CLINICIAN'S TRAUMA UPDATE Online
Issue 13(4), AUGUST 2019
For COMPLETE summaries, see this month's CTU-Online.
Treatment
Jury still out on Imagery Rehearsal Therapy for nightmares in PTSD
Evidence-based psychotherapies for PTSD have limited effects on sleep problems (see the August 2018 CTU-Online and February 2019 CTU-Online), suggesting the need for additional treatment approaches. In two recent studies, investigators tested imagery rehearsal therapy (IRT), a cognitive-behavioral therapy for recurrent posttraumatic nightmares, in combination with evidence-based treatments for PTSD and insomnia. Read this CTU-Online.
New evidence further supports use of CPT in Veterans with mild traumatic brain injury
Some providers may be reluctant to provide trauma-focused treatment to individuals with a history of mild traumatic brain injury (mTBI) due to concerns that cognitive deficits may interfere with treatment response. A recent study found CPT was effective for PTSD symptoms in Veterans with a history of mTBI (see the February 2019 CTU Online), but the role of injury characteristics on treatment outcome has never been explored. Read this CTU-Online.
Study examines how VA providers make PTSD treatment decisions
Most VA Medical Centers offer a variety of psychotherapies for PTSD, leaving it to the discretion of the Veteran and provider to select a treatment from the menu of available options. A new study led by investigators with the South Texas Veterans Health Care System sheds light on how VA providers approach decisions about patient-treatment matching. Read this CTU-Online.
Further evidence of efficacy of CPT delivered by videoconferencing
Telemedicine offers a solution for increasing access to care for Veterans in rural areas or those with other barriers to receiving treatment in traditional office settings. Several studies have shown CPT delivered via videoconferencing to be effective in treating PTSD (see the June 2014 and August 2015 CTU-Online). Investigators from the VA San Diego Healthcare System extended this research in a noninferiority RCT with a large sample of male and female Veterans with diverse trauma histories. Read this CTU-Online.
A new form of transcranial magnetic stimulation shows potential benefit for PTSD
Transcranial magnetic stimulation (TMS) is effective for depression and may have benefit for PTSD (see the August 2018 CTU-Online). Standard TMS protocols require 20-30 daily, nearly hour-long treatments. Investigators at the Providence VA Medical Center tested a novel form of TMS, called intermittent theta burst stimulation (iTBS), that appears to require much less time and may have unique physiological properties. Read this CTU-Online.
Exercise for older Veterans with PTSD
Exercise is associated with better psychological well-being and may have benefit for PTSD symptoms (see the December 2017 CTU-Online). Older Veterans with PTSD have a relatively high rate of physical inactivity, suggesting that an exercise-based intervention might be especially helpful for this group. Investigators at the VA Durham Healthcare System conducted a pilot study of exercise training versus treatment-as-usual in older Veterans with PTSD. Read this CTU-Online.
Assessment
Reporting military sexual trauma depends on how it is assessed
Military sexual trauma (MST) can be difficult for Veterans to disclose due to concerns about stigma and privacy. Because willingness to disclose may depend on how MST is queried, a team led by investigators at the National Center for PTSD compared three methods for assessing MST Read this CTU-Online.
Take Note
Clinical trials of PTSD treatments
The National Center for PTSD recently partnered with the Agency for Healthcare Research and Quality to create the PTSD Trials Standardized Database Repository (PTSD-Repository), a large database of PTSD clinical trials. The PTSD-Repository includes more than 70 variables extracted from 318 published randomized controlled trials of PTSD interventions. Data are freely available to researchers, clinicians, and other stakeholders.
For more information: https://www.ptsd.va.gov/
Special journal issue on PTSD
The most recent issue of Current Treatment Options in Psychiatry focuses on scientific advances in treating PTSD. Topics include brief novel therapies, adapting evidence-based psychotherapies, medication-enhanced psychotherapies, and transdiagnostic treatments.
Read the issue: https://link.springer.com/
Special journal issue on moral injury
The June issue of Journal of Traumatic Stress focuses on moral injury. Articles include an integrative review and studies of measurement of moral injury, moral injury-related cognitions, and associations between moral injury and spiritual struggles, substance use, and suicidal ideation.
Read the issue: https://onlinelibrary.wiley.
Systematic review and meta-analysis of psychological interventions for PTSD and pain
A team led by investigators at the University of Wisconsin-Madison School of Medicine conducted a systematic review and meta-analysis of studies that examined interventions for PTSD and pain symptoms. The authors concluded that most of the treatments more effectively treated PTSD than pain.
Read the article: https://doi.org/10.1097/ajp.
Network meta-analysis of treatments for PTSD
Investigators at the University of Basel in Switzerland conducted a network meta-analysis of 12 trials of psychotherapy, pharmacological, and combination treatments for PTSD. An editorial addressed the strengths and limitations of the network meta-analysis approach.
Read the article: https://doi.org/10.1001/
Read the editorial: http://www.ptsd.va.gov/
Review of RCTs testing treatments for PTSD that are delivered in primary care
A team led by investigators at the University of Washington School of Medicine reviewed studies of PTSD treatments that can be delivered in primary care settings. Findings further support the use of collaborative care to address PTSD in primary care (see the August 2016 CTU-Online).
Read the article: https://doi.org/10.1016/j.
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