Glucocorticoid Augmentation of Prolonged Exposure Therapy: Rationale and Case Report

Overview

Journal Eur J Psychotraumatol

Date 2012 Aug 16

PMID 22893802

Citations 14

Authors

Rachel Yehuda

Linda M Bierer

Laura Pratchett

Monica Malowney

Affiliations

Soon will be listed here.

Abstract

Rationale: Prolonged exposure (PE) therapy has been found to reduce symptoms of posttraumatic stress disorder (PTSD); however, it is difficult for many patients to engage fully in the obligatory retelling of their traumatic experiences. This problem is compounded by the fact that habituation and cognitive restructuring - the main mechanisms through which PE is hypothesized to work - are not instantaneous processes, and often require several weeks before the distress associated with imaginal exposure abates.

Case Reports: Two cases are described that respectively illustrate the use of hydrocortisone and placebo, in combination with PE, for the treatment of combat-related PTSD. Based on known effects of glucocorticoids on learning and memory performance, we hypothesized that augmentation with hydrocortisone would improve the therapeutic effects of PE by hastening "new" learning and facilitating decreases in the emotional impact of fear memories during the course of treatment. The veteran receiving hydrocortisone augmentation of PE displayed an accelerated and ultimately greater decline in PTSD symptoms than the veteran receiving placebo.

Conclusions: While no general conclusion can be derived from comparison of two patients, the findings are consistent with the rationale for augmentation. These case reports support the potential for an appropriately designed and powered clinical trial to examine the efficacy of glucocorticoids in augmenting the effects of psychotherapy for PTSD.

Citing Articles

Exogenous glucocorticoids to improve extinction learning for post-traumatic stress disorder patients with hypothalamic-pituitary-adrenal-axis dysregulation: a study protocol description.

de Nooij L, Wirz L, Heling E, Pais M, Hendriks G, Verkes R Eur J Psychotraumatol. 2024; 15(1):2364441.

PMID: 38973398 PMC: 11232644. DOI: 10.1080/20008066.2024.2364441.

Enhancing Psychological Interventions for Post-Traumatic Stress Disorder (PTSD) Treatment with Memory Influencing Drugs.

Marchetta E, Mancini G, Morena M, Campolongo P Curr Neuropharmacol. 2022; 21(3):687-707.

PMID: 36503450 PMC: 10207915. DOI: 10.2174/1570159X21666221207162750.

A decennial review of psychotraumatology: what did we learn and where are we going?.

Olff M, Amstadter A, Armour C, Birkeland M, Bui E, Cloitre M Eur J Psychotraumatol. 2020; 10(1):1672948.

PMID: 31897268 PMC: 6924542. DOI: 10.1080/20008198.2019.1672948.

Translating Molecular and Neuroendocrine Findings in Posttraumatic Stress Disorder and Resilience to Novel Therapies.

DePierro J, Lepow L, Feder A, Yehuda R Biol Psychiatry. 2019; 86(6):454-463.

PMID: 31466562 PMC: 6907400. DOI: 10.1016/j.biopsych.2019.07.009.

Glucocorticoid-induced enhancement of extinction-from animal models to clinical trials.

de Quervain D, Wolf O, Roozendaal B Psychopharmacology (Berl). 2019; 236(1):183-199.

PMID: 30610352 PMC: 6373196. DOI: 10.1007/s00213-018-5116-0.

References

Soravia L, Heinrichs M, Aerni A, Maroni C, Schelling G, Ehlert U . Glucocorticoids reduce phobic fear in humans. Proc Natl Acad Sci U S A. 2006; 103(14):5585-90. PMC: 1414637. DOI: 10.1073/pnas.0509184103. View

Conboy L, Sandi C . Stress at learning facilitates memory formation by regulating AMPA receptor trafficking through a glucocorticoid action. Neuropsychopharmacology. 2009; 35(3):674-85. PMC: 3055605. DOI: 10.1038/npp.2009.172. View

Hofmann S . Enhancing exposure-based therapy from a translational research perspective. Behav Res Ther. 2007; 45(9):1987-2001. PMC: 2174693. DOI: 10.1016/j.brat.2007.06.006. View

de Quervain D, Roozendaal B, McGaugh J . Stress and glucocorticoids impair retrieval of long-term spatial memory. Nature. 1998; 394(6695):787-90. DOI: 10.1038/29542. View

de Quervain D, Roozendaal B, Nitsch R, McGaugh J, Hock C . Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci. 2000; 3(4):313-4. DOI: 10.1038/73873. View

Yehuda R . Current status of cortisol findings in post-traumatic stress disorder. Psychiatr Clin North Am. 2002; 25(2):341-68, vii. DOI: 10.1016/s0193-953x(02)00002-3. View

Foa E . Psychosocial therapy for posttraumatic stress disorder. J Clin Psychiatry. 2006; 67 Suppl 2:40-5. View

Golier J, Yehuda R . Neuropsychological processes in post-traumatic stress disorder. Psychiatr Clin North Am. 2002; 25(2):295-315, vi. DOI: 10.1016/s0193-953x(01)00004-1. View

Bremner D, Vermetten E, Kelley M . Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder. J Nerv Ment Dis. 2007; 195(11):919-27. DOI: 10.1097/NMD.0b013e3181594ca0. View

10.

Schelling G, Kilger E, Roozendaal B, de Quervain D, Briegel J, Dagge A . Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study. Biol Psychiatry. 2004; 55(6):627-33. DOI: 10.1016/j.biopsych.2003.09.014. View

11.

Lupien S, Wilkinson C, Briere S, Menard C, Ng Ying Kin N, Nair N . The modulatory effects of corticosteroids on cognition: studies in young human populations. Psychoneuroendocrinology. 2002; 27(3):401-16. DOI: 10.1016/s0306-4530(01)00061-0. View

12.

Kohda K, Harada K, Kato K, Hoshino A, Motohashi J, Yamaji T . Glucocorticoid receptor activation is involved in producing abnormal phenotypes of single-prolonged stress rats: a putative post-traumatic stress disorder model. Neuroscience. 2007; 148(1):22-33. DOI: 10.1016/j.neuroscience.2007.05.041. View

13.

Eisenman D, Weine S, Green B, de Jong J, Rayburn N, Ventevogel P . The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries. J Trauma Stress. 2006; 19(1):5-17. DOI: 10.1002/jts.20094. View

14.

Scheel M, Strohle A, Bruhn H . Effects of short-term stress-like cortisol on cerebral metabolism: a proton magnetic resonance spectroscopy study at 3.0 T. J Psychiatr Res. 2009; 44(8):521-6. DOI: 10.1016/j.jpsychires.2009.11.010. View

15.

Krugers H, Hoogenraad C, Groc L . Stress hormones and AMPA receptor trafficking in synaptic plasticity and memory. Nat Rev Neurosci. 2010; 11(10):675-81. DOI: 10.1038/nrn2913. View

16.

Stein M, Kennedy C, Twamley E . Neuropsychological function in female victims of intimate partner violence with and without posttraumatic stress disorder. Biol Psychiatry. 2002; 52(11):1079-88. DOI: 10.1016/s0006-3223(02)01414-2. View

17.

Kuhlmann S, Piel M, Wolf O . Impaired memory retrieval after psychosocial stress in healthy young men. J Neurosci. 2005; 25(11):2977-82. PMC: 6725125. DOI: 10.1523/JNEUROSCI.5139-04.2005. View

18.

Schnurr P, Friedman M, Engel C, Foa E, Shea M, Chow B . Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007; 297(8):820-30. DOI: 10.1001/jama.297.8.820. View

19.

de Quervain D, Aerni A, Schelling G, Roozendaal B . Glucocorticoids and the regulation of memory in health and disease. Front Neuroendocrinol. 2009; 30(3):358-70. DOI: 10.1016/j.yfrne.2009.03.002. View

20.

Aerni A, Traber R, Hock C, Roozendaal B, Schelling G, Papassotiropoulos A . Low-dose cortisol for symptoms of posttraumatic stress disorder. Am J Psychiatry. 2004; 161(8):1488-90. DOI: 10.1176/appi.ajp.161.8.1488. View