title: Habituation of distress and craving during treatment as predictors of change in PTSD symptoms and substance use severity.
abstract: OBJECTIVE
  Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54).
  
  
  METHODS
  Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session.
  
  
  RESULTS
  Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome.
  
  
  CONCLUSIONS
  Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders. (PsycINFO Database Record
authors.affiliation: Department of Psychology, University of Kentucky.
authors.forename: Christal L
authors.initials: CL
authors.lastname: Badour
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
authors.forename: Julianne C
authors.initials: JC
authors.lastname: Flanagan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Gros
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
authors.forename: Therese
authors.initials: T
authors.lastname: Killeen
authors.affiliation: Department of Psychology, University of Oviedo.
authors.forename: Irene
authors.initials: I
authors.lastname: Pericot-Valverde
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital.
authors.forename: Kristina J
authors.initials: KJ
authors.lastname: Korte
authors.affiliation: Department of Psychology, Ohio University.
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Allan
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina.
authors.forename: Sudie E
authors.initials: SE
authors.lastname: Back
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods; D066249:Craving / Q000502:physiology*; D005260:Female; D006185:Habituation, Psychophysiologic; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D057566:Self Report; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data