Cognitive Behavioral Training for PTSD and Alcoholism
Recruiting in Palo Alto (17 mi)
+2 other locations
Age: 18 - 65
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of South Dakota
Disqualifiers: Psychosis, Severe AUD, Suicidal ideation, others
No Placebo Group
Trial Summary
What is the purpose of this trial?The present study seeks to increase understanding of Alcohol Use Disorder (AUD) and Posttraumatic Stress Disorder (PTSD) among veterans, an important public health concern. We will study the effects of regulatory deficits and sleep disturbance on the dynamic course of PTSD and AUD. The study will investigate whether a short, computerized training in the laboratory will alter maladaptive response biases and reduce associations between sleep disturbance, affect and behavioral dysregulation, AUD symptoms, and PTSD symptoms in the real world.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators.
What data supports the effectiveness of the treatment Cognitive Behavioral Training for PTSD and Alcoholism?
Research shows that cognitive behavioral therapy (CBT) can significantly reduce symptoms of both PTSD and alcohol use disorder (AUD) when used together. Studies found that integrated CBT for PTSD and AUD led to substantial improvements in PTSD severity and alcohol-related outcomes, suggesting that this combined approach can be effective for individuals with both conditions.
12345Is Cognitive Behavioral Training for PTSD and Alcoholism safe for humans?
Research on cognitive behavioral therapy (CBT) for PTSD and alcohol use disorders shows that it is generally well-tolerated by patients, with favorable outcomes in reducing symptoms and improving quality of life. There is no indication of significant safety concerns in the studies reviewed.
23456How does Cognitive Behavioral Training for PTSD and Alcoholism differ from other treatments?
Cognitive Behavioral Training for PTSD and Alcoholism is unique because it integrates cognitive behavior therapy (CBT) specifically for both PTSD and alcohol use disorders, focusing on exposure therapy to address PTSD symptoms. This approach contrasts with traditional treatments that may separately address PTSD and alcoholism, potentially leading to more significant improvements in PTSD symptoms when both conditions are treated together.
34789Eligibility Criteria
This trial is for OIF/OEF/OND veterans at risk for PTSD (with a PCL-5 score of 33 or higher) and/or AUD (AUDIT score of at least 7 for women, 8 for men). It's not suitable for individuals with active suicidal/homicidal thoughts, psychosis, severe alcohol use disorder, high risk or treatment history for sleep apnea.Exclusion Criteria
I am at high risk for sleep apnea or am being treated for it.
Participant Groups
The study examines the impact of computerized training aimed to modify harmful response tendencies and lessen the link between sleep issues, emotional and behavioral dysregulation, AUD symptoms, and PTSD symptoms in real-world settings among veterans.
4Treatment groups
Experimental Treatment
Placebo Group
Group I: Alcohol Sham + PTSD CBMExperimental Treatment2 Interventions
Group II: Alcohol Cognitive Bias Modification (CBM) + PTSD CBMExperimental Treatment2 Interventions
Group III: Alcohol CBM + PTSD ShamExperimental Treatment2 Interventions
Group IV: Alcohol Sham + PTSD ShamPlacebo Group2 Interventions
Find A Clinic Near You
Research locations nearbySelect from list below to view details:
Sioux Falls VA Health Care SystemSioux Falls, SD
The University of South DakotaVermillion, SD
Bay Pines VA Health Care SystemBay Pines, FL
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Who is running the clinical trial?
University of South DakotaLead Sponsor
Bay Pines VA Healthcare SystemCollaborator
Sioux Falls VA Health Care SystemCollaborator
National Institute of Mental Health (NIMH)Collaborator
References
Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial. [2021]Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are complex psychiatric conditions that commonly co-occur. No evidence-based, 'gold standard' treatments for PTSD/SUD comorbidity are currently available. The present pilot randomized clinical trial was designed to evaluate the feasibility and preliminary efficacy of a novel, integrated cognitive-behavioral treatment approach for PTSD/SUD, entitled Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS), as compared to standard cognitive-behavioral treatment (CBT) for SUD. The TIPSS program integrates cognitive processing therapy with CBT for SUD for the treatment of co-occurring PTSD/SUD. Both treatment conditions are comprised of 12, 60-minute individual psychotherapy sessions, delivered twice-weekly over six weeks. Primary aims examine whether TIPSS, compared to standard CBT for SUD, reduces: (1) PTSD symptoms and (2) substance use outcomes (i.e., self-report, objective). Secondary aims examine whether (a) trauma- and substance cue reactivity and (b) distress tolerance (i.e., actual or perceived ability to withstand uncomfortable emotional or physical states) are significant mechanisms of change. The study was recently closed to new enrollment. Participants included adults with substance dependence and at least four symptoms of PTSD.
A cognitive behavioral therapy for co-occurring substance use and posttraumatic stress disorders. [2022]Co-occurring posttraumatic stress disorder (PTSD) is prevalent in addiction treatment programs and a risk factor for negative outcomes. Although interventions have been developed to address substance use and PTSD, treatment options are needed that are effective, well tolerated by patients, and potentially integrated with existing program services. This paper describes a cognitive behavioral therapy (CBT) for PTSD that was adapted from a treatment for persons with severe mental illnesses and PTSD in community mental health settings. The new adaptation is for patients in community addiction treatment with co-occurring PTSD and substance use disorders. In this study, 5 community therapists delivered the CBT for PTSD. Outcome data are available on 11 patients who were assessed at baseline, post-CBT treatment, and at a 3-month follow-up post-treatment. Primary outcomes were substance use, PTSD severity, and retention, of which all were favorable for patients receiving the CBT for PTSD.
Randomized controlled trial of cognitive behaviour therapy for comorbid post-traumatic stress disorder and alcohol use disorders. [2019]Aims This study aimed to test the efficacy of integrated cognitive behaviour therapy (CBT) for coexisting post traumatic stress disorder (PTSD) and alcohol use disorders (AUD). Setting Clinics across Sydney, Australia.Design Randomized controlled trial of 12 once-weekly individual sessions of either integrated CBT for PTSD and AUD(integrated therapy, IT; n = 33) or CBT for AUD plus supportive counselling (alcohol-support, AS; n = 29). Blind assessments were conducted at baseline and post-treatment and at 5 [standard deviation (SD) = 2.25] and 9.16(SD = 3.45) months post-treatment. Participants Sixty-two adults with concurrent PTSD and AUD. Measurements Outcomes included changes in alcohol consumption (time-line follow-back), PTSD severity [clinician-administered PTSD scale (CAPS)], alcohol dependence and problems, and depression and anxiety. Findings Reductions in PTSD severity were evident in both groups. IT participants who had received one or more sessions of exposure therapy exhibited a twofold greater rate of clinically significant change in CAPS severity at follow-up than AS participants [IT60%, AS 39%, odds ratio (OR): 2.31, 95% confidence interval (CI): 1.06, 5.01]. AS participants exhibited larger reductions than IT participants in alcohol consumption, dependence and problems within the context of greater treatment from other services during follow-up. Results lend support to a mutually maintaining effect between AUD and PTSD. Conclusions Individuals with severe and complex presentations of coexisting post-traumatic stress disorder(PTSD) and alcohol use disorders (AUD) can derive substantial benefit from cognitive behaviour therapy targeting AUD, with greater benefits associated with exposure for PTSD. Among individuals with dual disorders, these therapies can generate significant, well-maintained treatment effects on PTSD, AUD and psychopathology.
Acceptance and Commitment Therapy for Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes. [2019]Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD-AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness- and acceptance-based form of behavior therapy, has potential as a treatment option for PTSD-AUD. In this uncontrolled pilot study, we examined ACT for PTSD-AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician-assessed and self-reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self-reported symptoms of PTSD remained lower at 3-month follow-up, d = 0.88. There were reductions on all alcohol-related outcomes (clinician-assessed and self-reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3-month follow-up, dmean = 0.91 (d range: 0.65-1.30). Quality of life increased at posttreatment and follow-up, ds = 0.55-0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow-up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow-up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow-up. Consistent with the ACT theoretical model, these improvements were associated with more between-session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD-AUD include assigning frequent between-session mindfulness practice and initiating values clarification work and values-based behavior assignments early in treatment.
Behavioral Treatments for Alcohol Use Disorder and Post-Traumatic Stress Disorder. [2023]Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are highly prevalent and debilitating psychiatric conditions that commonly co-occur. Individuals with comorbid AUD and PTSD incur heightened risk for other psychiatric problems (e.g., depression and anxiety), impaired vocational and social functioning, and poor treatment outcomes. This review describes evidence-supported behavioral interventions for treating AUD alone, PTSD alone, and comorbid AUD and PTSD. Evidence-based behavioral interventions for AUD include relapse prevention, contingency management, motivational enhancement, couples therapy, 12-step facilitation, community reinforcement, and mindfulness. Evidence-based PTSD interventions include prolonged exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing, psychotherapy incorporating narrative exposure, and present-centered therapy. The differing theories behind sequential versus integrated treatment of comorbid AUD and PTSD are presented, as is evidence supporting the use of integrated treatment models. Future research on this complex, dual-diagnosis population is necessary to improve understanding of how individual characteristics, such as gender and treatment goals, affect treatment outcome.
Treatment responder status and time to response as a function of hazardous drinking among active-duty military receiving variable-length cognitive processing therapy for posttraumatic stress disorder. [2023]A common concern is whether individuals with posttraumatic stress disorder (PTSD) and hazardous drinking will respond to PTSD treatment or need a higher dose. In a sample of active-duty military, we examined the impact of hazardous drinking on cognitive processing therapy (CPT) outcomes and whether number of sessions to reach good end-state or dropout differed by drinking status.
PTSD and alcoholism. [2015]PTSD is the development of symptoms after a distressful response. 52.20% of the respondents suffering from PTSD used to drink either moderately or excessively during the war. Some of their alcoholism stems from the pre-war period. According to our researches, more than one fifth (22.92%) of the respondents with PTSD consume alcohol more than they used to before the war. PTSD is frequently associated with chronic alcoholism as a kind of "self-healing". Alcoholism problem is particularly unfavourably reflected on the family of a PTSD patient, whose quality of life is already poor, due to their basic disease. Treatment of alcoholism with PTSD patients is rather demanding; emerging of PTSD is noticeable with a part of the staff who treat chronic alcoholism; what is noticed was the similarity in the intensity and frequency of the stressful responses, which is proportional to the one noticed with the staff treating AIDS patients. Chronic alcoholics are the source of strong and repetitive traumas for those who try to treat them. That is why the concern for the counter-transference responses is important while treating alcoholism.
Alcoholism treatment of Vietnam veterans with post-traumatic stress disorder. [2019]Vietnam veterans with alcoholism and Post-Traumatic Stress Disorder (PTSD) are a clinically problematic population. Early self-medication of the PTSD with alcohol led for some to alcohol abuse and dependency. These may often be treated in an intensive alcoholism program. At evaluation both diagnoses are made, and patients are told that alcohol or drug use is not tolerated. The program first focuses on traditional alcoholism treatment issues. Early and consistent support to enhance self-esteem and to reduce guilt helps the patient later to tolerate the gradual investigation of the anger and self-loathing associated with both disorders. Important forces include family and peer support, effective limit setting in a structured milieu, supportive confrontation of alcoholic denial through multidisciplinary treatment in the absence of alcohol. Outpatient follow-up treatment groups include other PTSD sufferers and focus on establishing trust, interweaving the issues of adjustment to sobriety with discussion of the combat experience in a safe, accepting environment, with careful modulation of anxiety by the clinician. Medication must be conservative; benzodiazepines are not used after the detoxification period.
Case report on the use of cognitive processing therapy-cognitive, enhanced to address heavy alcohol use. [2022]There is a high rate of co-occurring alcohol dependence (AD) in individuals with posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT) is an effective treatment for individuals diagnosed with PTSD. CPT-Cognitive (CPT-C) is a modified form of CPT. This case report describes a 12-week course of CPT-C treatment, enhanced to address heavy alcohol use, in a combat veteran with PTSD and co-occurring AD. By treatment end, the veteran demonstrated clinically significant improvement in both PTSD symptoms and alcohol-related problems and sustained these gains 12-weeks posttreatment. The results indicate promise for the use of CPT-C, enhanced for heavy alcohol use, for individuals diagnosed with PTSD and AD.