Habituation of distress and craving during treatment as predictors of change in PTSD symptoms and substance use severity

Abstract

Objective: Increasing evidence supports the efficacy of trauma-focused exposure therapy in the treatment of posttraumatic stress disorder (PTSD) and co-occurring substance use disorders. Little is known, however, about the mechanisms of change in treatment for patients with PTSD and co-occurring substance use disorders. The aim of the present study was to examine whether within- and between-session habituation of distress and substance craving during imaginal exposure relates to treatment outcomes among U.S. military veterans with PTSD and a co-occurring substance use disorder (N = 54).

Method: Veterans received Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure, a manualized integrated treatment combining prolonged exposure with cognitive-behavioral therapy for substance use disorders as part of a larger randomized clinical trial. Self-reported distress and craving ratings were collected during each imaginal exposure session.

Results: Data were analyzed using a series of random intercept and slope multilevel linear and generalized linear models. Results revealed that between-session habituation of distress and craving was associated with greater improvement in PTSD symptoms during treatment. Between-session habituation of craving was also associated with a marginally greater reduction in frequency of substance use among participants still reporting use during treatment. Within-session habituation of distress was unrelated to treatment outcome.

Conclusion: Together, these findings indicate that habituation in both distress and craving may be important in maximizing treatment outcome for patients with PTSD and comorbid substance use disorders. (PsycINFO Database Record

Conflict of interest statement

There are no conflicts of interest.

(c) 2017 APA, all rights reserved).

Figures

Figure 1. Means, standard errors, and unconditional growth models for change in (A) PTSD symptoms, (B) percent of participants using any substance, and (C) percent days using any substances, conditional on use

Figure 2. (A) Estimated change in PTSD symptoms across treatment as a function of between-session SUDS habituation, (B) Estimated change in PTSD symptoms across treatment as a function of between-session SUDS craving habituation, (C) Estimated change in percent days using any substances, conditional on use, as a function of between-session craving habituation