Research Paper about PTSD Treatments

In a 2021 study, Lortye and Will were looking at the prevalence of the co-occurrences of post-traumatic stress disorder and substance abuse disorder. They looked at the effectiveness of different types of PTSD treatments including Eye Moving Desensitisation and Reprocessing (EMDR) and Imagery Rescripting (ImRs), and other promising treatment options in people suffering from PTSD and SUD in a Dutch randomized control trial. Furthermore, they were looking for the most effective PTSD treatment plan offered simultaneously to or after SUD treatment. Research involving the comorbidity of PTSD and SUD and the individual treatment plans for each disorder has been researched as the authors of this study include multiple studies about the effectiveness of prolonged exposure treatment, Eye movement Desensitisation and Reprocessing treatments on PTSD individuals and for individuals with PTSD and SUD. This research does not imply to be novel, as the authors have stated multiples studies that have looked at PTSD and SUD interventions

The authors of this study explicitly state the three main objectives, followed with their expectations and hypothesis to each one, with an exception from the third objective-there is no hypothesis. It makes me wonder why they excluded the third objective? The three goals of this study are to compare the effectiveness of PE, EMDR, and ImRs as an add-on to regular SUD treatment with SUD treatment only in patients with co-occurring PTSD/SUD, to compare the effectiveness of simultaneous SUD/PTSD treatment with sequential SUD/PTSD treatment in patients with co-occurring PTSD/SUD, and finally, to explore differential effectiveness between active PTSD treatments (PE vs. EMDR; PE vs. ImRs, EMDR vs. ImRs) in patients with co-occurring PTSD/SUD. They expect to see a greater reduction in PTSD symptoms in the simultaneous treatment of PTDS and SUD, rather than the sequential treatment plans. The author does include procedural changes due to COVID-19, so I wonder how much of an impact this pandemic will have on the results. Additionally, it is important that they include that as a limitation in the study. 

The methods section was clear and explicit. Replicating this study is doable based on the information given. There are descriptions explaining the specific measures and conditions in each type of treatment plan. They included where the treatment was taking place as well as the timeline for each treatment plan, which was 3.5 years. The inclusive and exclusive criteria for each participant were explicitly stated, as they went into detail to make sure they have a note on multiple aspects of a person’s history. However, with the finite details the put into the criteria, this study poses a risk for high drop out rates. The researchers need to make sure there are enough participants recruited in this study, so the high drop-out potential will not effect the results of their study. They explained in details why they needed to recruit 240 patients. They also followed DSM-5 guidelines when diagnosing patients with PTSD or SUD patients. This allowed for a more uniform apporach in the diagnosis of PTSD and SUD. This also enhances the inter-rater reliability of the therapist when diagnosing these patients who will be a part of the study.  The researchers used and randomized double blind procedure that primarily measures the outcome if PTSD symptoms. The independent variable is the implementation of an additional type of PTSD treatment given in conjuction with a patient’s original SUD treatment, along with the timing they recive the PTSD treatment. Some patients will recieve PTSD treatment simultaneoustly with SUD treatments. Other patients will recieve treatment in squential order. The dependent variable is the scoring of the assessments and surveys that the patients will take every three months. Therapists will submit a self reporting questionsaire for their patient. Becuase the therapist knows what kind of treatment plan the patient is getting, I wonder if that will impact how they fill out the patients report. Implentation of self-reported questionnaires could put the validity of the study at risk, as surveys have high reliability, but poor validity. Furthermore, patients completed these assessments at before treatment, during treatment, and at the follow-up apponitment. This could lead to demand characteristics or bias due to familiarity with the measures. Fortunately, making this study a single blind study, this eliminates some bias with the patients when they are taking these assessments. As for potential outliers, the reaserchers do not state the exclusion criteria for that.

As for the results, the analysis were conducted on an intention-to-treat basis. Linear mixed models are going to be used to model the primary and secondary outcomes with the underlying distribution depending on the type of outcome variable and its distribution. A Bayesian approach will be used to model the outcome parameters, so that the hypothesis and null hypothesis can be estimated. Because this research is still ongoing, the researchers do not have much data to work with, but I am surprised how far along they are. I figured they would be a little more into the project to have some more conclusive results. Nevertheless, the pandemic definitely impacted the progression of this  project. The author of this paper concluded that there is current evidence that simultaneous treatment of PTSD and SUD was beneficial, despite dropout rates being high and reluctance amongst some therapists to treat these patients simultaneouly.

This study has the potential to generating some evidence for the effectiveness of simultaneous treatment of PTSD and SUD. The authors are cohert, organized and meticulous in the way they write this paper, despite having definite results, yet. They back their claims with prior literature. It was concerning to see the potential for an extremely high drop out rate, as this study had intricate inclusion/ exclusion criteria. However the authors were aware of this, and were thorough in assuring that their data results would not be impacted by this according to their statistics. The methods section gives lots of detail about what the patients will go throughout their treatment process.