recent advances in psychological treatments for ptsd
TRANSCRIPT
![Page 1: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/1.jpg)
Terence M. Keane, Ph.D. - Professor & Vice Chairman of Psychiatry; Assistant Dean for Research, | VA Boston Healthcare System; Boston University School of Medicine
Hogan Conference CenterCollege of the Holy Cross, Worcester, MA
September 15, 2016
Recent Advances in Psychological Treatments for PTSD
![Page 2: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/2.jpg)
COMMONWEALTH OF MASSACHUSETTSPublic Employee Retirement Administration CommissionFive Middlesex Avenue, Suite 304 | Somerville, MA 02145Phone: 617-666-4446 | Fax: 617-628-4002TTY: 617-591-8917 | Web: www.mass.gov/perac
![Page 3: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/3.jpg)
PERAC EMERGING ISSUES FORUM 2016 | 1
RECENT ADVANCES IN PSYCHOLOGICAL
TREATMENTS FOR PTSD
1
TERENCE M. KEANE, PH.D. VA Boston Healthcare System
Professor & Vice Chairman of Psychiatry Assistant Dean for Research
Boston University School of Medicine
![Page 4: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/4.jpg)
NOTES:
2 | PERAC EMERGING ISSUES FORUM 2016
Developing and Validating Treatments
3
A NEW GENERATION OF VETERANS
2
![Page 5: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/5.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 3
Psychosocial Exposure therapy
Cognitive Processing Tx Present Centered Tx
EMDR Anxiety Mgmt. Skills
PTSD Treatment OpEons (Foa, Keane, Friedman, & Cohen 2008)
Pharmacological
SSRIs
5
4
![Page 6: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/6.jpg)
NOTES:
4 | PERAC EMERGING ISSUES FORUM 2016
7
Common elements of PTSD Treatment?
• Disclosure of the elements of the experience. • Direct therapeuEc exposure to events.
– Countering avoidance strategies. • EducaEon about trauma & PTSD. • CogniEve restructuring on key distorEons. • Skills for Anxiety Management. Keane (2008;2010)
6
![Page 7: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/7.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 5
CBT Treatment of PTSD
§ Vietnam Veterans With PTSD § Prolonged Exposure v. Anxiety Management v. Wait List Control
§ 6-‐Month Follow-‐up
Keane, Fairbank, Caddell, & Zimering (1989)
9
First RCT for War Veterans with Chronic PTSD
8
![Page 8: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/8.jpg)
NOTES:
6 | PERAC EMERGING ISSUES FORUM 2016
More than fi?y internaBonal clinical trials before 2001. There’s more than another fi?y since that Bme.
11
PTSD Symptom Checklist Scores in Vietnam Combat Veterans
0
10
20
30
40
50
60
Exposure Therapy Wait List Control
Scor
e
Conditions
Pre Post Follow-up
10
![Page 9: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/9.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 7
Research Showing PTSD Treatment Works in Civilians (Resick et al., 2002)
12
Prolonged Exposure and Present-‐Centered Therapy in Veteran and AcEve Duty Women (Schnurr et al., 2007)
40
50
60
70
80
PTSD Severity (CAPS)
Prolonged Exposure
Present-Centered Therapy
Overall d = .27*
One of the largest psychotherapy trials, with 277 women Efficacy
– Prolonged Exposure was more effecEve than Present-‐Centered Therapy for reducing PTSD symptoms, as well as depression and anxiety, and improving quality of life
Feasibility – Implemented at 9 VA Medical Centers, 2 Vet Centers, 1 military hospital
– High therapy quality – High paEent saEsfacEon
13
![Page 10: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/10.jpg)
NOTES:
8 | PERAC EMERGING ISSUES FORUM 2016
Helping Veterans and Their Significant Others
• Couples therapy helps with PTSD (Monson et al., 2012) – Benefits from a 15-‐session therapy program for couples with one partner who has PTSD
– Couples receiving Tx showed significantly greater improvements in PTSD & relaEonship saEsfacEon.
– Couples therapy boosted PTSD outcomes, and helped a partner experiencing the burdens of caregiving and emoEonal distress
15
First study of CogniEve Processing Therapy with Veterans (Monson et al., 2006)
• CPT led to significantly greater improvements in PTSD, depression, and social adjustment compared to a wait-‐list control group.
• Veterans with PTSD-‐related disability improved just as much as Veterans without PTSD-‐related disability.
14
![Page 11: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/11.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 9
Overview of the Consortium to Alleviate PTSD (CAP)
Alan Peterson, PhD, PI; Terence M. Keane, Ph.D. CO-PI 17
Future IniEaEves: The ConsorEum to Alleviate PTSD (CAP)
• IntegraEon of VA and DoD Resources
• Aims: IdenEfy factors that influence PTSD onset and progression, examine biomarkers to help diagnose PTSD and track the effects of therapy, and develop novel treatments
16
![Page 12: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/12.jpg)
NOTES:
10 | PERAC EMERGING ISSUES FORUM 2016
BLASTS produce SIMULTANEOUS physical and psychological trauma
19
• Signature Wounds of OEF-‐OIF…..
18
![Page 13: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/13.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 11
PTSD N=232 68.2% 2.9% 16.5%
42.1% 6.8%
5.3%
10.3%
12.6%
TBI N=227 66.8%
Chronic Pain
N=277 81.5%
Prevalence of Chronic Pain, PTSD and TBI in a Sample of 340 OEF/OIF Veterans
21
OEF/OIF: Pain, TBI, PTSD
Photo by Lynsey Addario, Corbis © 2005 NY Times
Photo by Airman 1st Class Nathan Doza, USAF
20
![Page 14: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/14.jpg)
NOTES:
12 | PERAC EMERGING ISSUES FORUM 2016
Making Treatments More Efficient and Effective
23
Collaborations
• Chronic Effects of Neurotrauma Consortium (CENC) – Consortium Director: Dr David Cifu, Virginia
Commonwealth University • Military Suicide Research Consortium
– Co-Consortium Directors: Thomas Joiner, Florida State University and Peter Gutierrez, Denver VA MIRECC
• Army Study to Assess Risk and Resilience in Servicemembers (STARRS) – Robert Ursano (USUHS) & Murray Stein (UCSD)
22
![Page 15: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/15.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 13
Testing the Use of Technology for Greater Treatment Access
and Engagement
25
Ongoing Work to Improve Care
– Group CBT for Chronic PTSD: A Randomized Clinical Trial (Sloan)
– Variable Length CPT for Combat-‐Related PTSD (Resick & Wachen)
– PromoEng access to and engagement in evidence-‐based treatment (Sayer)
– CSP #591: ComparaEve EffecEveness Research in Veterans with PTSD (Schnurr)
– Treatment of post-‐traumaEc headaches (Penzien) – EvaluaEon of couple’s therapy: Strength at Home (Tah)
24
![Page 16: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/16.jpg)
NOTES:
14 | PERAC EMERGING ISSUES FORUM 2016
Web-‐Based IntervenEon for Returning Veterans With Risky Alcohol Use & PTSD Symptoms:
Support: NIAAA & VA NaLonal Center for PTSD
27
Telemental Health
• A pilot study of PE for PTSD delivered via telehealth technology (Tuerk et al., 2010) – Veterans who received PE via telehealth at their local VA CBOC experienced large reducEons in PTSD and depression; improvements were similar to those experienced by Veterans who received the treatment in-‐person at VA Medical Center
• Group CPT delivered to veterans via telehealth (Morland et al., 2011) – Results support the feasibility and safety of using video-‐teleconferencing; Both groups showed clinically meaningful reducEons in PTSD symptoms.
26
![Page 17: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/17.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 15
29
28
![Page 18: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/18.jpg)
NOTES:
16 | PERAC EMERGING ISSUES FORUM 2016
Web-‐based IntervenEons: VetChange (Brief, Keane, et al., 2013)
• A self-‐management Web IntervenEon using evidence-‐based strategies for OEF-‐OIF Veterans engaging in high risk drinking
• Study Design: – Two Groups: IniEal IntervenEon Group (IIG) & Delayed IntervenEon Group (DIG)
• Assessments at baseline, post-‐intervenEon, 3 months (DIG completed second baseline assessment)
31
Sample Facebook Ads • Seen by at least 317,000 users likely to be returning veterans, over 43 recruiEng days.
30
![Page 19: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/19.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 17
PTSD Symptom Changes
33
35
37
39
41
43
45
Time 1 Time 2
PCL5 Total Scores *
IIG
DIG
* p < .001
33
Drinking and Alcohol-‐Related Outcomes
* p < .001
* *
*
32
![Page 20: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/20.jpg)
NOTES:
18 | PERAC EMERGING ISSUES FORUM 2016
p<.001
p<.001 p<.001
p<.001
Outcomes Aher 2-‐weeks for ParEcipants with Subclinical or Probable PTSD
35
Mobile Phone ApplicaEons: PTSD Coach A mobile phone applicaEon for people with
PTSD and those interested in learning more about PTSD
This applicaEon provides: • EducaEon about PTSD • A self-‐assessment / monitoring tool • Portable skills to address acute symptoms • Direct connecEons to crisis support • InformaEon about treatment aimed at
guiding those who could benefit into care
Stand-‐alone educaEon and symptom management tool, or augmentaEon of face-‐to-‐face care
Easily accessible tools, when they are needed
34
![Page 21: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/21.jpg)
NOTES:
PERAC EMERGING ISSUES FORUM 2016 | 19
Summary Points:
• Stress Exposure & Rates of PTSD in is High in USA • PTSD is a Treatable CondiEon. • Psychological & Pharmacological Treatments are available. • CreaEve Delivery of Treatments is Needed • Develop IntegraEve Treatments for MulEply Injured PaEents. • Barriers to Care Need to be Addressed • Response Needed at Individual, Family, and Community Levels.
36
![Page 22: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/22.jpg)
NOTES:
20 | PERAC EMERGING ISSUES FORUM 2016
![Page 23: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/23.jpg)
PERAC EMERGING ISSUES FORUM 2016 | 21
![Page 24: Recent Advances in Psychological Treatments for PTSD](https://reader030.vdocuments.site/reader030/viewer/2022012701/61a3c0c6b4edd43cbd3e3b84/html5/thumbnails/24.jpg)
COMMONWEALTH OF MASSACHUSETTSPublic Employee Retirement Administration CommissionFive Middlesex Avenue, Suite 304 | Somerville, MA 02145
Phone: 617-666-4446 | Fax: 617-628-4002TTY: 617-591-8917 | Web: www.mass.gov/perac