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Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.

Publication ,  Journal Article
Crawford, EF; Wolf, GK; Kretzmer, T; Dillon, KH; Thors, C; Vanderploeg, RD
Published in: J Nerv Ment Dis
February 2017

In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed. Other patient-level factors including age, time since injury, and baseline NBS were unrelated to significant improvements. Findings emphasized the impact of PE dosage, indicated greater mastery of the protocol was beneficial, and showed that service connection could impede self-reported, clinically significant change during PE in this important cohort.

Duke Scholars

Published In

J Nerv Ment Dis

DOI

EISSN

1539-736X

Publication Date

February 2017

Volume

205

Issue

2

Start / End Page

140 / 146

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Time Factors
  • Stress Disorders, Post-Traumatic
  • Psychiatry
  • Middle Aged
  • Male
  • Injury Severity Score
  • Implosive Therapy
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Crawford, E. F., Wolf, G. K., Kretzmer, T., Dillon, K. H., Thors, C., & Vanderploeg, R. D. (2017). Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury. J Nerv Ment Dis, 205(2), 140–146. https://doi.org/10.1097/NMD.0000000000000594
Crawford, Eric Floyd, Gregory K. Wolf, Tracy Kretzmer, Kirsten H. Dillon, Christina Thors, and Rodney D. Vanderploeg. “Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.J Nerv Ment Dis 205, no. 2 (February 2017): 140–46. https://doi.org/10.1097/NMD.0000000000000594.
Crawford, Eric Floyd, et al. “Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.J Nerv Ment Dis, vol. 205, no. 2, Feb. 2017, pp. 140–46. Pubmed, doi:10.1097/NMD.0000000000000594.

Published In

J Nerv Ment Dis

DOI

EISSN

1539-736X

Publication Date

February 2017

Volume

205

Issue

2

Start / End Page

140 / 146

Location

United States

Related Subject Headings

  • Veterans
  • Treatment Outcome
  • Time Factors
  • Stress Disorders, Post-Traumatic
  • Psychiatry
  • Middle Aged
  • Male
  • Injury Severity Score
  • Implosive Therapy
  • Humans