Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T10:53:20.441Z Has data issue: false hasContentIssue false

Augmenting cognitive behaviour therapy for post-traumatic stress disorder with emotion tolerance training: a randomized controlled trial

Published online by Cambridge University Press:  14 February 2013

R. A. Bryant*
Affiliation:
University of New South Wales, NSW, Australia
J. Mastrodomenico
Affiliation:
University of New South Wales, NSW, Australia
S. Hopwood
Affiliation:
University of New South Wales, NSW, Australia
L. Kenny
Affiliation:
University of New South Wales, NSW, Australia
C. Cahill
Affiliation:
University of New South Wales, NSW, Australia
E. Kandris
Affiliation:
University of New South Wales, NSW, Australia
K. Taylor
Affiliation:
University of New South Wales, NSW, Australia
*
*Address for correspondence: Professor R. A. Bryant, School of Psychology, University of New South Wales, NSW, 2052, Australia. (Email: r.bryant@unsw.edu.au)

Abstract

Background

Many patients do not adhere to or benefit from cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD). This randomized controlled trial evaluates the extent to which preparing patients with emotion regulation skills prior to CBT enhances treatment outcome.

Method

A total of 70 adult civilian patients with PTSD were randomized to 12 sessions of either supportive counselling followed by CBT (Support/CBT) or emotion regulation training followed by CBT (Skills/CBT).

Results

Skills/CBT resulted in fewer treatment drop-outs, less PTSD and anxiety, and fewer negative appraisals at 6 months follow-up than Support/CBT. Between-condition effect size was moderate for PTSD severity (0.43, 95% confidence interval −0.04 to 0.90). More Skills/CBT (31%) patients achieved high end-state functioning at follow-up than patients in Support/CBT (12%) [χ2(n = 70) = 3.67, p < 0.05].

Conclusions

This evidence suggests that response to CBT may be enhanced in PTSD patients by preparing them with emotion regulation skills. High attrition of participants during the study limits conclusions from this study.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Australian Centre for Posttraumatic Mental Health (2007). Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. ACPMH: Melbourne,Victoria.Google Scholar
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.CrossRefGoogle ScholarPubMed
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. Guilford Press: New York.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Beck Depression Inventory, 2nd edn. The Psychological Corporation: San Antonio, TX.Google Scholar
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 7590.Google ScholarPubMed
Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214227.CrossRefGoogle ScholarPubMed
Cahill, SP, Rothbaum, BO, Resick, PA, Follette, VM (2009). Cognitive-behavioral therapy for adults. In Effective Treatments for PTSD: Practice Guidelines from the International Society of Traumatic Stress Studies(ed. Foa, E. B., Keane, T. M., Freidman, M. J. and Cohen, J. A.), pp. 139222. Guilford Press: New York.Google Scholar
Chatellier, G, Zapletal, E, Lemaitre, D, Menard, J, Degoulet, P (1996). The number needed to treat: a clinically useful nomogram in its proper context. British Medical Journal 312, 426429.CrossRefGoogle Scholar
Cloitre, M, Stovall-McClough, KC, Nooner, K, Zorbas, P, Cherry, S, Jackson, CL, Gan, W, Petkova, E (2010). Treatment for PTSD related to childhood abuse: a randomized controlled trial. American Journal of Psychiatry 167, 915924.CrossRefGoogle ScholarPubMed
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Academic Press: New York.Google Scholar
Devilly, GJ, Borkovec, TD (2000). Psychometric properties of The Credibility/Expectancy Questionnaire. Jornal of Behavior Therapy and Experimental Psychiatry 31, 7386.CrossRefGoogle ScholarPubMed
Foa, EB, Ehlers, A, Clark, DM, Tolin, DF, Orsillo, SM (1999). The Posttraumatic Cognitions Inventory (PTCI): development and validation. Psychological Assessment 11, 303314.CrossRefGoogle Scholar
Foa, EB, Keane, TM, Friedman, MJ, Cohen, JA (eds.) (2009). Effective Treatments for PTSD: Practice Guidelines from the International Society of Traumatic Stress Studies. Guilford Press: New York.Google Scholar
Foa, EB, Rothbaum, BO, Riggs, DS, Murdock, TB (1991). Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology 59, 715723.CrossRefGoogle ScholarPubMed
Foa, EB, Zoellner, LA, Feeny, NC, Hembree, EA, Alvarez-Conrad, J (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology 70, 10221028.CrossRefGoogle ScholarPubMed
Hedges, LV (1982). Estimation of effect size from a series of independent experiments. Psychological Bulletin 97, 490499.CrossRefGoogle Scholar
Horowitz, MJ, Wilner, N, Alvarez, W (1979). Impact of Events Scale: a measure of subjective stress. Psychosomatic Medicine 41, 209218.CrossRefGoogle Scholar
Kendall, PC, Hollon, SD, Beck, AT, Hammen, CL, Ingram, RE (1987). Issues and recommendations regarding use of the Beck Depression Inventory. Cognitive Therapy and Research 11, 289299.CrossRefGoogle Scholar
Monson, CM, Schnurr, PP, Resick, PA, Friedman, MJ, Young-Xu, Y, Stevens, SP (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 74, 898907.CrossRefGoogle ScholarPubMed
National Institute for Clinical Excellence (2005). The Management of PTSD in Adults and Children in Primary and Secondary Care, vol. 26. Cromwell Press: Trowbridge.Google Scholar
Schnurr, PP, Friedman, MJ, Engel, CC, Foa, EB, Shea, MT, Chow, BK, Resick, PA, Thurston, V, Orsillo, SM, Haug, R, Turner, C, Bernardy, N (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women – a randomized controlled trial. Journal of the American Medical Association 297, 820830.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JB, Gibbon, M, First, MB (1995). Structured Clinical Interview for DSM-IV – Patient Version (SCID-P, Version 2.0). American Psychiatric Press: Washington, DC.Google Scholar
Trusz, SG, Wagner, AW, Russo, J, Love, J, Zatzick, DF (2011). Assessing barriers to care and readiness for cognitive behavioral therapy in early acute care PTSD interventions. Psychiatry 74, 207223.CrossRefGoogle ScholarPubMed
Weathers, FW, Keane, TM, Davidson, J (2001). Clinician-administered PTSD scale: a review of the first ten years of research. Depression and Anxiety 13, 132156.CrossRefGoogle Scholar
Supplementary material: File

Bryant Supplementary Material

Appendix

Download Bryant Supplementary Material(File)
File 25.6 KB