In the Journals

Intensive outpatient program eases veterans’ PTSD symptoms

Veterans who completed a 3-week intensive outpatient program for daily cognitive processing therapy, mindfulness, yoga and psychoeducation saw large reductions in PTSD and depression symptoms, according to study findings.

“Understanding how veterans improve over the course of intensive treatment is important for establishing the proper dose of treatment, a key question for balancing the feasibility and effectiveness of these programs,” Alyson K. Zalta, PhD, of Rush University Medical Center and the University of California Irvine, and colleagues wrote. “[Prior] findings suggest that [intensive outpatient programs] are a promising avenue for delivering evidence-based treatment to veterans and service members with PTSD. However, existing studies have only evaluated key outcomes before and after treatment and have not evaluated the patterns of symptom change over the course of treatment.”

In total, 191 veterans in 12 combat-PTSD cohorts and 7 military sexual trauma-PTSD cohorts completed a 3-week intensive outpatient program for PTSD made up of daily group and individual cognitive processing therapy, mindfulness, yoga and psychoeducation. Specifically, participants received 15 sessions of individual and 13 of group cognitive processing therapy, 13 sessions of group mindfulness and 12 sessions of yoga, and were assigned daily cognitive processing therapy homework and mindfulness practice.

To examine patterns of PTSD and depression symptom change over the course of the program, researchers collected measures of PTSD symptoms, depression symptoms and posttraumatic cognitions pre-intervention, post-intervention and nearly every other day during the program. They also assessed changes in posttraumatic cognitions as a predictor of treatment response and whether patterns or predictors of treatment outcome differed by sex and cohort type (combat vs. military sexual trauma).

Of 176 participants who completed the intervention, analyses showed large reductions in PTSD and depression symptoms. Effect sizes were medium to large for veterans in the military sexual trauma cohort, but were large to very large for those in the combat cohorts. Participants in combat cohorts saw a greater decrease in PTSD symptoms over time compared with those in military sexual trauma cohorts.

Further, analysis after treatment end revealed that 53.4% of veterans no longer met criteria for PTSD. Importantly, remission rates were significantly different based on cohort type, with 62.9% of veterans treated in combat cohorts and 35.7% of those treated in military sexual trauma cohorts no longer meeting criteria for probable PTSD at the end of treatment (P = .001).

In their intensive outpatient program, Zalta and colleagues also found that reduction in posttraumatic cognitions significantly predicted reductions in PTSD and depression symptom scores. These changes remained robust after adjustment for autocorrelation.

“This study suggests that [intensive outpatient programs] show great promise in delivering full doses of evidence-based treatment and producing rapid and clinically meaningful symptom reduction for different types of veterans including men and women as well as combat and [military sexual trauma] survivors,” the researchers wrote. “Given that large amount of subject-level variance observed, more research is needed to determine which factors impact treatment outcomes in this intensive treatment approach to help improve treatment selection and effectiveness.” – by Savannah Demko

Disclosure: Zalta reports grants from the Brain & Behavior Research Foundation and the National Institute of Mental Health. Please see the study for all other authors’ relevant financial disclosures.

Veterans who completed a 3-week intensive outpatient program for daily cognitive processing therapy, mindfulness, yoga and psychoeducation saw large reductions in PTSD and depression symptoms, according to study findings.

“Understanding how veterans improve over the course of intensive treatment is important for establishing the proper dose of treatment, a key question for balancing the feasibility and effectiveness of these programs,” Alyson K. Zalta, PhD, of Rush University Medical Center and the University of California Irvine, and colleagues wrote. “[Prior] findings suggest that [intensive outpatient programs] are a promising avenue for delivering evidence-based treatment to veterans and service members with PTSD. However, existing studies have only evaluated key outcomes before and after treatment and have not evaluated the patterns of symptom change over the course of treatment.”

In total, 191 veterans in 12 combat-PTSD cohorts and 7 military sexual trauma-PTSD cohorts completed a 3-week intensive outpatient program for PTSD made up of daily group and individual cognitive processing therapy, mindfulness, yoga and psychoeducation. Specifically, participants received 15 sessions of individual and 13 of group cognitive processing therapy, 13 sessions of group mindfulness and 12 sessions of yoga, and were assigned daily cognitive processing therapy homework and mindfulness practice.

To examine patterns of PTSD and depression symptom change over the course of the program, researchers collected measures of PTSD symptoms, depression symptoms and posttraumatic cognitions pre-intervention, post-intervention and nearly every other day during the program. They also assessed changes in posttraumatic cognitions as a predictor of treatment response and whether patterns or predictors of treatment outcome differed by sex and cohort type (combat vs. military sexual trauma).

Of 176 participants who completed the intervention, analyses showed large reductions in PTSD and depression symptoms. Effect sizes were medium to large for veterans in the military sexual trauma cohort, but were large to very large for those in the combat cohorts. Participants in combat cohorts saw a greater decrease in PTSD symptoms over time compared with those in military sexual trauma cohorts.

Further, analysis after treatment end revealed that 53.4% of veterans no longer met criteria for PTSD. Importantly, remission rates were significantly different based on cohort type, with 62.9% of veterans treated in combat cohorts and 35.7% of those treated in military sexual trauma cohorts no longer meeting criteria for probable PTSD at the end of treatment (P = .001).

In their intensive outpatient program, Zalta and colleagues also found that reduction in posttraumatic cognitions significantly predicted reductions in PTSD and depression symptom scores. These changes remained robust after adjustment for autocorrelation.

“This study suggests that [intensive outpatient programs] show great promise in delivering full doses of evidence-based treatment and producing rapid and clinically meaningful symptom reduction for different types of veterans including men and women as well as combat and [military sexual trauma] survivors,” the researchers wrote. “Given that large amount of subject-level variance observed, more research is needed to determine which factors impact treatment outcomes in this intensive treatment approach to help improve treatment selection and effectiveness.” – by Savannah Demko

Disclosure: Zalta reports grants from the Brain & Behavior Research Foundation and the National Institute of Mental Health. Please see the study for all other authors’ relevant financial disclosures.