Summary: Augmenting exposure therapy with ten minutes of aerobic exercise reduces the severity of PTSD symptoms for up to six months after a nine-week course of treatment ends.
Font: University of New South Wales
Exposure therapy is one of the main treatments for post-traumatic stress disorder (PTSD), but up to half of all patients do not respond to it.
But now, a study led by UNSW Sydney psychologists found that augmenting therapy with 10 minutes of aerobic exercise has led patients to report a further reduction in the severity of PTSD symptoms six months after the nine-month treatment ended. weeks.
In the first known single-blind randomized control trial of its kind, researchers in Sydney recruited 130 adults with clinically diagnosed PTSD and assigned them to two groups. People in both groups received nine 90-minute exposure therapy sessions. At the end of each session, one group performed 10 minutes of aerobic exercise, while members of the control group received 10 minutes of passive stretching.
People in the aerobic exercise group on average reported less PTSD symptom severity, as measured by the CAPS-2 scale, than those who had their exposure therapy augmented with stretching exercises at six-month follow-up. Interestingly, there were no clear differences between the two groups one week after the treatment program ended, suggesting that benefits take time to develop.
The findings were reported in The Lancet Psychiatry.
extinction learning
Scientia Professor Richard Bryant supervised the clinical research that took place between 2012 and 2018. He says that the goal of exposure therapy in the treatment of PTSD is extinction learning, where a patient learns to equate something that until now I had associated with the trauma, with a feeling. of security
For example, a person who has experienced sexual violence may associate some of the stimuli that were present at the time of the trauma, such as the night, sexual activity, the smell of aftershave, etc., with threats. Exposure therapy would target these triggers and try to demonstrate that they pose no threat, in the hope that after gradual and repeated exposure, extinction learning would become embedded in the patient’s brain.
“Learning from extinction is not unlearning from bad experience,” says Prof. Bryant. “It is a new learning that inhibits the old learning.
“Previous studies have shown that very brief periods of aerobic exercise can be useful because they actually promote extinction learning in rats and have also been shown to promote it in humans under experimental conditions.”
But the theory had not been tested in clinical conditions until now. Prof. Bryant and his colleagues say they believe brief, intense exercise promotes a particular growth molecule in the brain called Brain-Derived Neurotrophic Factor, or BDNF.
“That’s really important because it actually promotes synaptic plasticity in the brain, which is really important for learning. And we know that this underpins extinction learning. So if we can make this BDNF more active in the brain, at the time of exposure therapy, theoretically that should lead to better extinction.”
More studies are needed
To Prof. Bryant’s knowledge, this is the first time the benefits of aerobic exercise in conjunction with exposure therapy have been observed in a clinical setting. But despite being pleasantly surprised by the results, he says the study needs to be repeated several times before this modification of therapy is recommended, becomes standard practice, or is used to treat other psychological conditions.
“I’d really like to stress that this is the first trial to show this in an anxiety disorder and I don’t think we need to get too excited,” he says.
“But as with all these things, you always need multiple tries to have faith in it. So I certainly don’t tell people to burn out and start exercising after all their exposure therapy, because I think it’s premature after a test. But having said that, this is very encouraging.”
Prof Bryant says there is a large trial replicating the method in Melbourne at the moment, which he and his colleagues will watch with interest.
See also
About these PTSD and exercise research news
Author: lachlan gilbert
Font: University of New South Wales
Contact: Lachlan Gilbert – University of New South Wales
Image: The image is in the public domain.
original research: closed access.
“Scaling trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomized clinical trial” by Richard A. Bryant et al. Lancet Psychiatry
Summary
Scaling trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomized clinical trial
Background
Although exposure therapy is central to most first-line psychotherapies for post-traumatic stress disorder (PTSD), many patients do not respond to this treatment. Our objective was to investigate the effects of brief aerobic exercise on the efficacy of exposure therapy in reducing the severity of PTSD.
methods
We did a single-blind, parallel, randomized controlled trial in Sydney, NSW, Australia. Adults (≥18 years) with physician-diagnosed PTSD were included. Participants 70 years of age or older, with imminent suicidal risk (reported suicide plan), presence of psychosis or substance dependence, history of moderate to severe head injury, or presence of a physical disorder or impairment that could be exacerbated were excluded. from aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine weekly 90-min sessions of PTSD exposure therapy with 10 min of aerobic exercise or the control group of exposure therapy with 10 min of passive stretching. The primary outcome was PTSD severity as measured by physician-administered PTSD scale 2 (CAPS-2), independently assessed at baseline, 1 week post-treatment, and 6 months post-treatment (time point of study). primary outcome).
recommendations
Between December 12, 2012, and July 25, 2018, we enrolled 130 participants with PTSD, with 65 (50%) participants randomized to exercise exposure therapy and 65 (50%) to stretch exposure therapy passive, including 79 (61%) women and 51 (39%) men, with a mean age of 39.1 years (SD 14.4; range 18-69). 99 (76%) participants were White, 14 (11%) were Asian, and 17 (13%) were listed as Other. At the 6-month follow-up assessment, participants in the exercise exposure therapy group showed greater reductions in CAPS-2 scores relative to those in the stretch exposure therapy group (mean difference 12 1 [95% CI 2·4–21·8]; p=0 023), resulting in a moderate effect size of 0 6 (0 1–1 1). No adverse events associated with the intervention were reported. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864.
Interpretation
Brief aerobic exercise has the potential to increase the long-term gains of exposure therapy for PTSD, which is consistent with evidence from animal and human studies on the role of exercise in modulating extinction learning processes. . This strategy could offer a simple and affordable means of increasing the treatment benefits of exposure therapy in people with PTSD.
Money
National Health and Medical Research Council of Australia.
