Suchergebnisse

Of troops returning from Iraq and Afghanistan, approximately 5–20% have PTSD, and another 11–23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with the ability to adhere to, and benefit from, CBTs. Co-morbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. We hypothesized that poorer pre-treatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD. The present study was a naturalistic examination of "treatment as usual" in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans aged 18–50 years with combat-related PTSD and symptom duration more than 1 year; 16 of whom had mild TBI. Our predictor variables were well-normed objective tests of cognitive ability measured at baseline; our outcome variables were: a) individual slopes of change of the PTSD Checklist 5 (PCL-5) and the Clinician Assessment of PTSD Scale (CAPS-5) over weeks of treatment; and b) pre- to post-treatment change (Δ) in PCL-5 and CAPS-5. Contrary to our prediction, neither pre-treatment cognitive performance, nor the presence of co-morbid mild TBI, predicted poorer response to CBTs for PTSD. Our results discourage any notion of excluding PTSD patients with poorer cognitive ability from CBTs. Study limitations include a naturalistic treatment design, which did not allow for control of confounders, and an inability to completely rule out type II error because of small sample size.

BACKGROUND: Complicated Grief (CG) is a bereavement-specific syndrome distinct from but commonly comorbid with posttraumatic stress disorder (PTSD). While bereavement is common among military personnel (Simon et al., 2018), there is little research on the impact of CG comorbidity on PTSD treatment outcomes. METHODS: To evaluate the impact of comorbid CG on PTSD treatment outcomes we analyzed data from a randomized trial comparing prolonged exposure (PE), sertraline, and their combination in veterans with a primary diagnosis of combat-related PTSD (n=194). Assessment of PTSD, trauma-related guilt, functional impairment, and suicidal ideation and behavior occurred at baseline and weeks 6, 12 and 24 during the 24-week trial. RESULTS: CG was associated with lower PTSD treatment response (OR=0.29, 95% CI [0.12, 0.69], p=0.005) and remission (OR=0.28, 95% CI [0.11, 0.71], p=0.007). Those with CG had greater severity of PTSD (p=.005) and trauma-related guilt (<.001) at baseline and endpoint. In addition, those with CG were more likely to experience suicidal ideation during the study (CG: 35%, 14/40 vs. no CG 15%, 20/130; OR: 3.01, 95% CI [1.29, 7.02], p=0.011). CONCLUSIONS: Comorbid CG is associated with elevated PTSD severity and independently associated with poorer endpoint treatment outcomes in veterans with combat-related PTSD, suggesting that screening and additional intervention for CG may be needed.