Psychotherapy and Psychosomatics最新文献

Introduction: Posttraumatic stress disorder (PTSD) presents a significant challenge within the treatment of mental health issues, particularly in veterans and first responders who often experience resistance to standard treatments. This study evaluated the effectiveness of a virtual reality exposure-based treatment with motion as compared to treatment as usual (TAU), as first-line treatment for PTSD within these populations.

Methods: This multicenter, parallel, single-blind, non-inferiority randomized controlled trial was conducted in three centers across the Netherlands. We included adults diagnosed with occupational or combat-related PTSD, without prior treatment history. Participants were randomized (1:1) to receive either manualized multi-modal motion-assisted memory desensitization and reconsolidation (3MDR) therapy or manualized regular trauma-focused psychotherapy (TAU). 3MDR was applied in fewer sessions than TAU. Primary outcome was self-reported PTSD severity, based on the PTSD Checklist for DSM-5, assessed at baseline, post-treatment, 3 and 6 months post-treatment. Secondary outcomes were clinician-rated PTSD, avoidance, comorbid disorders and symptoms, and functioning. The trial was prospectively registered in the Dutch Trial Register, NL-OMON55588.

Results: Between February 15, 2018, and July 22, 2022, 134 participants with PTSD were enrolled, with 67 (50%) randomized to 3MDR and 67 (50%) to TAU of whom 106 (79%) were veterans, and 28 (21%) were first responders. Significant time effects were demonstrated in self-reported and clinician-rated PTSD severity for both groups, as well as in avoidance, comorbid disorders, and functioning. At 6 months post-treatment, 3MDR proved to be non-inferior to TAU in terms of self-reported PTSD (mean difference = -2.91 [95% CI -7.92, 2.10], p = 0.25).

Conclusion: 3MDR demonstrates to be an effective alternative first-line treatment for PTSD stemming from occupational traumatic events. Even though it leans on infrastructure with a treadmill and other hardware components, it may offer an alternative over conventional trauma-focused psychotherapies for PTSD that yields savings of a quarter of time spent within therapy.

Introduction: Agoraphobic avoidance, fear of situations that seem hard to escape, is common across mental disorders and often remains untreated due to stigma and limited service access. Automated virtual reality (VR) exposure therapy offers a scalable alternative by enabling safe, guided simulations of feared situations. This randomized controlled trial evaluated the efficacy of a culturally adapted version of gameChange VR for reducing agoraphobic avoidance among adults in Hong Kong without psychiatric diagnoses.

Methods: 272 participants were randomly assigned to either a three-session VR intervention (n = 146) or a waitlist control condition (n = 126). Assessments were conducted at baseline, 3-week, and 1-month follow-ups. Compared to the control condition, participants in the VR intervention condition showed significant reductions in the primary outcome of agoraphobic avoidance (Cohen's d = 0.89), and all the secondary outcomes of agoraphobic distress (d = 1.0), social anxiety (d = 0.91), fear of negative evaluation (d = 0.68), generalized anxiety (d = 0.50), depressive symptoms (d = 0.67), and functional impairment (d = 0.85) at 3 weeks.

Results: Significant group differences for all outcomes remained at the 1-month follow-up. Higher baseline levels of agoraphobic symptoms were associated with larger improvements in agoraphobic avoidance.

Conclusion: These findings suggest that the automated VR intervention is effective in reducing agoraphobic symptoms in non-clinical populations and appears to be a scalable treatment in Asia where stigma is strong. Future studies could include longer follow-ups and address pandemic-related confounds on avoidance behaviours.

Introduction: Achieving sustainable success in the treatment of anxiety disorders remains a central objective in mental health care. Although research has demonstrated the short-term efficacy of psychotherapy, evidence regarding long-term sustainability is limited. This study examined treatment outcomes 5 years after prediction-error-based exposure therapy.

Methods: For 355 patients (616 eligible; 58% follow-up rate), newly collected follow-up data on anxiety symptoms and psychosocial functioning were compared to pretreatment, posttreatment, and 6-month follow-up data from a multicenter clinical trial characterized by high treatment fidelity.

Results: Improvements in anxiety symptoms and psychosocial functioning that were evident at posttreatment and 6-month follow-up were largely preserved after 5 years. No significant differences emerged between randomized groups of temporally intensified and non-intensified exposure. From 6 months to 5 years, overall remission rates remained stable, with the majority of patients exhibiting no reliable change in symptom severity. Reliable relapse occurred in 4.9% and reliable new remission in 6.5%. Most patients (63.4%) did not seek additional treatment. Among those who did, depression (64.2%) and anxiety (60.5%) were the most frequently cited reasons, although only a minority (6.0%) sought further treatment exclusively for anxiety. Additional treatment during the follow-up period was associated with higher symptom severity throughout assessments.

Conclusion: These findings highlight the sustainability and long-term public health benefits of exposure-based CBT for anxiety disorders. Most patients do not need additional treatments for mental disorders even 5 years after treatment. Nevertheless, further efforts are needed to optimize interventions for those patients who do not achieve remission or experience relapse.