical Center, Milwaukee; Medical College of Wisconsin.
[Ti] Título:Temporal Sequencing of Change in Posttraumatic Cognitions and PTSD Symptom Reduction During Prolonged Exposure Therapy.
[So] Source:Behav Ther;48(2):156-165, 2017 Mar.
[Is] ISSN:1878-1888
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Prolonged exposure (PE) effectively reduces negative cognitions about self, world, and self-blame associated with posttraumatic stress disorder (PTSD), with changes in posttraumatic cognitions being associated with reductions in PTSD symptoms (Foa & Rauch, 2004). Further, recent research has demonstrated that cognitive change is a likely mechanism for PTSD symptom reduction in PE (Zalta et al., 2014). The present study examines temporal sequencing of change in three domains of posttraumatic cognitions (i.e., negative cognitions about the self, negative cognitions about the world, and self-blame) and PTSD symptoms during the course of PE. Adult outpatients meeting diagnostic criteria for PTSD were recruited at 4 sites. Participants (N=46) received 8 sessions of PE over 4 to 6weeks. PTSD symptoms and posttraumatic cognitions were assessed at pretreatment and Sessions 2, 4, 6, and 8. PTSD symptom severity and negative cognitions about the self and the world each decreased significantly from pre- to posttreatment, while self-blame cognitions were unchanged. Examination of temporal sequencing of changes during the course of PE via time-lagged mixed effects regression modeling revealed that preceding levels of negative cognitions about the world drove successive severity levels of PTSD symptoms, whereas preceding PTSD symptom severity did not drive subsequent negative cognitions about the world. Reductions in negative cognitions about the self led to subsequent improvement in PTSD. Improvement in PTSD symptoms in prior sessions was related to later reduction in negative cognitions about the self, though the impact of negative cognitions in influencing subsequent symptom change demonstrated a stronger effect. Results support that reductions in negative cognitions about the self and world are mechanisms of change in PE, which may have valuable implications for maximizing treatment effectiveness.
[Mh] Termos MeSH primário: Terapia Implosiva/métodos
Índice de Gravidade de Doença
Transtornos de Estresse Pós-Traumáticos/terapia
Sobreviventes/psicologia
[Mh] Termos MeSH secundário: Adulto
Cognição
Feminino
Seres Humanos
Masculino
Transtornos de Estresse Pós-Traumáticos/psicologia
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE


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[PMID]:28221062
[Au] Autor:Badour CL; Flanagan JC; Gros DF; Killeen T; Pericot-Valverde I; Korte KJ; Allan NP; Back SE
[Ad] Endereço:Department of Psychology, University of Kentucky.
[Ti] Título:Habituation of distress and craving during treatment as predictors of change in PTSD symptoms and substance use severity.
[So] Source:J Consult Clin Psychol;85(3):274-281, 2017 Mar.
[Is] ISSN:1939-2117
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54). METHOD: Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session. RESULTS: Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome. CONCLUSION: Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders. (PsycINFO Database Record
[Mh] Termos MeSH primário: Fissura/fisiologia
Habituação Psicofisiológica
Terapia Implosiva/métodos
Transtornos de Estresse Pós-Traumáticos/psicologia
Transtornos de Estresse Pós-Traumáticos/terapia
Transtornos Relacionados ao Uso de Substâncias/psicologia
Transtornos Relacionados ao Uso de Substâncias/terapia
[Mh] Termos MeSH secundário: Adulto
Terapia Cognitiva/métodos
Feminino
Seres Humanos
Masculino
Autorrelato
Índice de Gravidade de Doença
Transtornos de Estresse Pós-Traumáticos/complicações
Estresse Psicológico/complicações
Estresse Psicológico/psicologia
Transtornos Relacionados ao Uso de Substâncias/complicações
Resultado do Tratamento
Veteranos/psicologia
Veteranos/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE
[do] DOI:10.1037/ccp0000180


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[PMID]:28170102
[Au] Autor:Najmi S; Amir N
[Ad] Endereço:San Diego State University.
[Ti] Título:Enhancement of Self-Conducted Exposure for OCD Using Cognitive Bias Modification: A Case Study.
[So] Source:J Clin Psychol;73(5):536-546, 2017 May.
[Is] ISSN:1097-4679
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure and response prevention (ERP). However, the training required for practitioners to be proficient in delivering ERP is not readily available, thereby rendering the treatment inaccessible to most patients. Self-directed ERP (sERP) programs designed to increase the accessibility of ERP have not proven effective, perhaps because patients find it difficult to comply with exposure exercises without the guidance of a clinician. Research on cognitive bias modification (CBM) suggests that CBM may help individuals approach feared situations. In this case study, a patient with OCD completed a 7-week treatment program that combines sERP with CBM. Treatment led to a significant decrease in OCD symptoms and functional impairment. Results suggest that this novel treatment, which requires only an initial couple of sessions with a clinician trained in ERP, has the potential to increase the accessibility of ERP for patients with OCD.
[Mh] Termos MeSH primário: Terapia Cognitiva/métodos
Terapia Implosiva/métodos
Transtorno Obsessivo-Compulsivo/terapia
Autocuidado/métodos
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170731
[Lr] Data última revisão:
170731
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170208
[St] Status:MEDLINE
[do] DOI:10.1002/jclp.22451



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