Background: Early studies show promising evidence for the feasibility and effectiveness of intensive Trauma-Focused Therapy (TFT) programs for patients with Posttraumatic Stress Disorder (PTSD)....Show moreBackground: Early studies show promising evidence for the feasibility and effectiveness of intensive Trauma-Focused Therapy (TFT) programs for patients with Posttraumatic Stress Disorder (PTSD). Little is known about the most effective treatment formats with regard to the therapy dose and frequency. The current study examines the effects of the High Intensive Trauma-focused Therapy (HITT) on the feasibility, tolerability, safety, and symptom outcomes. Methods: A Pragmatic Clinical Trial (PCT) was conducted with 16 treatment-resistant patients with PTSD who failed to respond sufficiently to previous treatment. The HITT treatment consisted of two five-day inpatient programs with Eye Movement Desensitization and Reprocessing, exposure, and trauma-sensitive yoga. Primary outcome was measured with the PCL-5 at the beginning and end of both HITT-weeks (T1 to T4). Clinically Significant Changes (CSC) and Reliable Change Indexes (RCI) were calculated. Results: No patients dropped out of treatment and no symptom exacerbations or adverse effects occurred. RCI and CSC from T1 to T4 showed that four patients recovered, two patients improved, and ten patients remained unchanged after treatment. The corresponding effect size on the PCL-5 between T1 and T4 was large (Cohen’s d = 0.88). Conclusions: Results demonstrated that the HITT-program was feasible, tolerable, and safe for all treatment-resistant patients and beneficial for six of these patients. Randomized controlled trials are needed to replicate these results and study the effectiveness of this treatment to further improve TFT formats. Also, future research is necessary to early select treatment-resistant patients who benefit from treatment to develop more cost- and time-effective treatments.Show less
BACKGROUND: Exposure therapy, which is based on extinction learning, is the therapy of choice for several anxiety disorders. However, the remission rate is not optimal for adults with an anxiety...Show moreBACKGROUND: Exposure therapy, which is based on extinction learning, is the therapy of choice for several anxiety disorders. However, the remission rate is not optimal for adults with an anxiety disorder, which could be due to non-response or to the return of the original fear after exposure therapy. Persons with high levels of anxiety have more difficulties constructing and consolidating extinction memories. Stimulating the vagus nerve (tVNS) is a promising method of enhancing the process of extinction learning as shown in previous animal and human studies. AIM: The aim of this study was to assess whether participants with high levels of anxiety would benefit more from the addition of tVNS measured in US expectancy ratings and skin conductance response. METHOD: This paper is a reanalysis of the data from the study of Burger et al. (2018). In this study healthy humans participated in a prepared fear learning paradigm, spider pictures were used as conditioned stimulus. After the acquisition phase participants were randomly allocated to the tVNS condition (N=42) and to the sham condition (N=43) for the extinction phase. High- and low-scoring groups were created based on the state and trait subscales of the STAI. RESULTS: There were no differences found between the high- and low-scoring groups in the effectiveness of tVNS, although the low state group in the tVNS condition showed lower US expectancy ratings for the CS- trials. CONCLUSION: This distinct study does not provide conclusive evidence to support the direction of studying tVNS in a clinical sample.Show less
