Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.
In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed. Other patient-level factors including age, time since injury, and baseline NBS were unrelated to significant improvements. Findings emphasized the impact of PE dosage, indicated greater mastery of the protocol was beneficial, and showed that service connection could impede self-reported, clinically significant change during PE in this important cohort.
*VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center; †Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC; ‡Mental Health and Behavioral Sciences, James A. Haley Veterans Affairs Medical Center; and §Departments of Psychiatry and Neurosciences, and Psychology, University of South Florida, Tampa, FL.
Eric Floyd
EF
Crawford
Gregory K
GK
Wolf
Tracy
T
Kretzmer
Kirsten H
KH
Dillon
Christina
C
Thors
Rodney D
RD
Vanderploeg
D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*