Post-Traumatic Stress Disorder (PTSD) is a prevalent, disabling anxiety disorder. This prospective cohort study reports on a new exposure-based therapy known as Accelerated Resolution Therapy (ART ？) that incorporates the use of eye movements administered in a brief treatment period (1–5 one-hour sessions within three weeks). Eighty adults aged 21–60 years with symptoms of PTSD were recruited from the Tampa Bay area. The ART-based psychotherapy was designed to minimize anxiety and body sensations associated with recall of traumatic memories and to replace distressing images with favorable ones. Participants’ mean age was 40 years, 77% were female, and 29% were Hispanic. Participants underwent a median of three ART sessions, 66 of 80 (82.5%) completed treatment, and 54 of 66 (81.8%) provided 2-month follow-up data. Mean scores pre- and post-ART and at 2-month follow-up were: PTSD Checklist: 54.5 ± 12.2 vs. 31.2 ± 11.4 vs. 30.0 ± 12.4; Brief Symptom Inventory: 30.8 ± 14.6 vs. 10.1 ± 10.8 vs. 10.1 ± 12.1; Center for Epidemiologic Studies Depression Scale: 29.5 ± 10.9 vs. 11.8 ± 11.1 vs. 13.5 ± 12.1; Trauma Related Growth Inventory-Distress scale: 18.9 ± 4.1 vs. 7.4 ± 5.9 vs. 8.2 ± 5.9 ( p < 0.0001 for all pre-ART vs. post-ART and 2-month comparisons). No serious adverse events were reported. ART appears to be a brief, safe, and effective treatment for symptoms of PTSD.
References
[1]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; American Psychiatric Association: Washington, DC, USA, 2000.
[2]
Kessler, R.C.; Sonnega, A.; Bromet, E.; Hughes, M.; Nelson, C.B. Posttraumatic stress disorder in the national comorbidity survey. Arch. Gen. Psychiatry 1995, 52, 1048–1060, doi:10.1001/archpsyc.1995.03950240066012.
[3]
National Comorbidity Survey. NCS-R appendix tables: Table 1. Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Table 2. Twelve-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Available online: http://www.hcp.med.harvard.edu/ncs/publications.php (accessed on June 15 2011).
[4]
Tanielian, T.; Jaycox, L. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery; RAND Corporation: Santa Monica, CA, USA, 2008.
[5]
Kang, H.K.; Natelson, B.H.; Mahan, C.M.; Lee, K.Y.; Murphy, F.M. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: A population-based survey of 30,000 veterans. Am. J. Epidemiol. 2003, 157, 141–148, doi:10.1093/aje/kwf187.
[6]
Kulka, R.A.; Schlenger, W.A.; Fairbanks, J.A.; Hough, R.L.; Jordan, B.K.; Marmar, C.R.; Cranston, A.S. Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study; Brunner Mazel Publishers: New York, NY, USA, 1990.
Davidson, J.R.T.; Foa, E.B. Posttraumatic Stress Disorder: DSM-IV and Beyond; American Psychiatric Press: Washington, DC, USA, 1993.
[9]
Hoge, C.W.; Terhakopian, A.; Castro, C.A.; Messer, S.C.; Engel, C.C. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am. J. Psychiatry 2007, 164, 150–153, doi:10.1176/appi.ajp.164.1.150. 17202557
[10]
VA National Center for PTSD. Relationships and PTSD. Available online: http://www.ptsd.va.gov/public/pages/ptsd-and-relationships.asp (accessed on June 15 2011).
[11]
Oquendo, M.A.; Friend, J.M.; Halberstam, B.; Brodsky, B.S.; Burke, A.K.; Grunebaum, M.F.; Malone, K.M.; Mann, J.J. Association of comorbid posttraumatic stress disorder and major depression with greater risk for suicidal behavior. Am. J. Psychiatry 2003, 160, 580–582, doi:10.1176/appi.ajp.160.3.580.
[12]
Foa, E.B.; Keane, T.M.; Friedman, M.J. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies; Guilford: New York, NY, USA, 2009.
[13]
Institute of Medicine. Treatment of Posttraumatic Stress Disorder: An Assessment of the Evidence; Institute of Medicine: Washington, DC, USA, 2008.
[14]
Ursano, R.J.; Bell, C.; Eth, S.; Friedman, M.J.; Norwood, A.E.; Pfefferbaum, B. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am. J. Psychiatry 2004, 161, 3–31, doi:10.1176/appi.ajp.161.1.3. 15617511
[15]
Resick, P.A.; Schnicke, M.K. Cognitive Processing Therapy for Rape Victims: A Treatment Manual; Sage Publications: Newbury Park, CA, USA, 1996.
[16]
Foa, E.B.; Rothbaum, B.O. Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD; Guilford: New York, NY, USA, 1998.
[17]
Chemtob, C.M.; Tolin, D.F.; van der Kolk, B.; Pitman, R.K. Eye Movement Desensitization and Reprocessing; Guilford: New York, NY, USA, 2000.
[18]
Shapiro, F. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures, 2nd ed.; Guilford: New York, NY, USA, 2001.
[19]
Brady, K.; Pearlstein, T.; Asnis, G.M.; Baker, D.; Rothbaum, B.; Sikes, C.R.; Farfel, G.M. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. J. Am. Med. Assoc. 2000, 283, 1837–1844, doi:10.1001/jama.283.14.1837.
[20]
VA National Center for PTSD. Clinicians Guide to Medications for PTSD. Available online: http://www.ptsd.va.gov/professional/pages/clinicians-guide-to-medications-for-ptsd.asp (accessed on January 18 2012).
Weathers, F.; Litz, B.; Herman, D.; Huska, J.; Keane, T. The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. In Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX, USA, 24–27 October 1993.
[23]
Zimmerman, M.; Chelminski, I. A scale to screen for DSM-IV Axis I disorders in psychiatric out-patients: Performance of the Psychiatric Diagnostic Screening Questionnaire. Psychol. Med. 2006, 36, 1601–1611, doi:10.1017/S0033291706008257.
[24]
Zimmerman, M.; Mattia, J.I. A self-report scale to help make psychiatric diagnoses: The Psychiatric Diagnostic Screening Questionnaire. Arch. Gen. Psychiatry 2001, 58, 787–794, doi:10.1001/archpsyc.58.8.787.
[25]
Stickgold, R.A. EMDR: A putative neurobiological mechanism of action. J. Clin. Psychol. 2002, 58, 61–75, doi:10.1002/jclp.1129.
[26]
Holmes, E.A.; Arntz, A.; Smucker, M.R. Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. J. Behav. Ther. Exp. Psychiatry 2007, 38, 297–305, doi:10.1016/j.jbtep.2007.10.007.
[27]
Grunert, B.K.; Weis, J.M.; Smucker, M.R.; Christianson, H. Imagery rescripting and reprocessing therapy after failed prolonged imaginal exposure for posttraumatic stress disorder following industrial injury. J. Behav. Ther. Exp. Psychiatry 2007, 38, 317–328, doi:10.1016/j.jbtep.2007.10.005. 18037391
[28]
Derogatis, L.R. Brief Symptom Inventory (BSI)-18. Administration, scoring and procedures manual. NCS Pearson Inc.: Minneapolis, MN, 2001. Available online: http://psychcorp.pearsonassessments.com/HAIWEB/Cultures/enus/Productdetail.htm?Pid=PAg110&Mode=summary (accessed on June 13,2012).
[29]
Radloff, L.S. The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Meas. 1977, 1, 385–401, doi:10.1177/014662167700100306.
[30]
Ree, M.J.; French, D.; MacLeod, C.; Locke, V. Distinguishing cognitive and somatic dimensions of state and trait anxiety: Development and validation of the state-trait inventory for cognitive and somatic anxiety (STICSA). Behav. Cogn. Psychother. 2008, 36, 313–332.
[31]
Neff, K.D. The development and validation of a scale to measure self-compassion. Self Identity 2003, 2, 223–250, doi:10.1080/15298860309027.
[32]
Buss, A.H.; Perry, M. The aggression questionnaire. J. Pers. Soc. Psychol. 1992, 63, 452–459, doi:10.1037/0022-3514.63.3.452.
[33]
Saunders, J.B.; Aasland, O.G.; Babor, T.F.; de la Fuente, J.R.; Grant, M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction 1993, 88, 791–804, doi:10.1111/j.1360-0443.1993.tb02093.x.
[34]
Kubany, E.S. Development and validation of the Trauma-Related Guilt Inventory (TRGI). Psychol. Assess. 1996, 8, 428–444, doi:10.1037/1040-3590.8.4.428.
[35]
Tedeschi, R.G.; Calhoun, L.G. The posttraumatic growth inventory: Measuring the positive legacy of trauma. J. Trauma. Stress 1996, 9, 455–471, doi:10.1002/jts.2490090305.
[36]
Buysse, D.J.; Reynolds, C.F.; Monk, T.H.; Berman, S.R.; Kupfer, D.J. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatr. Resid. 1989, 28, 193–213, doi:10.1016/0165-1781(89)90047-4.
[37]
Morris, S.B.; DeShon, R.P. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol. Methods 2002, 7, 105–125, doi:10.1037/1082-989X.7.1.105.
[38]
Grubaugh, A.L.; Elhai, J.D.; Cusack, K.J.; Wells, C.; Frueh, B.C. Screening for PTSD in public-sector mental health settings: The diagnostic utility of the PTSD checklist. Depress. Anxiety 2007, 24, 124–129, doi:10.1002/da.20226.
[39]
McDowell, I.; Newell, C. Measuring Health, a Guide to Rating Scales and Questionnaires, 2nd ed.; Oxford University Press: New York, NY, USA, 1996.
[40]
Monson, C.M.; Gradus, J.L.; Young-Xu, Y.; Schnurr, P.P.; Price, J.L.; Schumm, J.A. Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree? Psychol. Assess. 2008, 20, 131–138, doi:10.1037/1040-3590.20.2.131.
[41]
Andrade, J.; Kavanagh, D.; Baddeley, A. Eye movements and visual imagery: A working memory approach to the treatment of post-traumatic stress disorder. Br. J. Clin. Psychol. 1997, 36, 209–233, doi:10.1111/j.2044-8260.1997.tb01408.x.
[42]
van den Hout, M.; Muris, P.; Salemink, E.; Kindt, M. Autobiographical memories become less vivid and emotional after eye movements. Br. J. Clin. Psychol. 2001, 40, 121–130, doi:10.1348/014466501163571.
[43]
Lee, C.W.; Taylor, G.; Drummond, P.D. The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clin. Psychol. Psychother. 2006, 13, 97–107, doi:10.1002/cpp.479.
Sacka, M.; Lempa, W.; Steinmetz, A.; Lamprecht, F.; Hofmann, A. Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR)–Results of a preliminary investigation. J. Anxiety Disord. 2008, 22, 1264–1271, doi:10.1016/j.janxdis.2008.01.007.
[46]
MacCulloch, M.J.; Feldman, P. Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis. Br. J. Psychiatry 1996, 169, 571–579, doi:10.1192/bjp.169.5.571.
[47]
Foa, E.B.; Kozak, M.J. Emotional processing of fear: Exposure to corrective information. Psychol. Bull. 1986, 99, 20–35, doi:10.1037/0033-2909.99.1.20.
[48]
Paller, K.A.; Voss, J.L. Memory reactivation and consolidation during sleep. Learn. Mem. 2004, 11, 664–670, doi:10.1101/lm.75704.
[49]
Wagner, U.; Gais, S.; Born, J. Emotional memory formation is enhanced across sleep intervals with high amounts of rapid eye movement sleep. Learn. Mem. 2001, 8, 112–119, doi:10.1101/lm.36801. 11274257
[50]
Datta, S. Avoidance task training potentiates phasic pontine-wave density in the rat: A mechanism for sleep-dependent plasticity. J. Neurosci. 2000, 20, 8607–8613. 11069969
[51]
Walker, M.P.; Stickgold, R. Sleep, memory and plasticity. Annu. Rev. Psychol. 2006, 57, 139–166, doi:10.1146/annurev.psych.56.091103.070307.
[52]
Seidler, G.H.; Wagner, F.E. Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychol. Med. 2006, 36, 1515–1522, doi:10.1017/S0033291706007963.
[53]
Bryant, R.A.; Moulds, M.L.; Guthrie, R.M.; Dang, S.T.; Nixon, R.D.V. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J. Consult. Clin. Psychol. 2003, 71, 706–712, doi:10.1037/0022-006X.71.4.706.
[54]
Foa, E.B.; Dancu, C.V.; Hembree, E.A.; Jaycox, L.H.; Meadows, E.A.; Street, G.P. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. J. Consult. Clin. Psychol. 1999, 67, 194–200, doi:10.1037/0022-006X.67.2.194.
[55]
Marks, I.; Lovell, K.; Noshirvani, H.; Livanou, M.; Thrasher, S. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring. Arch. Gen. Psychiatry 1998, 55, 317–324, doi:10.1001/archpsyc.55.4.317.
[56]
Resick, P.A.; Nishith, P.; Weaver, T.L.; Astin, M.C.; Feuer, C.A. A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. J. Consult. Clin. Psychology 2002, 70, 867–879, doi:10.1037/0022-006X.70.4.867.
[57]
Rothbaum, B.O.; Astin, M.C.; Marsteller, F. Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. J. Trauma. Stress 2005, 18, 607–616, doi:10.1002/jts.20069.
[58]
Taylor, S.; Thordarson, D.S.; Maxfield, L.; Fedoroff, I.C.; Lovell, K.; Ogrodniczuk, J.S. Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. J. Consult. Clin. Psychol. 2003, 71, 330–338, doi:10.1037/0022-006X.71.2.330.
[59]
Schnurr, P.P.; Friedman, M.J.; Engel, C.C.; Foa, E.B.; Shea, M.T.; Chow, B.K.; Resick, P.A.; Thurston, V.; Orsillo, S.M.; Haug, R.; et al. Cognitive behavioral therapy for posttraumatic stress disorder in women. A randomized controlled trial. J. Am. Med. Assoc. 2007, 297, 820–830, doi:10.1001/jama.297.8.820.
