Abstract
Background: Although exposure-based therapy is a well-established, effective treatment for post-traumatic stress disorder (PTSD), some practitioners report reluctance to implement it due to concerns that it may exacerbate symptoms of PTSD and commonly comorbid disorders, such as substance use disorders (SUD). Aim: This study compared the exacerbation of psychological symptoms among participants with comorbid PTSD and SUD who received either SUD treatment alone or SUD treatment integrated with exposure therapy for PTSD. Method: Participants (N = 71) were treatment-seeking, military Veterans with comorbid PTSD and SUD who were randomized to 12 individual sessions of either (1) an integrated, exposure-based treatment (Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure; COPE); or (2) a non-exposure-based, SUD-only treatment (Relapse Prevention; RP). We examined between-group differences in the frequency of statistically reliable exacerbations of PTSD, SUD and depression symptoms experienced during treatment. Results: At each of the 12 sessions, symptom exacerbation was minimal and generally equally likely in either treatment group. However, an analysis of treatment completers suggests that RP participants experienced slightly more exacerbations of PTSD symptoms during the course of treatment. Conclusions: This study is the first to investigate symptom exacerbation throughout trauma-focused exposure therapy for individuals with comorbid PTSD and SUD. Results add to a growing literature which suggests that trauma-focused, exposure-based therapy does not increase the risk of symptom exacerbation relative to non-exposure-based therapy.
| Original language | English |
|---|---|
| Pages (from-to) | 38-53 |
| Number of pages | 16 |
| Journal | Behavioural and Cognitive Psychotherapy |
| Volume | 48 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2020 |
Bibliographical note
Publisher Copyright:© 2019 British Association for Behavioural and Cognitive Psychotherapies.
Funding
The authors would like to acknowledge support from the National Institute on Drug Abuse (S.E.B., grant numbers R01 DA030143, K02 DA039229; C.L.B., grant number K12 DA035150); the Department of Veteran Affairs Clinical Sciences Research and Development Career Development Award (D.F.G., grant number CX000845), and resources at the Ralph H. Johnson Veterans Affairs Medical Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIH, the VA, or the United States government. Financial support. The authors would like to acknowledge support from the National Institute on Drug Abuse (S.E.B., grant numbers R01 DA030143, K02 DA039229; C.L.B., grant number K12 DA035150); the Department of Veteran Affairs Clinical Sciences Research and Development Career Development Award (D.F.G., grant number CX000845), and resources at the Ralph H. Johnson Veterans Affairs Medical Center. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of NIH, the VA, or the United States government.
| Funders | Funder number |
|---|---|
| Department of Veteran Affairs | CX000845 |
| Ralph H. Johnson Veterans Affairs Medical Center | |
| National Institutes of Health (NIH) | |
| National Institute on Drug Abuse | K12 DA035150, K02 DA039229, R01 DA030143 |
| U.S. Department of Veterans Affairs | IK2CX000845 |
Keywords
- Veteran
- combined treatment
- depression
- post-traumatic stress disorder
- substance use
- therapy outcome
ASJC Scopus subject areas
- Clinical Psychology