Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?
Identifieur interne : 001158 ( Main/Corpus ); précédent : 001157; suivant : 001159Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?
Auteurs : Craig S. Rosen ; Mark A. Greenbaum ; Paula P. Schnurr ; Tyson H. Holmes ; Penny L. Brennan ; Matthew J. FriedmanSource :
- The Journal of clinical psychiatry [ 1555-2101 ] ; 2013.
English descriptors
- KwdEn :
- Adult (MeSH), Benzodiazepines (administration & dosage), Benzodiazepines (adverse effects), Combined Modality Therapy (MeSH), Diagnostic and Statistical Manual of Mental Disorders (MeSH), Drug Monitoring (methods), Female (MeSH), Humans (MeSH), Hypnotics and Sedatives (administration & dosage), Hypnotics and Sedatives (adverse effects), Middle Aged (MeSH), Military Personnel (psychology), Military Personnel (statistics & numerical data), Psychiatric Status Rating Scales (MeSH), Psychotherapy (methods), Stress Disorders, Post-Traumatic (psychology), Stress Disorders, Post-Traumatic (therapy), Treatment Outcome (MeSH), United States (MeSH), Veterans (psychology), Veterans (statistics & numerical data).
- MESH :
- chemical , administration & dosage : Benzodiazepines, Hypnotics and Sedatives.
- chemical , adverse effects : Benzodiazepines, Hypnotics and Sedatives.
- geographic : United States.
- methods : Drug Monitoring, Psychotherapy.
- psychology : Military Personnel, Stress Disorders, Post-Traumatic, Veterans.
- statistics & numerical data : Military Personnel, Veterans.
- therapy : Stress Disorders, Post-Traumatic.
- Adult, Combined Modality Therapy, Diagnostic and Statistical Manual of Mental Disorders, Female, Humans, Middle Aged, Psychiatric Status Rating Scales, Treatment Outcome.
Abstract
OBJECTIVE
Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy.
METHOD
Between August 2002 and October 2005, 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were randomly assigned to 10 weekly 90-minute sessions of either prolonged exposure (n = 140) or present-centered psychotherapy (n = 143). Benzodiazepine use (n = 57) or non-use (n = 226) at intake was not randomly assigned. Multilevel modeling was used to assess the effects of benzodiazepine status, psychotherapy condition, and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods.
RESULTS
Consistent with prior reports from these data, prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy (b = -0.48, P = .02). Patients prescribed benzodiazepines did not have weaker response to prolonged exposure, but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy (b = -0.78, P < .001).
CONCLUSIONS
Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines can benefit from it. It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients' poorer maintenance of gains in present-centered psychotherapy.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT00032617.
DOI: 10.4088/JCP.13m08592
PubMed: 24434093
Links to Exploration step
pubmed:24434093Le document en format XML
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Holmes</name></author><author><name sortKey="Brennan, Penny L" sort="Brennan, Penny L" uniqKey="Brennan P" first="Penny L" last="Brennan">Penny L. Brennan</name></author><author><name sortKey="Friedman, Matthew J" sort="Friedman, Matthew J" uniqKey="Friedman M" first="Matthew J" last="Friedman">Matthew J. Friedman</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2013">2013</date><idno type="RBID">pubmed:24434093</idno><idno type="pmid">24434093</idno><idno type="doi">10.4088/JCP.13m08592</idno><idno type="wicri:Area/Main/Corpus">001158</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001158</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?</title><author><name sortKey="Rosen, Craig S" sort="Rosen, Craig S" uniqKey="Rosen C" first="Craig S" last="Rosen">Craig S. Rosen</name><affiliation><nlm:affiliation>VA Palo Alto Health Care System, 795 Willow Rd (334-PTSD), Menlo Park, CA 94025 craig.rosen@va.gov.</nlm:affiliation></affiliation></author><author><name sortKey="Greenbaum, Mark A" sort="Greenbaum, Mark A" uniqKey="Greenbaum M" first="Mark A" last="Greenbaum">Mark A. Greenbaum</name></author><author><name sortKey="Schnurr, Paula P" sort="Schnurr, Paula P" uniqKey="Schnurr P" first="Paula P" last="Schnurr">Paula P. Schnurr</name></author><author><name sortKey="Holmes, Tyson H" sort="Holmes, Tyson H" uniqKey="Holmes T" first="Tyson H" last="Holmes">Tyson H. Holmes</name></author><author><name sortKey="Brennan, Penny L" sort="Brennan, Penny L" uniqKey="Brennan P" first="Penny L" last="Brennan">Penny L. Brennan</name></author><author><name sortKey="Friedman, Matthew J" sort="Friedman, Matthew J" uniqKey="Friedman M" first="Matthew J" last="Friedman">Matthew J. Friedman</name></author></analytic><series><title level="j">The Journal of clinical psychiatry</title><idno type="eISSN">1555-2101</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Benzodiazepines (administration & dosage)</term><term>Benzodiazepines (adverse effects)</term><term>Combined Modality Therapy (MeSH)</term><term>Diagnostic and Statistical Manual of Mental Disorders (MeSH)</term><term>Drug Monitoring (methods)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Hypnotics and Sedatives (administration & dosage)</term><term>Hypnotics and Sedatives (adverse effects)</term><term>Middle Aged (MeSH)</term><term>Military Personnel (psychology)</term><term>Military Personnel (statistics & numerical data)</term><term>Psychiatric Status Rating Scales (MeSH)</term><term>Psychotherapy (methods)</term><term>Stress Disorders, Post-Traumatic (psychology)</term><term>Stress Disorders, Post-Traumatic (therapy)</term><term>Treatment Outcome (MeSH)</term><term>United States (MeSH)</term><term>Veterans (psychology)</term><term>Veterans (statistics & numerical data)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Benzodiazepines</term><term>Hypnotics and Sedatives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Benzodiazepines</term><term>Hypnotics and Sedatives</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>United States</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Drug Monitoring</term><term>Psychotherapy</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Military Personnel</term><term>Stress Disorders, Post-Traumatic</term><term>Veterans</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Military Personnel</term><term>Veterans</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Stress Disorders, Post-Traumatic</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Combined Modality Therapy</term><term>Diagnostic and Statistical Manual of Mental Disorders</term><term>Female</term><term>Humans</term><term>Middle Aged</term><term>Psychiatric Status Rating Scales</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy.</p></div><div type="abstract" xml:lang="en"><p><b>METHOD</b></p><p>Between August 2002 and October 2005, 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were randomly assigned to 10 weekly 90-minute sessions of either prolonged exposure (n = 140) or present-centered psychotherapy (n = 143). Benzodiazepine use (n = 57) or non-use (n = 226) at intake was not randomly assigned. Multilevel modeling was used to assess the effects of benzodiazepine status, psychotherapy condition, and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Consistent with prior reports from these data, prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy (b = -0.48, P = .02). Patients prescribed benzodiazepines did not have weaker response to prolonged exposure, but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy (b = -0.78, P < .001).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines can benefit from it. It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients' poorer maintenance of gains in present-centered psychotherapy.</p></div><div type="abstract" xml:lang="en"><p><b>TRIAL REGISTRATION</b></p><p>ClinicalTrials.gov identifier: NCT00032617.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24434093</PMID><DateCompleted><Year>2014</Year><Month>04</Month><Day>08</Day></DateCompleted><DateRevised><Year>2014</Year><Month>01</Month><Day>17</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1555-2101</ISSN><JournalIssue CitedMedium="Internet"><Volume>74</Volume><Issue>12</Issue><PubDate><Year>2013</Year><Month>Dec</Month></PubDate></JournalIssue><Title>The Journal of clinical psychiatry</Title><ISOAbbreviation>J Clin Psychiatry</ISOAbbreviation></Journal><ArticleTitle>Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?</ArticleTitle><Pagination><MedlinePgn>1241-8</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.4088/JCP.13m08592</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">Benzodiazepines, other anxiolytics, or sedative hypnotics are prescribed for 30%-50% of posttraumatic stress disorder (PTSD) patients. Prior data and theory suggest that these medications may inhibit response to exposure therapy, one of the most effective PTSD treatments. The present post hoc study reanalyzed results from a psychotherapy trial to assess whether benzodiazepine use was associated with reduced response to exposure therapy.</AbstractText><AbstractText Label="METHOD" NlmCategory="METHODS">Between August 2002 and October 2005, 283 female veterans and soldiers meeting DSM-IV criteria for PTSD were randomly assigned to 10 weekly 90-minute sessions of either prolonged exposure (n = 140) or present-centered psychotherapy (n = 143). Benzodiazepine use (n = 57) or non-use (n = 226) at intake was not randomly assigned. Multilevel modeling was used to assess the effects of benzodiazepine status, psychotherapy condition, and their interaction on changes on the Clinician-Administered PTSD Scale and the PTSD Checklist during the treatment and 6-month follow-up periods.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Consistent with prior reports from these data, prolonged exposure psychotherapy produced greater reductions per week in PTSD symptoms than did present-centered psychotherapy (b = -0.48, P = .02). Patients prescribed benzodiazepines did not have weaker response to prolonged exposure, but demonstrated poorer posttreatment maintenance of gains from present-centered psychotherapy (b = -0.78, P < .001).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Prolonged exposure is a sufficiently robust treatment that patients who are taking benzodiazepines can benefit from it. It is unclear whether benzodiazepine use or other patient factors accounted for benzodiazepine recipients' poorer maintenance of gains in present-centered psychotherapy.</AbstractText><AbstractText Label="TRIAL REGISTRATION" NlmCategory="BACKGROUND">ClinicalTrials.gov identifier: NCT00032617.</AbstractText><CopyrightInformation>© Copyright 2013 Physicians Postgraduate Press, Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rosen</LastName><ForeName>Craig S</ForeName><Initials>CS</Initials><AffiliationInfo><Affiliation>VA Palo Alto Health Care System, 795 Willow Rd (334-PTSD), Menlo Park, CA 94025 craig.rosen@va.gov.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Greenbaum</LastName><ForeName>Mark A</ForeName><Initials>MA</Initials></Author><Author ValidYN="Y"><LastName>Schnurr</LastName><ForeName>Paula P</ForeName><Initials>PP</Initials></Author><Author ValidYN="Y"><LastName>Holmes</LastName><ForeName>Tyson H</ForeName><Initials>TH</Initials></Author><Author ValidYN="Y"><LastName>Brennan</LastName><ForeName>Penny L</ForeName><Initials>PL</Initials></Author><Author ValidYN="Y"><LastName>Friedman</LastName><ForeName>Matthew J</ForeName><Initials>MJ</Initials></Author></AuthorList><Language>eng</Language><DataBankList CompleteYN="Y"><DataBank><DataBankName>ClinicalTrials.gov</DataBankName><AccessionNumberList><AccessionNumber>NCT00032617</AccessionNumber></AccessionNumberList></DataBank></DataBankList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D013486">Research Support, U.S. Gov't, Non-P.H.S.</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Clin 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