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Both Massed and Intensive Outpatient Therapy Effective Against PTSD
Both massed and intensive outpatient forms of prolonged exposure (PE) therapy were found to be effective in treating combat-related post-traumatic stress disorder (PTSD), according to a randomized clinical trial published in JAMA Network Open.
“Given the previously identified limitations of PE for military-related PTSD, the results of this study provide important new evidence that combat-related PTSD can be effectively treated,” lead author Alan L. Peterson, PhD, department of psychiatry and behavioral sciences, University of Texas Health Science Center at San Antonio, and co-authors noted in the study. “The compressed treatment formats evaluated in this study also provide a potential for new alternative modes of therapy using combined treatments, medications, and devices.”
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From 2017 to 2019, researchers conducted the study among military personnel and veterans across 4 sites in Texas and analyzed data from November 2020 to October 2022. Researchers focused on the effect of massed-PE therapy versus intensive outpatient therapy. The massed-PE consisted of 15 90-minute therapy sessions over 3 weeks, and the intensive outpatient program PE (IOP-PE) was 15 full-day therapy sessions over 3 weeks. To measure success of therapy programs, the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (CAPS-5) and the PTSD Checklist for DSM-5 were administered to patients at baseline and at posttreatment follow-ups.
Though 319 military personnel and veterans were screened, 234 were randomized into either IOP-PE or massed-PE, with 117 patients in each. Mean patient age was 39.2 years and 78% of the group was male. CAPS-5 and PCL-5 scores decreased in both groups at the 1-month follow-up. The CAPS-5 mean difference for the IOP-PE group was −13.85 [95% CI, −16.47 to −11.23]; P < .001, while the massed-PE group’s mean difference was −14.13 [95% CI, −16.63 to −11.62]; P < .001. Lowered PCL-5 scores were maintained at 6 months.
From 1- to 6-month follow-ups, PTSD symptoms increased in the massed-PE group (mean difference, 3.21 [95% CI, 0.65 to 5.77]; P = .01) while IOP-PE patients’ scores continued to improve (mean difference, 1.23 [95% CI, −3.72 to 1.27]; P = .33). Patients in both groups showed notable diagnostic PTSD remission at 6 months (IOP-PE: 53% [95% CI, 40% to 66%] of participants; massed-PE: 52% [95% CI, 38% to 66%] of participants) and showed change on the CAPS-5 (61% [95% CI, 52% to 69%] of participants) and the PCL-5 (74% [95% CI, 66% to 81%] of participants) at the 1-month follow-up.
“These findings provide strong support that combat-related PTSD can be effectively treated. Significant posttreatment reductions in clinician-rated and self-reported PTSD symptoms were seen across both therapies, and these changes were statistically significant and clinically meaningful,” authors concluded. “Effective treatments are needed to mitigate the long-term negative consequences of PTSD in military service members, veterans, and civilians, including psychological casualties from the war in Ukraine.”
