Does prolonged exposure increase suicide risk? Results from an active duty military sample.

The efficacy of prolonged exposure (PE) on suicide ideation (SI) as a secondary outcome among individuals with posttraumatic stress disorder (PTSD) is unclear. The purpose of this study was to compare the efficacy of PE in two formats (spaced, S-PE, 10 sessions over 8 weeks, and massed, M-PE, 10 sessions over 2 weeks) to Present Centered Therapy (PCT) and minimal contact control (MCC) on SI exacerbation among patients without suicide intent or plans. Active duty military personnel (n = 335) were randomized to: (1) S-PE vs. PCT and (2) M-PE vs. MCC. All participants completed the Beck Scale for Suicide Ideation and the Beck Depression Inventory (Suicide item) at baseline, posttreatment, and follow-ups. S-PE and PCT had significant and comparable reductions in SI during treatment. M-PE had significantly steeper reductions in SI during treatment compared to MCC. Specifically, more participants in M-PE compared to MCC had reliable improvement versus reliable exacerbation. Reduction in PTSD symptoms was significantly associated with reduction of SI. PE was associated with significant reductions in SI over time that were comparable to PCT and superior to MCC. These findings suggest that both trauma- and non-trauma-focused treatments are associated with reductions in SI, and that trauma-focused treatments improve SI relative to waitlist.

Brown LA ，McLean CP ，Zang Y ，Zandberg L ，Mintz J ，Yarvis JS ，Litz BT ，Peterson AL ，Bryan CJ ，Fina B ，Petersen J ，Dondanville KA ，Roache JD ，Young-McCaughan S ，Foa EB ，STRONG STAR consortium ... -  《-》

Effect of Prolonged Exposure Therapy Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD Symptom Severity in Military Personnel: A Randomized Clinical Trial.

Foa EB ，McLean CP ，Zang Y ，Rosenfield D ，Yadin E ，Yarvis JS ，Mintz J ，Young-McCaughan S ，Borah EV ，Dondanville KA ，Fina BA ，Hall-Clark BN ，Lichner T ，Litz BT ，Roache J ，Wright EC ，Peterson AL ，STRONG STAR Consortium ... -  《-》

The pattern of symptom change during prolonged exposure therapy and present-centered therapy for PTSD in active duty military personnel.

Brown LA ，Clapp JD ，Kemp JJ ，Yarvis JS ，Dondanville KA ，Litz BT ，Mintz J ，Roache JD ，Young-McCaughan S ，Peterson AL ，Foa EB ，STRONG STAR Consortium ... -  《-》

Guilt in the Treatment of Posttraumatic Stress Disorder Among Active Duty Military Personnel.

The current study examined the role of trauma-related guilt on posttraumatic stress disorder (PTSD) symptom change during prolonged exposure therapy (PE) as well as the efficacy of PE in reducing three dimensions of guilt (responsibility, wrongdoing, and lack of justification) during treatment. Participants were 331 active duty U.S. military personnel seeking treatment for PTSD who were randomized to one of four groups: massed PE (10 sessions delivered over 2 weeks), spaced PE (10 sessions delivered over 8 weeks), present-centered therapy (PCT; 10 sessions delivered over 8 weeks), or minimal contact control (MCC; weekly therapist phone check-in for 4 weeks). The results showed that baseline guilt did not predict reductions in PTSD symptoms for spaced PE or for PCT, ps = .178-.387, ds = -0.02-0.07. Treatment condition (massed PE vs. MCC; spaced PE vs. PCT) did not moderate reductions in guilt for spaced PE versus PCT. Guilt decreased significantly over treatment in all groups, p < .001 to p = .038, ds = -0.19 to -0.42, except concerning justification in the spaced PE and PCT groups, p = .140, d = -0.10. The findings suggest that guilt may be reduced significantly following active PTSD treatment and attention control and that PTSD recovery is not impacted by baseline levels of trauma-related guilt in military personnel with PTSD, although reported levels of guilt were low to moderate in this sample.

McLean CP ，Zandberg L ，Brown L ，Zang Y ，Benhamou K ，Dondanville KA ，Yarvis JS ，Litz BT ，Mintz J ，Young-McCaughan S ，Peterson AL ，Foa EB ，STRONG STAR Consortium ... -  《-》

Mediation of suicide ideation in prolonged exposure therapy for posttraumatic stress disorder.

Evidence-based treatments for posttraumatic stress disorder (PTSD) are associated with reduction in suicidal ideation (SI), yet the mechanisms underlying this reduction are unclear. The current study investigated improvements in PTSD, depression, and social support as potential mediators of the change in SI over time. Participants (N = 200) were active duty military personnel with PTSD randomized to prolonged exposure therapy (PE) or present-centered therapy (PCT). Using parallel mediation and serial mediation models, we examined the relative influence of the mediators on suicidal ideation over time. Consistent with our hypotheses, lagged mediation analyses revealed that depression was the strongest mediator of improvements in SI over time in PE and PCT. Reductions in PTSD were associated with subsequent reductions in depression, which was associated with reductions in SI. Treatment condition did not moderate this relationship, and social support was not a significant mediator. In active duty military personnel, reduction in depression was the strongest mediator of reduction in suicidal ideation in PE and PCT for PTSD. These results were not altered by treatment condition. Clinicaltrials. gov identifier: NCT01049516. http://www.clinicaltrials.gov/show/NCT01049516.

Brown LA ，Zang Y ，Benhamou K ，Taylor DJ ，Bryan CJ ，Yarvis JS ，Dondanville KA ，Litz BT ，Mintz J ，Roache JD ，Pruiksma KE ，Fina BA ，Young-McCaughan S ，Peterson AL ，Foa EB ，STRONG STAR Consortium ... -  《-》