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The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel

Published online by Cambridge University Press:  17 September 2018

Lily A. Brown ,
Joshua D. Clapp ,
Joshua J. Kemp ,
Jeffrey S. Yarvis ,
Katherine A. Dondanville ,
Brett T. Litz ,
Jim Mintz ,
John D. Roache ,
Stacey Young-McCaughan  and
Alan L. Peterson
...Show all authors
Lily A. Brown*
Affiliation:
Department of Psychiatry, University of Pennsylvania, 3535 Market Street Suite 600 N, Philadelphia, PA 19104,USA
Joshua D. Clapp
Affiliation:
University of Wyoming, Laramie, WY, USA
Joshua J. Kemp
Affiliation:
Warren Alpert Medical School, Providence, RI, USA
Jeffrey S. Yarvis
Affiliation:
Carl R. Darnall Army Medical Center, Fort Hood, Texas,USA
Katherine A. Dondanville
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Brett T. Litz
Affiliation:
VA Boston Healthcare System and Boston University School of Medicine, Boston, MA,USA
Jim Mintz
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
John D. Roache
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Stacey Young-McCaughan
Affiliation:
University of Texas Health Science Center at San Antonio, San Antonio, TX,USA
Alan L. Peterson
Affiliation:
University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, TX,USA
Edna B. Foa
Affiliation:
University of Pennsylvania, Philadelphia, PA,USA
*
Author for correspondence: Lily A. Brown, E-mail: lilybr@upenn.edu
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Abstract

Background

Few studies have investigated the patterns of posttraumatic stress disorder (PTSD) symptom change in prolonged exposure (PE) therapy. In this study, we aimed to understand the patterns of PTSD symptom change in both PE and present-centered therapy (PCT).

Methods

Participants were active duty military personnel (N = 326, 89.3% male, 61.2% white, 32.5 years old) randomized to spaced-PE (S-PE; 10 sessions over 8 weeks), PCT (10 sessions over 8 weeks), or massed-PE (M-PE; 10 sessions over 2 weeks). Using latent profile analysis, we determined the optimal number of PTSD symptom change classes over time and analyzed whether baseline and follow-up variables were associated with class membership.

Results

Five classes, namely rapid responder (7–17%), steep linear responder (14–22%), gradual responder (30–34%), non-responder (27–33%), and symptom exacerbation (7–13%) classes, characterized each treatment. No baseline clinical characteristics predicted class membership for S-PE and M-PE; in PCT, more negative baseline trauma cognitions predicted membership in the non-responder v. gradual responder class. Class membership was robustly associated with PTSD, trauma cognitions, and depression up to 6 months after treatment for both S-PE and M-PE but not for PCT.

Conclusions

Distinct profiles of treatment response emerged that were similar across interventions. By and large, no baseline variables predicted responder class. Responder status was a strong predictor of future symptom severity for PE, whereas response to PCT was not as strongly associated with future symptoms.

Keywords

Active duty militaryposttraumatic stress disorderpresent-centered therapyprolonged exposurePTSD
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 12 , September 2019 , pp. 1980 - 1989
Copyright
Copyright © Cambridge University Press 2018 

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