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First Comparative Study of Early and Delayed CBT Interventions for PTSD

A recent and first comparative study of early and delayed cognitive behavior therapy (CBT) interventions for PTSD found that prolonged exposure (PE), cognitive therapy (CT), and delayed PE prevent chronic PTSD in recent survivors. This study published in the Archives of General Psychiatry used equipoise-stratified randomization with trauma survivors who were recruited from Hadassah Hospital in Jerusalem. Adult trauma survivors were initially screened via telephone to ensure that they met DSM-IV criteria for PTSD. Adults (516) who met criteria were randomly assigned to receive treatment in a prolonged exposure (PE) group, a cognitive therapy (CT) group, double blind comparison of treatment with escitalopram (SSRI) or placebo groups, and a control wait-list group. Of the 756 adults who did not meet DSM-IV criteria, 296 of them accepted an invitation to receive clinical assessment.

The participants were evaluated following early interventions at 5 months and assessed again at 9 months. PE and CT treatment sessions were recorded and evaluated by CT experts. The Clinician-Administered PTSD Scale (CAPS) was used to measure the presence of PTSD at 5 and 9 months following treatment. Results showed that PE, CT, and delayed PE treatments were effective in lowering the rates and symptoms of PTSD in participants. Furthermore, there was no significant difference between the presence of PTSD in participants who received PE or CT and delayed PE treatment. This suggests that delaying PTSD interventions may not pose a threat to treatment outcomes. There was also no difference in improvement between the groups who received the SSRI versus placebo pills.

Since this was the first comparative study of early and delayed PTSD interventions, the researchers recommend replication studies to test for reliability. They also propose that future research focus on more simple CBT techniques to determine how those methods play a role in preventing PTSD. Finally, the lack of improvement from pharmacological treatment with escitalopram necessitates further evaluation and replication with larger samples.

Shalev, A.Y., Ankri, Y., Israeli-Shalev, Y., Peleg, T., Adessky, R., & Freedman, S. (2011). Prevention of posttraumatic stress disorder by early treatment. Arch Gen Psychiatry.

Therapist adherence to manualized cognitive-behavioral therapy for anger management delivered to veterans with PTSD via videoconferencing

It is important that veterans with Posttraumatic Stress Disorder (PTSD) have access to evidence-based treatment (EBT). A significant number (40%) of military service members leaving active duty return to rural or remote areas where access to EBT and specialized PTSD treatment is often limited or unavailable. To overcome this obstacle, the use of video conferencing is becoming a more widespread and acceptable method of providing therapy to those living in areas with limited access to EBT.

While research indicates that cognitive behavior therapy (CBT) is an effective treatment for PTSD, there are few studies that examine outcomes of group CBT with veterans.  In the current study, Morland et al. compared therapist adherence to manualized cognitive-behavioral anger management group treatment (AMT) between therapy delivered via video conference (VC) and the traditional in-person modality. The researchers also compared the equivalency of cognitive-behavioral anger management group therapy delivered via VC and the same therapy delivered in-person.

The results of this study indicate that utilizing video conferencing did not affect therapists’ adherence to CBT anger management group therapy. This study provides support for the utility of video conferencing as a method for delivering effective therapy to veterans. It also identifies video-conferencing as a potential gateway to evidence-based CBT for veterans and service members returning to remote areas following deployment. These findings encourage future research on the effectiveness of video conferencing among different populations and EBTs.

Morland, L.A., Greene, C.J., Grubbs, K., Kloezeman, K., Mackintosh, M., Rosen, C., et al. (2011). Therapist Adherence to Manualized Cognitive-Behavioral Therapy for Anger Management Delivered to Veterans with PTSD via Videoconferencing. Journal of Clinical Psychology, 67, 629-638.

Beck Spotlight on Antonette Zeiss

At a 90th birthday party for Dr. Aaron Beck, given by Pearson Assessment at the American Psychological Association annual conference in Washington, D.C., we had the opportunity to catch up with our colleague, Dr. Antonette Zeiss, Ph.D., whom we have known for many years. We are so pleased that she, a very prominent cognitive behavior therapist, has been appointed to be Chief Consultant for the Office of Mental Health Services, in the Veterans Health Administration at the Department of Veterans Affairs (VA). Dr. Zeiss was already the highest ranking psychologist in the VA, and is now the first psychologist, and first woman, to hold the role of Chief Consultant.

In 2007, Dr. Zeiss received an American Psychological Association (APA) Presidential Citation recognizing her leadership contributions both in APA and the VA. And last year, Dr. Zeiss won a Distinguished Career Award from the Association of VA Psychologist Leaders for her continued efforts to improve mental health services.

We applaud Dr. Zeiss’s accomplishments in the field of psychology and cognitive behavior therapy, and we appreciate the efforts of the tens of thousands of health and mental health professionals who treat active duty and veteran military service members and their families. To learn more about a scholarship initiative to help train these professionals in cognitive behavior therapy please visit www.soldiersuicideprevention.org.