Acceptance and Commitment Therapy for Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorders in Veterans: Pilot Treatment Outcomes.
Eric C Meyer, Robyn D. Walser, Barbara Hermann, Heidi La Bash, Bryann B DeBeer, Sandra B Morissette, Nathan A Kimbrel, Oi-Man Kwok, Sonja V Batten, Paula P. Schnurr
Journal of Traumatic Stress October 19, 2018 DOI: 10.1002/jts.22322 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Uncontrolled pilot study Peer reviewed |
|---|---|
| Sample size | 43 |
| Population | Veterans with co-occurring PTSD and alcohol use disorder |
| Intervention | Acceptance and Commitment Therapy (ACT) |
| Duration | 12-session outpatient individual therapy protocol; 3-month follow-up |
| Topics | Meditation Addiction PTSD |
| Keywords | Humans Alcoholism Treatment outcome Cohort studies Pilot projects Stress disorders, post-traumatic Quality of life Veterans Female |
| Key points | Among 43 veterans with co-occurring PTSD and AUD, an uncontrolled 12-session ACT protocol was associated with reductions in PTSD and alcohol-related symptoms at posttreatment that largely persisted at 3-month follow-up, along with higher quality of life and fewer depressive symptoms. The authors report that improvements were associated with more between-session mindfulness practice and reductions in experiential avoidance and psychological inflexibility, consistent with the ACT model. |
Abstract
Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co-occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD-AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness- and acceptance-based form of behavior therapy, has potential as a treatment option for PTSD-AUD. In this uncontrolled pilot study, we examined ACT for PTSD-AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician-assessed and self-reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self-reported symptoms of PTSD remained lower at 3-month follow-up, d = 0.88. There were reductions on all alcohol-related outcomes (clinician-assessed and self-reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3-month follow-up, dmean = 0.91 (d range: 0.65-1.30). Quality of life increased at posttreatment and follow-up, ds = 0.55-0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow-up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow-up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow-up. Consistent with the ACT theoretical model, these improvements were associated with more between-session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD-AUD include assigning frequent between-session mindfulness practice and initiating values clarification work and values-based behavior assignments early in treatment.
Comparable studies
Other non-randomized and open-label trials on PTSD, most cited first.
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