PHILADELPHIA – Symptoms of Post-Traumatic Stress Disorder (PTSD) can be debilitating and standard treatment can take months, often leaving those affected unable to work or care for their families. But, a new study demonstrated that many PTSD sufferers can benefit from an expedited course of treatment. In the first study of its kind, Prolonged Exposure (PE) therapy was found to be as effective when administered over two weeks as when it is provided over eight weeks for treating PTSD in active-duty military personnel. The study was conducted by researchers from Penn Medicine, under the leadership of Edna B. Foa, PhD, The University of Texas Health Science Center at San Antonio (UT Health San Antonio) and the STRONG STAR Consortium. The findings were published in the January 23 issue of JAMA.
The research team notes that the results obtained in active military personnel also offer possible new treatment options for veterans and civilians. As much as 10 to 20 percent of military members deployed to Iraq and Afghanistan following the September 11th attacks suffer from PTSD, a condition that is often chronic and incapacitating. A constant increase in the number of individuals suffering from PTSD as a result of massive natural disasters, terror attacks, and the wars in Iraq and Afghanistan, has prompted an urgent need for effective and efficient evidence-based treatments for PTSD.
“This study not only addresses the pressing need for an effective treatment option for PTSD but also encourages a more speedy treatment and recovery, allowing affected service members to return to active duty sooner and enabling veterans to reintegrate into civilian life more quickly,” said Foa, a professor of Clinical Psychology in Psychiatry in the Perelman School of Medicine at the University of Pennsylvania and principle investigator on the study, who developed PE. “Our findings are good news—about half of those treated achieved remission and many others demonstrated substantial relief from their symptoms. This is critical for the hundreds of thousands of post-9/11 combat veterans affected by PTSD and can do so much to improve lives and assist with military readiness.”
The study was conducted at Fort Hood in collaboration with Carl R. Darnall Army Medical Center and was co-led by Alan Peterson, PhD, a professor of psychiatry at UT Health San Antonio and director of the STRONG STAR Consortium. It is the largest and first-ever randomized clinical study of PE for PTSD with active-duty military members.
PE is a form of cognitive-behavioral therapy that involves exposure to trauma memories and daily life trauma reminders. Previous studies have proven PE is quite effective for treating civilians and veterans with PTSD. In this five-year (2011-2016) study, the researchers sought to determine whether PE could have similar success with active-duty military personnel. The researchers examined the benefit of various methods for delivering PE including Massed-PE, (10 therapy sessions administered over two weeks) and Spaced-PE (10 sessions administered over 8 weeks), as well as Present Centered Therapy (PCT), a non-trauma-focused therapy that involves identifying and discussing daily stressors in 10 sessions over eight weeks, and Minimal Contact Control (MCC), which included supportive phone calls from therapists once weekly for four weeks. Of the 370 military personnel with PTSD who participated in the single-blind randomized clinical trial, 110 received Massed-PE, 110 received Spaced-PE, 110 received PCT, and 40 received MCC.
Outcomes were assessed before treatment, at 2-weeks and 12-weeks after treatment, and at 6-month follow up. Patients who received Massed-PE therapy, delivered over two weeks, saw a greater reduction in PTSD symptoms than those who received MCC. Importantly, Massed-PE therapy was found to be equally effective to Spaced-PE in reducing PTSD symptom severity. The researchers also found that PCT might be an effective treatment option for PTSD in active military personnel although it was less effective than PE in veteran and civilian PTSD sufferers.
While all participants in the study saw some reduction in PTSD symptoms, the researchers say these symptom reductions were relatively modest, indicating there is still more work to be done with treating active military personnel with PTSD.
“This seminal study validates that combat-related PTSD can be effectively treated in active duty military personnel, and it sets a high benchmark to which future studies will be compared. However, we need to do more,” said Peterson, a retired lieutenant colonel and clinical psychologist with the U.S. Air Force. “Even with our most effective PTSD treatments, we’re seeing greater challenges to successful recovery from combat-related PTSD.”
The researchers plan to expand their work with the Department of Defense by conducting additional studies to determine the best methods for training military mental health providers to deliver PE therapy and by further tailoring PE treatments to better meet the unique obstacles to successful treatment for combat PTSD.
Other study co-authors include Carmen P. McLean, PhD; Yinyin Zang, PhD; David Rosenfield, PhD; Elna Yadin, PhD; Jeffrey S. Yarvis, PhD; Jim Mintz, PhD; Stacey Young-McCaughan, RN, PhD; Elisa V. Borah, PhD; Katherine A. Dondanville, PsyD; Brooke A. Fina, MSW; Brittany N. Hall-Clark, PhD; Tracey Lichner PhD; Brett T. Litz, PhD; John Roache, PhD; and Edward C. Wright, PhD.
Funding for the study was awarded to Foa by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program awards W81XWH-08-02-0111, W81XWH-08-02-109 and W81XWH-08-02-0114.
Editor’s Note: Dr. Foa received research funding from the Department of Defense, the Department of Veterans Affairs, and the National Institutes of Health. In addition, Dr. Foa has published books on PTSD treatment for which she receives income. Dr. Peterson received research funding from the Department of Defense, the Department of Veterans Affairs, the National Institutes of Health, and the Robert Wood Johnson Foundation.
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The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $405 million awarded in the 2017 fiscal year.
The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center — which are recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report — Chester County Hospital; Lancaster General Health; Penn Medicine Princeton Health; Penn Wissahickon Hospice; and Pennsylvania Hospital – the nation’s first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare.
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