The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer.

Two studies suggest that reductions in posttraumatic symptoms (Aderka et al., 2013) and cognitions (Zalta et al., 2014) precede reductions in depressive symptoms during prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) in female assault survivors. The present study explored the temporal relationship between posttraumatic and depressive symptoms in a randomized trial of D-Cycloserine (DCS) versus placebo augmented virtual reality exposure (VRE) therapy for chronic World Trade Center-related PTSD following the September 11, 2001 terrorist attacks. Twenty-five male and female participants were randomly assigned to receive either 100 mg DCS (N = 13) or placebo (N = 12) 90 min before 12 weekly VRE sessions. Participants contributed a total of 280 weekly PTSD Checklist (PCL; Weathers et al., 1993) and Beck Depression Inventory-second edition (BDI-II; Beck et al., 1996) symptom scores. Two sets of mediation analyses for longitudinal mixed models assessed the effects of 1) lagged PCL on BDI-II (Model 1), and 2) lagged BDI-II on PCL (Model 2) in the VRE-DCS and VRE-Placebo treatment groups, respectively. Results revealed reciprocal relations between posttraumatic and depressive symptoms during VRE treatment, although reductions in posttraumatic symptoms led to subsequent reductions in depressive symptoms to a greater extent than the converse. These effects were stronger in the DCS-enhanced group. Findings suggest that VRE primarily decreases posttraumatic symptoms, which in turn leads to decreased depressive symptoms, and that DCS may strengthen these effects.

[1]  M. Sim,et al.  Comorbidity of PTSD and depression in Korean War veterans: prevalence, predictors, and impairment. , 2010, Journal of affective disorders.

[2]  Peter W. Tuerk,et al.  A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. , 2010, Journal of traumatic stress.

[3]  J. Gradus,et al.  TREATMENT OF POSTTRAUMATIC STRESS DISORDER REDUCES SUICIDAL IDEATION , 2013, Depression and anxiety.

[4]  E. Youngstrom,et al.  The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. , 2013, Journal of traumatic stress.

[5]  J. Fairbank,et al.  Lifetime major depression and comorbid disorders among current-era women veterans. , 2014, Journal of affective disorders.

[6]  Israel Liberzon,et al.  Prolonged exposure for PTSD in a Veterans Health Administration PTSD clinic. , 2009, Journal of traumatic stress.

[7]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[8]  Jacqueline Grennon.  , 2nd Ed. , 2002, The Journal of nervous and mental disease.

[9]  H. Sørensen,et al.  Posttraumatic stress disorder and completed suicide. , 2010, American journal of epidemiology.

[10]  D. A. Kenny,et al.  Lower Level Mediation in Multilevel Models , 2022 .

[11]  Matthew S. Fritz,et al.  PSYCHOLOGICAL SCIENCE Research Article Required Sample Size to Detect the Mediated Effect , 2022 .

[12]  J. Boscarino,et al.  Predictors of PTSD and Delayed PTSD After Disaster: The Impact of Exposure and Psychosocial Resources , 2006, The Journal of nervous and mental disease.

[13]  D. Cole,et al.  A longitudinal look at the relation between depression and anxiety in children and adolescents. , 1998, Journal of consulting and clinical psychology.

[14]  R. Richardson,et al.  Effects of D-cycloserine on extinction of conditioned freezing. , 2003, Behavioral neuroscience.

[15]  M. O'Donnell,et al.  Posttraumatic stress disorder and depression following trauma: understanding comorbidity. , 2004, The American journal of psychiatry.

[16]  E. Spitznagel,et al.  The Course of PTSD, Major Depression, Substance Abuse, and Somatization After a Natural Disaster , 2004, The Journal of nervous and mental disease.

[17]  David P MacKinnon,et al.  RMediation: An R package for mediation analysis confidence intervals , 2011, Behavior research methods.

[18]  Michael K Suvak,et al.  Changes in posttraumatic stress disorder and depressive symptoms during cognitive processing therapy: evidence for concurrent change. , 2012, Journal of consulting and clinical psychology.

[19]  Nicholas Tarrier,et al.  Cognitive behaviour therapy for posttraumatic stress disorder. , 2003, Clinical psychology review.

[20]  Naomi M Simon,et al.  Augmentation of exposure therapy with D-cycloserine for social anxiety disorder. , 2006, Archives of general psychiatry.

[21]  S. Orr,et al.  Prospective study of posttraumatic stress disorder and depression following trauma. , 1998, The American journal of psychiatry.

[22]  E. Foa,et al.  Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. , 2005, Journal of consulting and clinical psychology.

[23]  Rick Richardson,et al.  Effects of D-Cycloserine on Extinction: Translation From Preclinical to Clinical Work , 2006, Biological Psychiatry.

[24]  P. Nishith,et al.  An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. , 2004, Journal of affective disorders.

[25]  S. Mineka,et al.  Comorbidity of anxiety and depressive disorders: A helplessness-hopelessness perspective. , 1990 .

[26]  P. Schnurr,et al.  Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. , 2006, Journal of consulting and clinical psychology.

[27]  D. King,et al.  Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis. , 2001, Journal of consulting and clinical psychology.

[28]  J. Difede,et al.  Evidence-based treatment of post-traumatic stress disorder. , 2014, Annual review of medicine.

[29]  Idan M. Aderka,et al.  Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents. , 2011, Journal of consulting and clinical psychology.

[30]  A. Guastella,et al.  A Randomized Controlled Trial of D-Cycloserine Enhancement of Exposure Therapy for Social Anxiety Disorder , 2008, Biological Psychiatry.

[31]  E. Foa,et al.  Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. , 2004, Journal of consulting and clinical psychology.

[32]  Z. Steel,et al.  Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. , 2004, Journal of affective disorders.

[33]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[34]  G. Pearlson,et al.  Efficacy of D-Cycloserine for Enhancing Response to Cognitive-Behavior Therapy for Panic Disorder , 2010, Biological Psychiatry.

[35]  T. Galovski,et al.  A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. , 2008, Journal of consulting and clinical psychology.

[36]  Seth J. Gillihan,et al.  The relationship between posttraumatic and depressive symptoms during prolonged exposure with and without cognitive restructuring for the treatment of posttraumatic stress disorder. , 2013, Journal of consulting and clinical psychology.

[37]  M. Linehan,et al.  A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. , 2014, Behaviour research and therapy.

[38]  Michael Davis,et al.  Facilitation of Conditioned Fear Extinction by Systemic Administration or Intra-Amygdala Infusions of d-Cycloserine as Assessed with Fear-Potentiated Startle in Rats , 2002, The Journal of Neuroscience.

[39]  P. Nishith,et al.  How Well Does Cognitive-Behavioral Therapy Treat Symptoms of Complex PTSD? An Examination of Child Sexual Abuse Survivors Within A Clinical Trial , 2003, CNS Spectrums.

[40]  Barbara O Rothbaum,et al.  Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. , 2004, Archives of general psychiatry.

[41]  P. Nishith,et al.  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. , 2002, Journal of consulting and clinical psychology.

[42]  B. Green,et al.  Impact of PTSD comorbidity on one-year outcomes in a depression trial. , 2006, Journal of clinical psychology.

[43]  G. Loas,et al.  Vulnerability to depression: a model centered on anhedonia. , 1996, Journal of affective disorders.

[44]  Peter W. Tuerk,et al.  Reducing suicidal ideation through evidence-based treatment for posttraumatic stress disorder. , 2016, Journal of psychiatric research.

[45]  Idan M. Aderka,et al.  Longitudinal associations between post-traumatic distress and depressive symptoms following a traumatic event: a test of three models , 2010, Psychological Medicine.

[46]  Alyson K. Zalta,et al.  Change in negative cognitions associated with PTSD predicts symptom reduction in prolonged exposure. , 2014, Journal of consulting and clinical psychology.

[47]  B. Litz,et al.  PROSPECTIVE INVESTIGATION OF MENTAL HEALTH FOLLOWING SEXUAL ASSAULT , 2013, Depression and anxiety.

[48]  A. Morral,et al.  Influence of emotional engagement and habituation on exposure therapy for PTSD. , 1998, Journal of consulting and clinical psychology.

[49]  H. Hoffman,et al.  D-Cycloserine Augmentation of Exposure Therapy for Post-Traumatic Stress Disorder: A Pilot Randomized Clinical Trial , 2014, Neuropsychopharmacology.

[50]  K. Chard,et al.  An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. , 2005, Journal of consulting and clinical psychology.

[51]  Mark B. Powers,et al.  A meta-analytic review of prolonged exposure for posttraumatic stress disorder. , 2010, Clinical psychology review.