Physiological response to combat memories and preliminary treatment outcome in Vietnam veteran PTSD patients treated with direct therapeutic exposure.

Two individual treatment conditions for PTSD in Vietnam veterans were compared: direct therapeutic exposure (DTE) was compared to conventional one-on-one counseling (controls). All patients received an intensive group treatment milieu program in a VA inpatient treatment program specifically designed for PTSD. Physiological responses to imaginal exposure scenes of stressful memories of combat were recorded. These physiological measures were taken prior to treatment, and immediately following treatment. Three physiological responses were evaluated: heart rate, frontalis electromyography and skin conductance. All three measures indicated strong responding to the exposure scenes at both pre-and post-treatment. While there were no significant differences between the treatment conditions in physiological responding after therapy, there were trends that indicated that the DTE group had decreased physiological responding to the exposure scenes when compared to controls that could prove significant at planned follow-up. Subjects were also given a preliminary psychological and behavioral evaluation to determine treatment outcome at three months following treatment. This evaluation indicated that the DTE treated group improved when compared to controls. Results supported the notion that those subjects who did evidence decreased physiological responding to the imaginal scenes immediately following treatment, also improved psychologically at three months follow-up when compared to subjects who did not have reduced physiological responding, regardless of treatment received.

[1]  J. Fairbank,et al.  Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. , 1989 .

[2]  L. Kolb.  A neuropsychological hypothesis explaining posttraumatic stress disorders. , 1987, The American journal of psychiatry.

[3]  L. Hyer,et al.  PTSD among vietnam veterans: An early look at treatment outcome using direct therapeutic exposure , 1990 .

[4]  D. Kilpatrick,et al.  Some cautionary remarks on treating sexual assault victims with implosion , 1984 .

[5]  D. Levis,et al.  Essentials of implosive therapy: a learning-theory-based psychodynamic behavioral therapy. , 1967, Journal of abnormal psychology.

[6]  R. Shipley,et al.  Flooding and implosive therapy: Are they harmful? , 1980 .

[7]  J. Fairbank,et al.  Validation of a multimethod assessment of posttraumatic stress disorders in Vietnam veterans. , 1983, Journal of consulting and clinical psychology.

[8]  L. Hyer,et al.  Key determinants of the MMPI-PTSD subscale: treatment considerations. , 1987, Journal of clinical psychology.

[9]  F. Brush.  The effects of shock intensity on the acquisition and extinction of an avoidance response in dogs. , 1957, Journal of comparative and physiological psychology.

[10]  R. Solomon,et al.  Traumatic avoidance learning: the principles of anxiety conservation and partial irreversibility. , 1954, Psychological review.

[11]  L. Kolb.  The post-traumatic stress disorders of combat: a subgroup with a conditioned emotional response. , 1984, Military medicine.

[12]  J. Fairbank,et al.  Empirical development of an MMPI subscale for the assessment of combat-related posttraumatic stress disorder. , 1984, Journal of consulting and clinical psychology.

[13]  W. Wilson,et al.  Observations on persistence of war neurosis. , 1960, Diseases of the nervous system.

[14]  L. Hyer,et al.  Concurrent Validation of the Millon Clinical Multiaxial Inventory among Vietnam Veterans with Posttraumatic Stress Disorder , 1988 .

[15]  R. T. Saucer,et al.  Vietnam veterans: overreporting versus acceptable reporting of symptoms. , 1988, Journal of personality assessment.

[16]  E. Blanchard,et al.  Cardiac response to relevant stimuli as an adjunctive tool for diagnosing post-traumatic stress disorder in Vietnam veterans * , 1986 .

[17]  D. Levis,et al.  Autonomic reactivity of high and low ego-strength subjects to repeated anxiety eliciting scenes. , 1975, Journal of abnormal psychology.

[18]  R. Gerardi,et al.  Multidimensional assessment of combat-related PTSD: Phenomenological, psychometric, and psychophysiological considerations , 1988 .

[19]  S. Orr,et al.  Psychophysiologic assessment of posttraumatic stress disorder imagery in Vietnam combat veterans. , 1987, Archives of general psychiatry.

[20]  J. Mintz,et al.  Measuring the outcomes of psychotherapy: findings of the Penn Psychotherapy Project. , 1979, Journal of consulting and clinical psychology.

[21]  R. T. Saucer,et al.  Inpatient diagnosis of posttraumatic stress disorder. , 1986, Journal of consulting and clinical psychology.

[22]  C. Turner,et al.  Self-control practices associated with weight loss maintenance in children and adolescents* , 1980 .

[23]  J. Fairbank,et al.  Flooding for combat-related stress disorders: Assessment of anxiety reduction across traumatic memories , 1982 .

[24]  T. Keane,et al.  Mississippi Scale for Combat-Related Posttraumatic Stress Disorder: three studies in reliability and validity. , 1988, Journal of consulting and clinical psychology.

[25]  J. Fallon,et al.  MMPI overreporting by Vietnam combat veterans. , 1987, Journal of clinical psychology.

[26]  D. Levis,et al.  A Review of the Theoretical Rationale and Empirical Support for the Extinction Approach of Implosive (Flooding) Therapy , 1977 .

[27]  R. Mcfarland.  Post-Traumatic Stress Disorder and Concurrent Psychiatric Illness , 1985 .

[28]  Some characteristics of effective psychiatric treatment programs. , 1979 .

[29]  L. Robins,et al.  National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. , 1981, Archives of general psychiatry.

[30]  K. Morganstern.  Implosive therapy and flooding procedures: a critical review. , 1973, Psychological bulletin.