Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?
Identifieur interne : 001318 ( Main/Exploration ); précédent : 001317; suivant : 001319Do benzodiazepines reduce the effectiveness of exposure therapy for posttraumatic stress disorder?
Auteurs : Craig S. Rosen [États-Unis] ; Mark A. Greenbaum ; Paula P. Schnurr ; Tyson H. Holmes ; Penny L. Brennan ; Matthew J. FriedmanSource :
- The Journal of clinical psychiatry [ 1555-2101 ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Anciens combattants (psychologie), Anciens combattants (statistiques et données numériques), Association thérapeutique (MeSH), Benzodiazépines (administration et posologie), Benzodiazépines (effets indésirables), Diagnostic and stastistical manual of mental disorders (USA) (MeSH), Femelle (MeSH), Humains (MeSH), Hypnotiques et sédatifs (administration et posologie), Hypnotiques et sédatifs (effets indésirables), Personnel militaire (psychologie), Personnel militaire (statistiques et données numériques), Psychothérapie (méthodes), Résultat thérapeutique (MeSH), Surveillance des médicaments (méthodes), Troubles de stress post-traumatique (psychologie), Troubles de stress post-traumatique (thérapie), Échelles d'évaluation en psychiatrie (MeSH), États-Unis (MeSH).
- MESH :
- administration et posologie : Benzodiazépines, Hypnotiques et sédatifs.
- effets indésirables : Benzodiazépines, Hypnotiques et sédatifs.
- méthodes : Psychothérapie, Surveillance des médicaments.
- psychologie : Anciens combattants, Personnel militaire, Troubles de stress post-traumatique.
- statistiques et données numériques : Anciens combattants, Personnel militaire.
- thérapie : Troubles de stress post-traumatique.
- Adulte, Adulte d'âge moyen, Association thérapeutique, Diagnostic and stastistical manual of mental disorders (USA), Femelle, Humains, Résultat thérapeutique, Échelles d'évaluation en psychiatrie, États-Unis.
- Wicri :
- geographic : États-Unis.
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
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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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></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><idno type="wicri:Area/Main/Curation">001158</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">001158</idno><idno type="wicri:Area/Main/Exploration">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 wicri:level="2"><nlm:affiliation>VA Palo Alto Health Care System, 795 Willow Rd (334-PTSD), Menlo Park, CA 94025 craig.rosen@va.gov.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>VA Palo Alto Health Care System, 795 Willow Rd (334-PTSD), Menlo Park</wicri:cityArea></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. 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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="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Anciens combattants (psychologie)</term><term>Anciens combattants (statistiques et données numériques)</term><term>Association thérapeutique (MeSH)</term><term>Benzodiazépines (administration et posologie)</term><term>Benzodiazépines (effets indésirables)</term><term>Diagnostic and stastistical manual of mental disorders (USA) (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Hypnotiques et sédatifs (administration et posologie)</term><term>Hypnotiques et sédatifs (effets indésirables)</term><term>Personnel militaire (psychologie)</term><term>Personnel militaire (statistiques et données numériques)</term><term>Psychothérapie (méthodes)</term><term>Résultat thérapeutique (MeSH)</term><term>Surveillance des médicaments (méthodes)</term><term>Troubles de stress post-traumatique (psychologie)</term><term>Troubles de stress post-traumatique (thérapie)</term><term>Échelles d'évaluation en psychiatrie (MeSH)</term><term>États-Unis (MeSH)</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="administration et posologie" xml:lang="fr"><term>Benzodiazépines</term><term>Hypnotiques et sédatifs</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" 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xml:lang="fr"><term>États-Unis</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 Psychiatry</MedlineTA><NlmUniqueID>7801243</NlmUniqueID><ISSNLinking>0160-6689</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006993">Hypnotics and Sedatives</NameOfSubstance></Chemical><Chemical><RegistryNumber>12794-10-4</RegistryNumber><NameOfSubstance UI="D001569">Benzodiazepines</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001569" MajorTopicYN="Y">Benzodiazepines</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003131" MajorTopicYN="N">Combined Modality Therapy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D039721" MajorTopicYN="N">Diagnostic and Statistical Manual of Mental Disorders</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016903" MajorTopicYN="N">Drug Monitoring</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006993" MajorTopicYN="N">Hypnotics and Sedatives</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008889" MajorTopicYN="N">Military Personnel</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011569" MajorTopicYN="N">Psychiatric Status Rating Scales</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011613" MajorTopicYN="N">Psychotherapy</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="Y">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013313" MajorTopicYN="Y">Stress Disorders, Post-Traumatic</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D014728" MajorTopicYN="N">Veterans</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2013</Year><Month>05</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2013</Year><Month>10</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>1</Month><Day>18</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2014</Year><Month>4</Month><Day>9</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24434093</ArticleId><ArticleId IdType="doi">10.4088/JCP.13m08592</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li></region></list><tree><noCountry><name sortKey="Brennan, Penny L" sort="Brennan, Penny L" uniqKey="Brennan P" first="Penny L" last="Brennan">Penny L. Brennan</name><name sortKey="Friedman, Matthew J" sort="Friedman, Matthew J" uniqKey="Friedman M" first="Matthew J" last="Friedman">Matthew J. Friedman</name><name sortKey="Greenbaum, Mark A" sort="Greenbaum, Mark A" uniqKey="Greenbaum M" first="Mark A" last="Greenbaum">Mark A. Greenbaum</name><name sortKey="Holmes, Tyson H" sort="Holmes, Tyson H" uniqKey="Holmes T" first="Tyson H" last="Holmes">Tyson H. Holmes</name><name sortKey="Schnurr, Paula P" sort="Schnurr, Paula P" uniqKey="Schnurr P" first="Paula P" last="Schnurr">Paula P. Schnurr</name></noCountry><country name="États-Unis"><region name="Californie"><name sortKey="Rosen, Craig S" sort="Rosen, Craig S" uniqKey="Rosen C" first="Craig S" last="Rosen">Craig S. Rosen</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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