This article was originally published on December 30, 2013. Subsequently, the author corrected an error in the expansion of the term EMDR. The correct version was published on January 13, 2014.
PRIMUM NON NOCERE (FIRST DO NO HARM): SYMPTOM WORSENING AND IMPROVEMENT IN FEMALE ASSAULT VICTIMS AFTER PROLONGED EXPOSURE FOR PTSD
Article first published online: 30 DEC 2013
© 2013 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 31, Issue 5, pages 412–419, May 2014
How to Cite
Jayawickreme, N., Cahill, S. P., Riggs, D. S., Rauch, S. A. M., Resick, P. A., Rothbaum, B. O. and Foa, E. B. (2014), PRIMUM NON NOCERE (FIRST DO NO HARM): SYMPTOM WORSENING AND IMPROVEMENT IN FEMALE ASSAULT VICTIMS AFTER PROLONGED EXPOSURE FOR PTSD. Depress. Anxiety, 31: 412–419. doi: 10.1002/da.22225
Contract grant sponsor: United States National Institute of Mental Health; Contract grant number: NIH-1 R01-MH51509 (to Patricia A. Resick); Contract grant sponsor: United States National Institute of Mental Health; Contract grant number: MH42178 (to Edna B. Foa); Contract grant number: 1 R01 MH-56351-01A1 (to Barbara O. Rothbaum).
Disclosure of Potential Conflicts of Interest: Shawn P. Cahill has received funding from the National Institute of Mental Health, consulted for Behavioral Tech Research Inc and Eastern Carolina University, and received financial compensation for lectures. Patricia A. Resick is employed by the Boston VA Research Institute and Boston University, has received grants from the University of Missouri – St Louis and the United States Department of Defense, and has received book royalties and financial compensation for workshops and travel. Edna B. Foa has received grants from the National Institute of Mental Health.
- Issue published online: 22 APR 2014
- Article first published online: 30 DEC 2013
- Manuscript Accepted: 20 NOV 2013
- Manuscript Revised: 18 NOV 2013
- Manuscript Received: 30 JAN 2013
- United States National Institute of Mental Health. Grant Number: NIH-1 R01-MH51509
- United States National Institute of Mental Health. Grant Number: MH42178
- Cognitive Behavioral Therapy;
- Exposure Therapy;
- Treatment Outcome
Prolonged Exposure (PE) therapy is an efficacious treatment for PTSD; despite this, many clinicians do not utilize it due to concerns it could cause patient decompensation.
Data were pooled from four published well-controlled studies of female assault survivors with chronic PTSD (n = 361) who were randomly assigned to PE, waitlist (WL), or another psychotherapy, including cognitive processing therapy (CPT), Eye Movement and Desensitization Reprocessing (EMDR), or the combination of PE plus stress inoculation training (SIT) or PE plus cognitive restructuring. PTSD and depression severity scores were converted to categorical outcomes to evaluate the proportion of participants who showed reliable symptom change (both reliable worsening and reliable improvement).
The majority of participants completing one of the active treatments showed reliable improvement on both PTSD and depression compared to WL. Among treatment participants in general, as well as those who received PE, reliable PTSD worsening was nonexistent and the rate of reliable worsening of depression was low. There were no differences on any outcome measures among treatments. By comparison, participants in WL had higher rates of reliable symptom worsening for both PTSD and depression. Potential alternative explanations were also evaluated.
PE and a number of other empirically supported therapies are efficacious and safe treatments for PTSD, reducing the frequency of which symptom worsening occurs in the absence of treatment.