Monday, April 29, 2019

Exposure Therapy for PTSD Benefits Patients With Comorbid Alcohol Use Disorder, Study Shows

People with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) can tolerate and benefit from prolonged exposure therapy, according to a study published online April 24 in JAMA Psychiatry. Among veterans with both disorders, prolonged exposure therapy more effectively reduced PTSD symptoms than a therapy focused on coping skills and did not increase alcohol problems.

“This information is critical because having an AUD continues to be a barrier to receiving exposure therapy because of therapist perceptions of patients’ fragility (i.e., beliefs that patients will not be able to handle trauma-related memories and may have an increase in alcohol use),” wrote Sonya Norman, Ph.D., of the Veterans Affairs San Diego Healthcare System, and colleagues.

Veterans with PTSD and AUD (N=119) were randomly divided to receive 12 sessions of either prolonged exposure therapy or coping skills therapy; both therapies were integrated to focus on both PTSD and substance use symptoms. The exposure program, known as COPE, combines live and image-based exposure to traumatic memories alongside cognitive-behavioral therapy (CBT) techniques to strengthen relapse prevention skills. The coping skills therapy combines CBT with case management to develop coping skills to manage trauma and substance use in a patient’s daily life. The participants were asked to attend at least one session a week but were allowed up to six months to finish therapy.

At the end of the study, participants in both treatment groups showed significant reductions in their PTSD severity (measured with the Clinician Administered PTSD Scale for DSM-5 [CAPS-5]) and total number of heavy drinking days. The prolonged exposure group did have greater CAPS-5 reductions on average, as well as a higher rate of remission for PTSD (22.2% vs. 6.8% in the coping skills group), despite attending fewer sessions on average (8.4 vs. 11.4 in the coping skills group).

“It is not clear whether some participants in the I-PE [integrated prolonged exposure] arm attended fewer sessions because they found I-PE treatment to be too difficult, if they completed treatment more quickly because they felt better, or for other reasons,” Norman and colleagues wrote. “Future research is needed to understand why participants had better PTSD outcomes with I-PE treatment even though they attended significantly fewer sessions, and who is most likely to benefit from each treatment under which conditions.”

To read more about PTSD therapy, see the Psychiatric Services article, “Factors Associated With Receipt of Cognitive-Behavioral Therapy or Prolonged Exposure Therapy Among Individuals With PTSD.

(image: iStock/vadimguzhva)


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