Steven R Thorp1, Lisa H Glassman2, Stephanie Y Wells3, Kristen H Walter4, Heather Gebhardt5, Elizabeth Twamley6, Shahrokh Golshan7, James Pittman8, Kendra Penski9, Carolyn Allard10, Leslie A Morland11, Julie Wetherell12. 1. Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; California School of Professional Psychology at Alliant International University; 10455 Pomerado Rd. San Diego, CA 92131, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States. Electronic address: steven.thorp@alliant.edu. 2. Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States. Electronic address: lglassman@ucsd.edu. 3. Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology; 6363 Alvarado Court, Suite 103 San Diego, CA 92120, United States. Electronic address: Stephanie.Wells2@va.gov. 4. VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States. Electronic address: Kristen.Walter@va.gov. 5. VA Puget Sound Healthcare System, Seattle Division; 1660 S Columbian Way, Seattle, WA 98108, United States. Electronic address: Heather.Gebhardt@va.gov. 6. Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; Research Service, VA San Diego Healthcare System; VA San Diego Healthcare System, 3350 La Jolla Village Drive, 6th floor, San Diego, CA 92161, United States. Electronic address: etwamley@ucsd.edu. 7. Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States. Electronic address: sgolshan@ucsd.edu. 8. Veterans Affairs (VA) Center of Excellence for Stress and Mental Health; VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States. Electronic address: James.Pittman@va.gov. 9. VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States; University of Phoenix; 1625 W Fountainhead Pkwy, Tempe, AZ 85282, United States. Electronic address: Kendra.Penski@va.gov. 10. California School of Professional Psychology at Alliant International University; 10455 Pomerado Rd. San Diego, CA 92131, United States; Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States. Electronic address: carolyn.allard@alliant.edu. 11. Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States; National Center for PTSD - Pacific Island Healthcare; 3375 Koapaka Street, Suite I-560, Honolulu, HI, 96819, United States. Electronic address: Leslie.Morland@va.gov. 12. Department of Psychiatry, University of California, San Diego; 9500 Gilman Dr, La Jolla, CA 92093, United States; VA San Diego Healthcare System; 3350 La Jolla Village Drive, San Diego, CA 92161, United States. Electronic address: jwetherell@ucsd.edu.
Abstract
OBJECTIVE: Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. METHOD: This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. RESULTS: Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. CONCLUSIONS:PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00539279. Published by Elsevier Ltd.
RCT Entities:
OBJECTIVE: Although prolonged exposure (PE) has strong support for treating posttraumatic stress disorder (PTSD), there is little research on PE for older adults. Likewise, Relaxation Training (RT) has shown some benefit for PTSD, but has not been adequately tested in this population. METHOD: This study represents the first randomized controlled trial of two active psychotherapies for PTSD among older adults. Male combat veterans (N = 87; mean age = 65 years) were randomly assigned to 12 sessions of PE (n = 41) or RT (n = 46). Clinician-administered and self-report assessments were conducted at pre-treatment, post-treatment, and six-month follow-up; self-reported symptoms were also measured at each treatment session. RESULTS: Multi-level modeling indicated that Clinician-Administered PTSD Scale scores significantly decreased from pre-treatment to follow-up, but the time by treatment condition interaction was not significant. Pre- to post-treatment change was large in PE and moderate in RT, but many gains were lost at follow-up. For self-reported PTSD symptoms, a significant time by treatment condition interaction emerged, suggesting that participants who received PE had both greater decreases in symptoms and a greater rebound in self-reported PTSD symptoms than those who received RT. Unlike PTSD symptoms, depression symptoms neither changed nor were moderated by treatment condition from pre-treatment to follow-up. For self-reported PTSD and depression symptoms assessed at each session, time significantly predicted symptom reductions across psychotherapy sessions. CONCLUSIONS: PE and RT are well-tolerated, feasible, and effective for older adults, though treatment gains were not maintained at follow-up. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00539279. Published by Elsevier Ltd.
Authors: Jeannette C G Lely; F Jackie June Ter Heide; Mirjam Moerbeek; Jeroen W Knipscheer; Rolf J Kleber Journal: Eur J Psychotraumatol Date: 2022-01-28
Authors: Simon Forstmeier; Elisheva van der Hal; Martin Auerbach; Andreas Maercker; Danny Brom Journal: BMC Psychiatry Date: 2020-04-25 Impact factor: 3.630