Positive Psychiatry for PTSD

(RFPP Trial)

Overseen By Naser Ahmadi, MD PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of California, Los Angeles

Disqualifiers: Intellectual disabilities, Psychotic behavior, Seizure disorder, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 16

Duration: 6 weeks

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new treatment called Reminder Focused Positive Psychiatry (RFPP) for adolescents with PTSD. Researchers aim to determine if RFPP can improve PTSD symptoms, reduce reactions to trauma reminders, and enhance overall well-being. Participants will be divided into two groups: one will try RFPP, and the other will focus on relaxation and education about PTSD. Children aged 11-15 with PTSD who can read and write in English may be suitable for this trial. As an unphased trial, this study offers a unique opportunity to contribute to pioneering research that could shape future PTSD treatments for adolescents.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications. It is best to discuss this with the trial coordinators or your doctor.

What prior data suggests that Reminder Focused Positive Psychiatry is safe for adolescents with PTSD?

Research has shown that Reminder Focused Positive Psychiatry (RFPP) is generally safe for treating PTSD. In past studies, participants handled RFPP well. For instance, one study found that RFPP helped reduce PTSD symptoms and improved coping skills without causing major side effects. Another study demonstrated that RFPP significantly reduced PTSD symptoms and enhanced emotional management when participants were reminded of trauma. These findings suggest that RFPP is a safe option for those considering joining a trial. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Reminder Focused Positive Psychiatry (RFPP) for PTSD because it shifts the focus from traditional symptom management to enhancing emotional regulation and adaptive coping strategies. Unlike standard treatments that often center on exposure therapy or medication, RFPP helps patients recognize trauma reminders and pivot their attention toward positive feelings, thoughts, and goals. This innovative approach not only aims to improve contextual discrimination but also empowers individuals to make proactive, positive choices in response to their trauma, offering a fresh, optimistic angle in PTSD care.

What evidence suggests that Reminder Focused Positive Psychiatry might be an effective treatment for PTSD?

Research has shown that Reminder Focused Positive Psychiatry (RFPP), which participants in this trial may receive, can help improve PTSD symptoms. Studies have found that RFPP aids in managing emotions and dealing with trauma reminders more effectively. For those with PTSD, RFPP has been linked to fewer symptoms and improved heart and blood vessel health. It also appears to reduce neuroinflammation, the body's response to stress. These findings suggest that RFPP might benefit people with PTSD by fostering positive feelings and better coping strategies. ^{2 4 6 7 8}

Are You a Good Fit for This Trial?

This trial is for boys and girls aged 11-15 with documented PTSD. They must be able to read and write in English. It's not for those with substance use disorders, other neurodevelopmental disorders, psychotic or self-injurious behavior, seizure or language disorders, intellectual disabilities, or eye disorders.

Inclusion Criteria

You are a boy or girl who has been diagnosed with PTSD.

You are between the ages of 11 and 15.

Able to read/write in English

Exclusion Criteria

You have been diagnosed with drug or alcohol addiction.

You have other conditions that affect your brain development.

You have shown behavior where you harm yourself or have experienced hallucinations or delusions.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive twice weekly telehealth intervention of either RFPP or group process for 6 weeks

6 weeks

12 visits (virtual)

Follow-up

Participants undergo neuropsychiatric assessments and monitoring of vascular function and biomarkers

24 weeks

4 visits (in-person) at baseline, 3, 6, and 24 weeks

What Are the Treatments Tested in This Trial?

Interventions

• attentional control condition (group process)
• Reminder Focused Positive Psychiatry

Trial Overview The study tests Reminder Focused Positive Psychiatry (RFPP) against an attention control group process in adolescents with PTSD. Participants will receive telehealth sessions twice a week for six weeks and undergo assessments at multiple points to measure the intervention's impact on PTSD symptoms and biomarkers.

How Is the Trial Designed?

Group I: RFPP group intervention Active Control 1 Intervention

The focus of RFPP is on enhancing contextual discrimination and emotional regulation, and promoting the use of adaptive coping strategies in response to trauma reminders, including recognizing reminders, shifting attention from intrusive memories during exposure to reminders to a focus on positive feelings, thoughts, goals, and choices.

Group II: attentional control condition (group process) Placebo Group 1 Intervention

Subjects will receive progressive muscle relaxation and other relaxation techniques as well as education about PTSD and supportive psychotherapy. Parents will receive 4 sessions of relaxation techniques.

Who Is Running the Clinical Trial?

University of California, Los Angeles

Lead Sponsor

Trials

1,594

Recruited

10,430,000+

UCLA Cousins Center for Psychoneuroimmunology

Collaborator

Trials

1

Recruited

60+

Published Research Related to This Trial

In a study involving 134 therapists and 188 patients, significant reductions in PTSD symptoms were observed across all training conditions, indicating that evidence-based psychotherapy can effectively improve patient outcomes in routine care settings.

Therapists who received Standard Consultation (without audio review) achieved greater improvements in patient PTSD symptoms compared to those with No Consultation, suggesting that consultation is beneficial for therapist training, while audio review may not be necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled effectiveness trial of training strategies in cognitive processing therapy for posttraumatic stress disorder: Impact on patient outcomes. Monson, CM., Shields, N., Suvak, MK., et al.[2019]

The reminder-focused positive psychiatry (RFPP) intervention significantly improved ADHD and PTSD symptoms, as well as vascular function and overall well-being in adolescents, with more robust results compared to trauma-focused cognitive-behavioral therapy (TF-CBT) after a 6-week trial involving 11 participants.

At the 12-month follow-up, RFPP continued to show lasting benefits, including reduced inflammation and increased resilience and gratitude, with no reports of psychiatric hospitalization or suicidal ideation in either group, highlighting its potential as a long-term treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Feasibility Trial of Reminder-Focused Positive Psychiatry in Adolescents With Comorbid Attention-Deficit/Hyperactivity Disorder and Posttraumatic Stress Disorder. Ahmadi, N., Chaudhry, S., Salam, T., et al.[2022]

A review of 12 controlled studies indicates that atypical antipsychotics are effective and safe for treating posttraumatic stress disorder (PTSD), with some evidence of efficacy in managing related symptoms like anxiety and depression.

While the findings support the use of atypical antipsychotics for PTSD, the overall evidence is limited, suggesting a need for further research to confirm these results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atypical antipsychotics in the treatment of posttraumatic stress disorder. Wang, HR., Woo, YS., Bahk, WM.[2013]

The brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) intervention significantly reduced PTSD symptoms and suicidal ideation among youths, with an 80% reduction in suicidal ideation compared to only 15% in the treatment as usual group.

RFPP-S led to faster stabilization of PTSD crises (average of 2 days) and a 0% readmission rate for suicidality one month post-discharge, compared to a 20% readmission rate in the control group, indicating its effectiveness in improving clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reminder-Focused Positive Psychiatry: Suicide Prevention Among Youths With Comorbid Posttraumatic Stress Disorder and Suicidality. Ahmadi, N., Pynoos, R., Leuchter, A., et al.[2022]

In a study of 2,643 veterans receiving treatment for PTSD, 25.9% experienced substantial improvement in symptoms, while 74.1% showed modest improvement, indicating that significant progress is possible in routine clinical practice.

The only strong predictor of substantial improvement was gender, with men having lower odds of achieving significant symptom reduction compared to women, suggesting that treatment approaches may need to be tailored based on gender differences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using patient-reported outcomes to understand the effectiveness of guideline-concordant care for post-traumatic stress disorder in clinical practice. Shiner, B., Gui, J., Leonard Westgate, C., et al.[2023]

Measurement-based care (MBC) can help identify patients with posttraumatic stress disorder (PTSD) who are not responding to treatment as early as the sixth session, allowing for timely adjustments to their treatment plans.

In a study involving 2,182 patients from VA PTSD specialty clinics, session-by-session benchmarks were developed to visualize treatment progress using the PTSD Checklist (PCL-5), enhancing the potential for personalized, evidence-based care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expected symptom change trajectories for the early identification of probable treatment nonresponse in VA PTSD specialty care clinics: A proof-of-concept. Darnell, BC., Benfer, N., Vannini, MBN., et al.[2023]

Out of 13 reviewed PTSD intervention manuals, only about 54% explicitly addressed positive memories, while around 69% discussed positive emotions and cognitions, indicating a limited focus on positive internal experiences in most therapies.

Eye Movement Desensitization and Reprocessing (EMDR) was found to have the most comprehensive approach to incorporating positive internal experiences, suggesting it may be particularly effective in addressing the emotional deficits associated with PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Positive Internal Experiences in PTSD Interventions: A Critical Review. Contractor, AA., Weiss, NH., Forkus, SR., et al.[2023]

In a study of 203 trauma-exposed individuals, it was found that higher severity of PTSD symptoms negatively impacted the number of specific positive memories recalled, suggesting that trauma can hinder positive memory encoding and retrieval.

The accessibility of positive memories was also negatively affected by PTSD symptoms, indicating that integrating positive memory recall into trauma treatment could be beneficial for improving mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relation of positive memory recall count and accessibility with post-trauma mental health. Contractor, AA., Banducci, AN., Dolan, M., et al.[2023]

In a study of 73 veterans with chronic combat-related PTSD, risperidone significantly improved overall PTSD symptoms and specifically reduced arousal symptoms compared to placebo over a 4-month period.

Risperidone was well tolerated and showed potential benefits for a range of psychiatric symptoms, suggesting that atypical antipsychotics like risperidone may be effective beyond just treating psychosis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adjunctive risperidone in the treatment of chronic combat-related posttraumatic stress disorder. Bartzokis, G., Lu, PH., Turner, J., et al.[2015]

In a study of 110 patients with chronic PTSD, 79% expressed treatment preferences, with a significant majority preferring interpersonal psychotherapy over other options, despite prolonged exposure having more empirical support.

While treatment preferences did not significantly predict overall treatment outcomes, patients with comorbid depression who received their unwanted treatment showed worse PTSD symptoms, indicating that patient preference can subtly influence therapy effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment preferences of psychotherapy patients with chronic PTSD. Markowitz, JC., Meehan, KB., Petkova, E., et al.[2016]

The FDA and the Spanish Ministry of Health have approved pilot studies for MDMA-assisted psychotherapy in chronic PTSD patients who have not responded to conventional treatments, indicating a favorable risk/benefit ratio for this approach.

These studies, funded by the Multidisciplinary Association for Psychedelic Studies (MAPS), aim to rigorously evaluate the safety and efficacy of MDMA in treating PTSD over a five-year period, with an estimated cost of 5 million dollars.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD): partnering with the FDA. Doblin, R.[2013]

In a pilot study with 12 participants, the Processing of Positive Memories Technique (PPMT) showed promising effects on reducing PTSD severity, with 9 out of 12 participants demonstrating reliable improvements.

PPMT also positively impacted depression and negative affect levels, suggesting it may be a valuable addition to existing PTSD treatments, particularly in enhancing emotional regulation and cognitive processing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Open Label Pilot Study on Posttrauma Health Impacts of the Processing of Positive Memories Technique (PPMT). Contractor, AA., Jin, L., Weiss, NH.[2023]

The Prolonged Exposure for Primary Care (PE-PC) treatment, developed for veterans with PTSD, has shown efficacy in reducing PTSD symptoms and could serve as a new access point for effective care in primary care settings.

The IMPACT study aims to assess the functional improvements in veterans receiving PE-PC compared to standard treatment, potentially increasing access to high-quality PTSD care for a larger number of veterans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving function through primary care treatment of PTSD: The IMPACT study protocol. Rauch, SAM., Kim, HM., Acierno, R., et al.[2023]

A study involving 183 participants (60 from a community mental health center and 123 from Amazon's Mechanical Turk) found that individuals with PTSD are open to discussing positive memories in therapy, which could enhance their treatment experience.

Participants reported that focusing on positive memories could improve mood, self-esteem, and overall satisfaction with PTSD treatment, suggesting that integrating this approach could be beneficial in existing therapeutic practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Exploratory Examination of Client Perspectives on a Positive Memory Technique for PTSD. Caldas, SV., Jin, L., Dolan, M., et al.[2021]

The Positive Memory-PTSD model suggests that focusing on positive memory retrieval can be beneficial for individuals with PTSD, emphasizing the need to differentiate between specific and overgeneral positive memories.

The review highlights the importance of considering individual differences, such as trauma type and co-occurring conditions, which may influence how positive memories affect PTSD symptoms and recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Critical considerations for the positive memory-posttraumatic stress disorder model. Contractor, AA., Banducci, AN., Weiss, NH.[2022]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT04336072

Reminder Focused Positive Psychiatry in Adolescents With ... In this randomized clinical trial, 24 subjects with comorbid ADHD and PTSD, aged 12-18 years old, free of known medical and other major psychiatric disorders, ...

2. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.psychotherapy.20200061

Reminder-Focused Positive Psychiatry: Suicide Prevention ... The current evidence supports the capacity for RFPP-S to improve symptoms of posttraumatic stress disorder (PTSD) and suicidality. ... RFPP-S is ...

3. psychiatrist.com psychiatrist.com/pcc/reminder-focused-positive-psychiatry-in-adhd-and-ptsd/

A Randomized Controlled Feasibility Trial of Reminder ... This study investigated the impact of reminder-focused positive psychiatry on PTSD and ADHD symptoms, neuroinflammation, vascular function, well

4. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/32898346/

A Randomized Controlled Feasibility Trial of Reminder ... Conclusions: RFPP is associated with improvement in core PTSD and ADHD symptoms, decrease in inflammation, and increase in well-being, vascular ...

5. trialx.com trialx.com/clinical-trials/listings/258865/biomolecular-characteristics-of-reminder-focused-positive-psychiatry/?&radius=50

Biomolecular Characteristics of Reminder-Focused ... Reminder focused positive psychiatry (RFPP) has been shown as well tolerated feasible trauma focused intervention that is associated with ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT04529031

NCT04529031 | Biomolecular Characteristics of Reminder- ... Reminder focused positive psychiatry (RFPP) has been shown as well tolerated feasible trauma focused intervention that is associated with improved core PTSD ...

7. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/35903914/

Reminder-Focused Positive Psychiatry: Suicide Prevention ... Conclusions: RFPP-S was associated with reduced PTSD symptoms, enhanced coping skills while experiencing trauma reminders, adoption of safety ...

8. researchgate.net researchgate.net/publication/362341655_Reminder-Focused_Positive_Psychiatry_Suicide_Prevention_Among_Youths_With_Comorbid_Posttraumatic_Stress_Disorder_and_Suicidality

Reminder-Focused Positive Psychiatry: Suicide Prevention ... Results: On day 2, the RFPP-S group showed a greater reduction in PTSD symptoms (55%) and reactivity to trauma and loss reminders (80%) compared ...