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INFLUENTIAL PUBLICATIONS   |    
Augmenting Cognitive Behaviour Therapy for Post-Traumatic Stress Disorder with Emotion Tolerance Training: A Randomized Controlled Trial
R. A. Bryant; J. Mastrodomenico; S. Hopwood; L. Kenny; C. Cahill; E. Kandris; K. Taylor
FOCUS 2013;11:379-386. doi:10.1176/appi.focus.11.3.379
Abstract

Background  Many patients do not adhere to or benefit from cognitive behaviour therapy (CBT) for post-traumatic stress disorder (PTSD). This randomized controlled trial evaluates the extent to which preparing patients with emotion regulation skills prior to CBT enhances treatment outcome.

Method  A total of 70 adult civilian patients with PTSD were randomized to 12 sessions of either supportive counselling followed by CBT (Support/CBT) or emotion regulation training followed by CBT (Skills/CBT).

Results  Skills/CBT resulted in fewer treatment drop-outs, less PTSD and anxiety, and fewer negative appraisals at 6 months follow-up than Support/CBT. Between-condition effect size was moderate for PTSD severity (0.43, 95% confidence interval –0.04 to 0.90). More Skills/CBT (31%) patients achieved high end-state functioning at follow-up than patients in Support/CBT (12%) [χ2(n = 70) = 3.67, p < 0.05].

Conclusions  This evidence suggests that response to CBT may be enhanced in PTSD patients by preparing them with emotion regulation skills. High attrition of participants during the study limits conclusions from this study.
(Reprinted with permission from Psychological Medicine 2013;11:1–8) 

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Fig. 1. Patient Participation in the Study. Support/CBT, Supportive Counselling Followed by Cognitive Behaviour Therapy; Skills/CBT, Emotion Regulation Training Followed by CBT.
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Table 1.Participant Characteristics
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Support/CBT, Supportive counselling followed by cognitive behaviour therapy; Skills/CBT, emotion regulation training followed by CBT; s.d., standard deviation; MVA, motor vehicle accident; MDD, major depressive disorder.

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Table 2.Psychopathology Measures on Intent-to-Treat Sample
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Support/CBT, Supportive counselling followed by cognitive behaviour therapy; Skills/CBT, emotion regulation training followed by CBT; CI, confidence interval; CAPS, Clinician Administered Posttraumatic Stress Disorder Scale; IES, Impact of Event Scale; BDI-II, Beck Depression Inventory, 2nd edn; BAI, Beck Anxiety Inventory; PTCI, Posttraumatic Cognitions Inventory.

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Data are given as mean (standard deviation).

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Table 3.Distress Ratings Across Sessionsa
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Data are given as mean (standard deviation).

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Support/CBT, Supportive counselling followed by cognitive behaviour therapy; Skills/CBT, emotion regulation training followed by CBT.

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aRange of Subjective Units of Distress Rating: 0 = not at all distressed; 100 = extremely distressed.

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bExposure therapy commenced in session 6.

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