Faculty Collaboration Database

Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion. Behav Res Ther 2016 Feb;77:68-77

Date

01/06/2016

Pubmed ID

26731171

DOI

10.1016/j.brat.2015.12.009

Scopus ID

2-s2.0-84960356868 (requires institutional sign-in at Scopus site)   80 Citations

Abstract

Trauma-focused treatments are underutilized, partially due to clinician concerns that they will cause symptom exacerbation or dropout. We examined a sample of women undergoing Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and a version of CPT (CPT-C) without a written trauma narrative to investigate the possibility of symptom exacerbation. Participants (n = 192) were drawn from two RCT's. Participants were administered self-report measures of PTSD symptoms (i.e., the PTSD Symptom Scale or Posttraumatic Diagnostic Scale [PSS/PDS]) and the Clinician-Administered PTSD Scale. Exacerbations were defined as increases greater than 6.15 points on the PSS/PDS. A minority of participants experienced PTSD exacerbations during treatment, and there were no significant differences across treatment type (28.6% in CPT, 20.0% in PE, and 14.7% in CPT-C). Neither diagnostic nor trauma-related factors at pre-treatment predicted symptom exacerbations. Those who experienced exacerbations had higher post-treatment PSS/PDS scores and were more likely to retain a PTSD diagnosis (both small but statistically significant effects). However, even those who experienced an exacerbation experienced clinically significant improvement by end of treatment. Further, symptom exacerbations were not related to treatment non-completion. These results indicate that trauma-focused treatments are safe and effective, even for the minority of individuals who experience temporary symptom increases.

Author List

Larsen SE, Wiltsey Stirman S, Smith BN, Resick PA

Author

Sadie E. Larsen PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Implosive Therapy
Self Report
Stress Disorders, Post-Traumatic
Symptom Flare Up
Treatment Outcome