Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

Comparison of the effectiveness of prolonged exposure therapy and its combination with dialectical behavior therapy on the improvement of post-traumatic growth of veterans with post-traumatic stress disorder

Document Type : Original Article

Author
sanaz eyni
Assistant Professor, Department of Psychology, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
10.22075/jcp.2023.31648.2716
Abstract
Introduction: Prolonged exposure therapy is the first line of treatment for PTSD in veterans and military personnel; However, PE may not meet the preferences of many patients with PTSD. Therefore, the present study was conducted with the aim of determining the effectiveness of prolonged exposure therapy and DBT-PE combined treatment protocol on improving the post-traumatic growth of veterans with PTSD.
Method: The research method was a pre-test-post-test experiment with a control group along with a follow-up period. The statistical population of the study consisted of all veterans with PTSD who referred to Isar Psychiatric Hospital in Ardabil in 2022. The research sample included 60 veterans with PTSD who were selected as a purposeful sampling. In order to collect data, the post-traumatic growth questionnaire was used. The first experimental group received prolonged exposure therapy (10 sessions), and the second experimental group received integrated therapy for post-traumatic stress disorder (16 sessions of 90 to 120 minutes). The data were analyzed using mixed analysis of variance and Bonferroni's post hoc test.
Results: The findings of the results showed that exposure therapy and its combination with dialectical behavior therapy were effective in improving post-traumatic growth of veterans with PTSD (P<0.01); However, the effect of combined treatment was greater than other intervention (P<0.05).
Conclusion: Therefore, using these results, it is possible to suggest the use of exposure therapy methods and its combination with dialectical behavior therapy as effective methods in improving psychological symptoms related to post-traumatic stress disorder in veterans, along with medical treatments.
Keywords
veteran
post-traumatic growth
exposure therapy
dialectical behavior therapy
Subjects

  1. منابع

    1. Basharpoor S, Einy S. The effectiveness of mentalization-based therapy on emotional dysregulation and impulsivity in veterans with post-traumatic stress disorder. Shefaye Khatam. 2020; 8(3):10-9. [Persian]
    2. Sadeghi Z, Noghani F, Larigani T, Ghafarzadeh M. The relationship between daily spiritual experiences and perceived stress with self-efficacy of wives of veterans suffering post-traumatic stress disorder in Golestan province. Health, Spirituality and Medical Ethics. 2021; 8(1): 55-62.
    3. Williams C, Milanak M, Judah M, Berenbaum H. The association between PTSD and facial affect recognition. Psychiatry Research. 2018; 265: 298-302.
    4. American Psychiatric Association D-TF. Diagnostic and statistical manual of mental disorders: DSM-5™ ed. t, editor. Inc: American Psychiatric Publishing; 2013.
    5. Henkelmann J, de Best S, Deckers C, Jensen K, Shahab M, Elzinga B, et al. Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis. BJPsych Open. 2020;6(4):e68.
    6. Yuan G, Goh PH, Xu W, An Y. Perceived social support mediates the relations between parental attachment and posttraumatic growth and resilience in adolescents following the Yancheng Tornado. J Aggress Maltreat Trauma. 2018; 27(6): 631-44.
    7. Cormio C, Muzzatti B, Romito F, Mattioli V, Annunziata MA. Posttraumatic growth and cancer: a study 5 years after treatment end. Support Care Cancer. 2017;25(4):1087-96.
    8. Tedeschi R, Calhoun L. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J Trauma Stress. 2011;9:455-71.
    9. Tedeschi R, Shakespeare-Finch J, Taku K, Calhoun L. Posttraumatic growth: Theory, research, and applications ed s, editor: Routledge; 2018.
    10. Tsai J, El-Gabalawy R, Sledge W, Southwick S, Pietrzak R. Post-traumatic growth among veterans in the USA: results from the national health and resilience in veterans study. Psychol Med. 2014;45(1):165-79.
    11. Tsai J, Pietrzak R. Trajectories of posttraumatic growth among US military veterans: a 4-year nationally representative, prospective cohort study. Acta Psychiatr Scand. 2017;136(5):483-92.
    12. Greenberg J, Tsai J, Southwick S, Pietrzak R. Can military trauma promote psychological growth in combat veterans? Results from the national health and resilience in veterans study. J Affect Disord. 2021;282:732-9.
    13. Foa E, Hembree E, Rothbaum B, Rauch S. Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide eds n, editor: Oxford University Press; 2019.
    14. Foa E, Hembree E, Rothbaum B. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide. Ed, editor: Oxford: Oxford University Press; 2007.
    15. Shiner B, D’Avolio L, Nguyen T, Zayed M, Young-Xu Y, Desai R, et al. Measuring use of evidence based psychotherapy for posttraumatic stress disorder. Adm Policy Ment Health. 2013;40(4): 311-8.
    16. Huang T, Li H, Tan S, Xie S, Cheng Q, Xiang Y, et al. The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis. BMC Psychiatry. 2022; 2(1): 1-12.
    17. Rossouw J, Yadin E, Alexander D, Seedat S. Long-term follow-up of a randomised controlled trial of prolonged exposure therapy and supportive counselling for post-traumatic stress disorder in adolescents: a task-shifted intervention. Psychol Med. 2022;52(6):1022-30.
    18. Harned M, Ritschel L, Schmidt S. Effects of workshop training in the dialectical behavior therapy prolonged exposure protocol on clinician beliefs, adoption, and perceived clinical outcomes. J Trauma Stress. 2021;34(2):427-39.
    19. Landes S, Garovoy N, Burkman K. Treating complex trauma among veterans: Three Sstage-based treatment models. J Clin Psychol. 2013;69(5):523-33.
    20. Frye L, Spates C. Prolonged exposure, mindfulness, and emotion regulation for the treatment of PTSD. Clinical Case Studies. 2012;11(3):184-200.
    21. Harned MS, Linehan MM. Integrating dialectical behavior therapy and prolonged exposure to treat co-occurring borderline personality disorder and PTSD: Two case studies.. Cognitive and Behavioral Practice. 2008;15(3):263-76.
    22. Wagner A, Rizvi S, Harned M. Applications of dialectical behavior therapy to the treatment of complex trauma-related problems: When one case formulation does not fit all. J Trauma Stress. 2007;20(4):391-400.
    23. Harned M, Korslund K, Linehan M. A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy. 2014;55:7-17.
    24. Meyers L, Voller E, McCallum E, Thuras P, Shallcross S, Ve- lasquez T, et al. Treating veterans with PTSD and border- line personality symptoms in a 12-week intensive outpatient setting: Findings from a pilot program. J Trauma Stress. 2017;30(2):178-81.
    25. Esmaiel M, Abdelhamied M. Impact of dialectical behavior therapy prolonged exposure protocol on trauma-related symptoms in Egyptian women with borderline personality disorder. Eur Psychiatry. 2022;65(S1):S746.
    26. Mehlum L, Ramleth R, Tørmoen A, Haga E, Diep L, Stanley B, et al. Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self‐harming and suicidal behavior. J Child Psychol Psychiatry. 2019;60(10):1112-22.
    27. Bourassa K, Smolenski D, EdwardsStewart A, Campbell S, Reger G, Norr A. The impact of prolonged exposure therapy on social support and PTSD symptoms. Journal Affect Disord. 2020;260:410-7.
    28. Back S, Acierno R, Saraiya T, Harley B, Wangelin B, Jarnecke A, et al. Enhancing prolonged exposure therapy for PTSD using physiological biomarker-driven technology. Contemporary Clinical Trials Communications. 2022; 28:100940.
    29. Delavar A. Research methods in psychology and educational sciences. Tehran: Virayesh Publishing; 2017. [Persian]
    30. First M, Williams J, Karg R, Spitzer R. Structured Clinical Interview for DSM-5® Disorders—Clinician Version (SCID-5-CV): American Psychiatric Association; 2016.
    31. Sharifi V, Asadi S, Mohammadi M, Amini H, Kaviani H, Semnani Y, et al. Reliability and Feasibility of The Persian Version of The Structured Diagnostic Interview for DSM-IV (SCID). Advances in Cognitive Sciences. 2004;6(1and 2):10-22. [Persian]
    32. Tedeschi R, Calhoun L. The post traumatic growth inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996(3):455-71.
    33. Hoseinlu A, Namvar H. Validity & Reliability of Post-Traumatic Growth Questionnaire in veterans by Post-Traumatic Stress Disorder in the City of Saveh. J Psychometry. 2020;9(33):63-77. [Persian]
    34. Bisson J, Berliner L, Cloitre M, Forbes D, Jensen T, Lewis C, et al. The international society for traumatic stress studies new guidelines for the prevention and treatment of PTSD: Methodology and development process. Journal of Traumatic Stress. 2019;32(4):475-83.
    35. DeCou C, Comtois K, Landes SJ. Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behav Ther. 2019;50(1):60-72.
    36. Mørkved N, Hartmann K, Aarsheim L, Holen D, Milde A, Bomyea J, et al. A comparison of narrative exposure therapy and prolonged exposure therapy for PTSD. Clin Psychol Rev. 2014;34(6):453-67.
    37. Peterson A, Foa E, Resick P, Hoyt T, Straud C, Moore B, et al. A nonrandomized trial of prolonged exposure and cognitive processing therapy for combat-related posttraumatic stress disorder in a deployed setting. Behav Ther. 2020;51(6):882-94.
    38. Watkins L, Sprang K, Rothbaum B. Treating PTSD: A review of evidence-based psychotherapy interventions. Front Behav Neurosci. 2018;12:258.
    39. Hundt N, Mott J, Miles S, Arney J, Culley J, Stanley M. Veterans’ perspectives on initiating evidencebased psychotherapy for posttraumatic stress disorder. Psychol Trauma. 2015;7(6):539-46.
    40. Harned M, Schmidt S. Perspectives on a stage-based treatment for posttraumatic stress disorder among dialectical behavior therapy consumers in public mental health settings. Community Ment Health J. 2019;55(3):409-19.
    41. Choi-Kain L, Wilks C, Ilagan G, Iliakis E. Dialectical behavior therapy for early life trauma. Current Treatment Options in Psychiatry. 2021;8111-24.

  • Receive Date 31 August 2023
  • Revise Date 28 October 2023
  • Accept Date 27 November 2023
  • First Publish Date 31 December 2023
  • Publish Date 12 March 2024