The enhancing effects of testosterone in exposure treatment for social anxiety disorder: a randomized proof-of-concept trial

Individuals with a social anxiety disorder (SAD) show hypofunctioning of the hypothalamus-pituitary-gonadal (HPG) axis, which is linked to social fear and avoidance behavior. As testosterone administration has been shown to facilitate social-approach behavior in this population, it may enhance the effectiveness of exposure treatment. In this proof-of-concept study, we performed a randomized clinical assay in which 55 women diagnosed with SAD received two exposure therapy sessions. Session 1 was supplemented with either testosterone (0.50 mg) or placebo. Next, transfer effects of testosterone augmentation on within-session subjective fear responses and SAD symptom severity were assessed during a second, unenhanced exposure session (session 2) and at a 1-month follow-up, respectively. The participants having received testosterone showed a more reactive fear pattern, with higher peaks and steeper reductions in fear levels in session 2. Post-hoc exploration of moderating effects of endogenous testosterone levels, revealed that this pattern was specific for women with high basal testosterone, both in the augmented and in the transfer session. In contrast, the participants with low endogenous testosterone showed reduced peak fear levels throughout session 1, again with transfer to the unenhanced session. Testosterone did not significantly affect self-reported anxiety. The effects of testosterone supplementation on fear levels show transfer to non-enhanced exposure, with effects being modulated by endogenous testosterone. These first preliminary results indicate that testosterone may act on important fear mechanisms during exposure, providing the empirical groundwork for further exploration of multi-session testosterone-enhanced exposure treatment for SAD.Stress and Psychopatholog

Does complex PTSD predict or moderate treatment outcomes of three variants of exposure therapy?

Background: One reason for the inclusion of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th revision of the International Classification of Diseases (ICD-11) was its suspected relevance for treatment indications. We investigated whether CPTSD predicted and moderated treatment outcomes of Prolonged Exposure (PE), intensified PE (iPE) and Skills Training in Affective and Interpersonal Regulation followed by PE (STAIR + PE). We expected that CPTSD would predict worse treatment outcomes across treatments. Secondly, we expected that CPTSD would lead to better treatment effect in STAIR + PE compared to PE and iPE.Methods: We analyzed 149 patients with childhood-abuse related PTSD from a randomized clinical trial. CPTSD diagnosis and symptom severity were measured with the International Trauma Questionnaire. The main outcome was change in clinician-assessed PTSD symptoms. Assessments took place at baseline, week 4, week 8, week 16 (post-treatment) and at a 6-and 12-month follow-up. Analyses were based on an intention-to-treat sample using mixed effect models.Results: More than half (54 %) of the patients met criteria for CPTSD at baseline. CPTSD was related to more severe PTSD symptoms and higher comorbidity at baseline. CPTSD neither predicted nor moderated treatment outcome. Limitations: Inclusion was limited to patients with PTSD related to childhood abuse. Replication is needed in different samples.Conclusions: CPTSD is associated with more severe PTSD and with higher comorbidity. CPTSD did not predict treatment outcome and did not indicate differential treatment outcome of STAIR + PE compared to PE and iPE.Stress-related psychiatric disorders across the life spa

Temporal relationship between change in subjective distress and PTSD symptom decrease during prolonged exposure therapy for Posttraumatic Stress Disorder

Stress and Psychopatholog

Effect of prolonged exposure, intensified prolonged exposure and STAIR+prolonged exposure in patients with PTSD related to childhood abuse: a randomized controlled trial

Stress and Psychopatholog

Optimizing the efficacy of exposure in PTSD treatment

Contains fulltext : 140446.pdf (publisher's version ) (Open Access)2 p

Behandeling van patiënten met een posttraumatische stressstoornis

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D-cycloserine en exposure in de behandeling van posttraumatische stressstoornis

Item does not contain fulltextOriginele artikel: de Kleine, R.A., G.-J. Hendriks, W.J.C. Kusters, T.G. Broekman, and A. van Minnen, A randomized placebo-controlled trial of d-Cycloserine to enhance exposure therapy for posttraumatic stress disorder. Biological Psychiatry, 2012. 71(11): p. 962-968. Exposuretherapie is een bewezen effectieve behandeling voor posttraumatische stressstoornis (PTSS). Desalniettemin is er ruimte voor verbetering, aangezien niet elke patiënt van de behandeling profiteert en er sprake is van hoge drop-outcijfers. Onderzoek bij andere angststoornissen heeft aangetoond dat de toevoeging van het leerversterkende middel d-cycloserine (DCS) de effectiviteit van exposuretherapie kan vergroten. In ons onderzoek naar de combinatie van exposuretherapie en DCS bij 67 PTSS patiënten vonden wij enkel voor een subgroep van patiënten een toegevoegde waarde van DCS. In de subgroep patiënten met ernstige klachten die alle behandelsessies nodig hadden, knapten patiënten die DCS kregen meer op dan patiënten die placebo kregen. Hoewel de combinatie van exposuretherapie met een leerversterkend middel veelbelovend lijkt, moet er nog verder onderzoek naar worden gedaan voordat de GZ-psycholoog deze combinatie in zijn of haar behandelpraktijk kan toepassen.3 p

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

Contains fulltext : 185908.pdf (publisher's version ) (Open Access)Background: Suboptimal response and high dropout rates leave room for improvement of trauma-focused treatment (TFT) effectiveness in ameliorating posttraumatic stress disorder (PTSD) symptoms. Objective: To explore the effectiveness and safety of intensive prolonged exposure (iPE) targeting chronic PTSD patients with a likely diagnosis of ICD-11 Complex PTSD following multiple interpersonal trauma and a history of multiple treatment attempts. Method: Participants (N = 73) received iPE in 12 x 90-minute sessions over four days (intensive phase) followed by four weekly 90-minute booster prolonged exposure (PE) sessions (booster phase). The primary outcomes, clinician-rated severity of PTSD symptoms, and diagnostic status (Clinician-Administered PTSD Scale; CAPS-IV) were assessed at baseline, post-treatment, and at three and six months. Treatment response trajectories were identified and predictors of these trajectories explored. Results: Mixed model repeated measures analysis of CAPS-IV scores showed a baseline-to-posttreatment decrease in PTSD symptom severity (p 1.2); 71% of the participants responded. None of the participants dropped out during the intensive phase and only 5% during the booster phase. Adverse events were extremely low and only a minority showed symptom exacerbation. Cluster analysis demonstrated four treatment response trajectories: Fast responders (13%), Slow responders (26%), Partial responders (32%), and Non-responders (29%). Living condition and between-session fear habituation were found to predict outcome. Participants living alone were more likely to belong to the Partial responders than to the Non-responders cluster, and participants showing more between-session fear habituation were more likely to belong to the Fast responders than to the Non-responders cluster. Conclusions: The results of this open study suggest that iPE can be effective in PTSD patients with multiple interpersonal trauma and after multiple previous treatment attempts. In addition, in this chronic PTSD population iPE was safe.14 p