Top

BMC Psychiatry

Published in:

Open Access 01-12-2024 | Post-Traumatic Stress Disorder | Research

12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity

Authors: Julie Rendum Klaeth, Andreas Gjerde Jensen, Trude Julie Brynhildsvoll Auren, Stian Solem

Published in: BMC Psychiatry | Issue 1/2024

Abstract

Background

Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD.

Methods

All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity.

Results

The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46–60% of patients achieved recovery with respect to PTSD symptoms, and that 44–48% no longer met diagnostic criteria for PTSD.

Conclusions

Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy.

Trial registration

The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.

Sherrill AM, Maples-Keller JL, Yasinski CW, Loucks LA, Rothbaum BO, Rauch SAM. Perceived benefits and drawbacks of massed prolonged exposure: a qualitative thematic analysis of reactions from treatment completers. Psychol Trauma: Theory Res Pract Policy. 2020;14(5):862–70.CrossRef

Thoresen IH, Auren TJB, Klæth JR, Jensen AG, Engesæth C, Langvik EO. Intensive outpatient treatment for PTSD: a thematic analysis of patient experience European. J Psychotraumatology. 2022;13(1):2043639.CrossRef

Gutner CA, Suvak MK, Sloan DM, Resick PA. Does timing matter? Examining the impact of session timing on outcome. J Consult Clin Psychol. 2016;84(12):1108–15.CrossRefPubMedPubMedCentral

Sciarrino NA, Warnecke AJ, Teng EJ. A systematic review of intensive empirically supported treatments for posttraumatic stress disorder. 2020;33(4):443–54.

Hoppen TH, Kip A, Morina N. Are psychological interventions for adult PTSD more efficacious and acceptable when treatment is delivered in higher frequency? A meta-analysis of randomized controlled trials. J Anxiety Disord. 2023;95:102684.CrossRefPubMed

Weber M, Schumacher S, Hannig W, Barth J, Lotzin A, Schäfer I, et al. Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis. Psychol Med. 2021;51:1420–30.CrossRefPubMedPubMedCentral

Resick PA, Williams LF, Suvak MK, Monson CM, Gradus JL. Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. J Consult Clin Psychol. 2012;80:201–10.CrossRefPubMed

Resick PA, Nishith P, Weaver TL, Astin MC, Feuer CA. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J Consult Clin Psychol. 2002;70:867–79.CrossRefPubMedPubMedCentral

Held P, Zalta AK, Smith DL, Bagley JM, Steigerwald VL, Boley RA, et al. Maintenance of treatment gains up to 12-months following a three-week cognitive processing therapy-based intensive PTSD treatment programme for veterans. Eur J Psychotraumatology. 2020;11(1):1789324.CrossRef

10.

Yasinski CW, Watkins LE, Maples-Keller JL, Ragsdale KA, Sherrill AM, Burton MS, et al. Long-term effectiveness of a prolonged exposure-based intensive outpatient program for veterans with posttraumatic stress disorder. J Psychiatr Res. 2022;152:313–20.CrossRefPubMed

11.

Hurley EC. Effective treatment of veterans with PTSD: comparison between intensive daily and weekly EMDR approaches. Front Psychol. 2018;9:1458.CrossRefPubMedPubMedCentral

12.

Auren TJB, Jensen AG, Klæth JR, Maksic E, Solem S. Intensive outpatient treatment for PTSD: a pilot feasibility study combining prolonged exposure therapy, EMDR, physical activity, and psychoeducation. Eur J Psychotraumatology. 2021;12(1):1917878.CrossRef

13.

van Woudenberg C, Voorendonk EM, Bongaerts H, Zoet HA, Verhagen M, Lee CW, et al. Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. Eur J Psychotraumatology. 2018;9(1):1487225.CrossRef

14.

Auren TJB, Klæth JR, Jensen AG, Solem S. Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity. Eur J Psychotraumatology. 2022;13(2):2128048.CrossRef

15.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The mini-international neuropsychiatric interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33.PubMed

16.

Brown T, Di Nardo P, Barlow D. Anxiety disorders interview schedule for DSM-IV (ADIS-IV). San Antonio, TX: Psychological Corporation: Graywind Publications Incorporated; 1994.

17.

Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress. 1993;6(4):459–73.

18.

Foa EB, Hembree EA, Rothbaum BO. Treatments that work. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences: therapist guide. New York, NY, US: Oxford University Press; 2007.CrossRef

19.

Shapiro F, Korn DL, Stickgold R, Maxfield L, Smyth NJ. Eye Movement Desensitization and Reprocessing (EMDR) Therapy. 3rd ed. Guilford Press; 2018.

20.

Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL‐5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98.CrossRefPubMed

21.

The Improving Access to Psychological Therapies Manual. Appendices and helpful resources 2018 [Available from: https://www.england.nhs.uk/wp-content/uploads/2018/06/iapt-manual-resources-v2.pdf.

22.

Beck AT, Steer RA, Brown GK. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996.

23.

Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consulting Clin Psychol. 1988;56(6):893–7.CrossRef

24.

Mundt JC, Marks IM, Shear MK, Greist JM. The work and Social Adjustment Scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002;180(5):461–4.CrossRefPubMed

25.

Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: a systematic review of the literature. Psychoterapy Psychosom. 2015;84(3):167–76.CrossRef

26.

Löwe B, Spitzer RL, Gräfe K, Kroenke K, Quenter A, Zipfel S, et al. Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord. 2004;78(2):131–40.CrossRefPubMed

27.

Alden LE, Wiggins JS, Pincus AL. Construction of circumplex scales for the inventory of interpersonal problems. J Pers Assess. 1990;55(3–4):521–36.CrossRefPubMed

28.

Schafer J. Analysis of incomplete Multivariate Data. 1st ed. ed. New York: Chapman and Hall/CRC; 1997.CrossRef

29.

Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–9.CrossRefPubMed

Title: 12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity
Authors: Julie Rendum Klaeth
Andreas Gjerde Jensen
Trude Julie Brynhildsvoll Auren
Stian Solem
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Post-Traumatic Stress Disorder
Published in: BMC Psychiatry / Issue 1/2024
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-024-05656-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

Why do patients want medication free treatment for psychosis? An explorative study on reasons for applying to medication free programs

Low-intensity mindfulness and cognitive–behavioral therapy for social anxiety: a pilot randomized controlled trial

Depressive symptoms and daily living dependence in older adults with type 2 diabetes mellitus: the mediating role of positive and negative perceived stress

Prevalence and risk factors for psychotic symptoms in young, first-episode and drug-naïve patients with major depressive disorder

Cytokine profile in first-episode drug-naïve major depressive disorder patients with or without anxiety

Assessing the clinical and cost-effectiveness of inpatient mental health rehabilitation services provided by the NHS and independent sector (ACER): protocol