CNS Neuroscience and Therapeutics
Volume 15, Issue 3, 2009, Pages 255-263

Mechanisms of efficacy of CBT for cambodian refugees with PTSD: Improvement in emotion regulation and orthostatic blood pressure response (Article)

Hinton D.E. , Hofmann S.G. , Pollack M.H. , Otto M.W.
  • a Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA, United States, Southeast Asian Clinic, Arbour Counseling, Lowell, MA, United States
  • b Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States
  • c Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA, United States
  • d Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States

Abstract

Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure - the systolic blood pressure response to orthostasis (d = 1.31) - as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment. © 2009 Blackwell Publishing Ltd.

Author Keywords

posttraumatic stress disorder Cognitive-behavior therapy Panic attacks Orthostatic intolerance Emotion regulation Cambodian refugees

Index Keywords

Panic Disorder Heart Rate blood pressure Emotions Cambodia human Hypotension, Orthostatic Refugees middle aged blood pressure regulation Asian continental ancestry group controlled study cognitive therapy panic Humans Treatment Outcome male female standing psychological rating scale scoring system psychologic test Article psychometry adult emotionality posttraumatic stress disorder Stress Disorders, Post-Traumatic blood pressure measurement vagus tone orthostatic blood pressure serotonin uptake inhibitor systolic blood pressure diastolic blood pressure Pilot Projects
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-68849089513&doi=10.1111%2fj.1755-5949.2009.00100.x&partnerID=40&md5=97b4e8b2ae21f34f32880fca78b6a075
DOI: 10.1111/j.1755-5949.2009.00100.x
ISSN: 17555930
Cited by: 89
Original Language: English