title: Symptom exacerbations in trauma-focused treatments: Associations with treatment outcome and non-completion.
abstract: Trauma-focused treatments are underutilized, partially due to clinician concerns that they will cause symptom exacerbation or dropout. We examined a sample of women undergoing Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and a version of CPT (CPT-C) without a written trauma narrative to investigate the possibility of symptom exacerbation. Participants (n = 192) were drawn from two RCT's. Participants were administered self-report measures of PTSD symptoms (i.e., the PTSD Symptom Scale or Posttraumatic Diagnostic Scale [PSS/PDS]) and the Clinician-Administered PTSD Scale. Exacerbations were defined as increases greater than 6.15 points on the PSS/PDS. A minority of participants experienced PTSD exacerbations during treatment, and there were no significant differences across treatment type (28.6% in CPT, 20.0% in PE, and 14.7% in CPT-C). Neither diagnostic nor trauma-related factors at pre-treatment predicted symptom exacerbations. Those who experienced exacerbations had higher post-treatment PSS/PDS scores and were more likely to retain a PTSD diagnosis (both small but statistically significant effects). However, even those who experienced an exacerbation experienced clinically significant improvement by end of treatment. Further, symptom exacerbations were not related to treatment non-completion. These results indicate that trauma-focused treatments are safe and effective, even for the minority of individuals who experience temporary symptom increases.
authors.affiliation: Psychology Service, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA; Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, USA. Electronic address: selarsen@mcw.edu.
authors.forename: Sadie E
authors.initials: SE
authors.lastname: Larsen
authors.affiliation: National Center for PTSD, VA Palo Alto Healthcare System and Stanford University, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, USA; Department of Psychiatry, Boston University School of Medicine, USA.
authors.forename: Brian N
authors.initials: BN
authors.lastname: Smith
authors.affiliation: Duke University, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Resick
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000628:therapy*; D000067251:Symptom Flare Up; D016896:Treatment Outcome
keywords: Cognitive behavioral therapy; Cognitive processing therapy; Posttraumatic stress disorder; Prolonged exposure; Symptom exacerbations