Acceptance and Mindfulness-Based Exposure Therapy for PTSD After Cardiac Arrest: An Open Feasibility Trial

Maja Bergman; John C Markowitz; Ian M Kronish; Sachin Agarwal; Chana T Fisch; Elizabeth Eder-Moreau; Yuval Neria

doi:10.4088/JCP.23m14883

Acceptance and Mindfulness-Based Exposure Therapy for PTSD After Cardiac Arrest: An Open Feasibility Trial

J Clin Psychiatry. 2023 Nov 22;85(1):23m14883. doi: 10.4088/JCP.23m14883.

Authors

Maja Bergman^{1

2}, John C Markowitz^{1

3}, Ian M Kronish⁴, Sachin Agarwal⁵, Chana T Fisch¹, Elizabeth Eder-Moreau¹, Yuval Neria^{1

3}

Affiliations

¹ New York State Psychiatric Institute, New York.
² Corresponding Author: Maja Bergman, PhD, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032 ([email protected]).
³ Columbia University Department of Psychiatry, New York, New York.
⁴ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York.
⁵ Columbia University Department of Neurology, New York.

PMID: 38019593
DOI: 10.4088/JCP.23m14883

Abstract

Background: Posttraumatic stress disorder (PTSD) is prevalent after surviving sudden cardiac arrest (SCA). SCA-induced PTSD is associated with increased mortality and cardiovascular risk, yet no psychotherapeutic treatment has been developed and tested for this population. Exposure therapy is standard treatment for PTSD, but its safety and efficacy remain unconfirmed for SCA survivors: current protocols do not address their specific disease course and have high attrition. Mindfulness-based interventions are typically well-tolerated and have shown promise in reducing PTSD symptoms from other traumas.

Objective: This study sought to determine feasibility, safety, and preliminary efficacy of acceptance and mindfulness-based exposure therapy (AMBET), a novel SCA-specific psychotherapy protocol combining mindfulness and exposure-based interventions with cardiac focused psychoeducation to reduce symptoms and improve health behaviors in patients with post-SCA PTSD.

Methods: We conducted an open feasibility pilot study from January 2021 to April 2022 with a small sample (N = 11) of SCA survivors meeting DSM-5 PTSD criteria. AMBET comprised eight 90-minute remotely delivered individual sessions. Clinical evaluators assessed PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at baseline, midpoint, posttreatment, and 3-month follow-up.

Results: Ten (91%) of 11 enrolled patients completed treatment. Satisfaction was high and patients reported no adverse events. PTSD symptoms significantly improved statistically (P < .001) and clinically with large effect sizes (g = 1.34-2.21) and treatment gains sustained at 3-month follow-up. Posttreatment, 80% of completers (n = 8) showed significant treatment response, 70% (n = 7) with PTSD diagnostic remission. No patient reported symptom increases.

Conclusions: This initial trial found AMBET feasible, safe, and potentially efficacious in reducing PTSD following SCA. These encouraging pilot results warrant further research.

Trial Registration: ClinicalTrials.gov identifier: NCT04596891.

MeSH terms

Death, Sudden, Cardiac
Feasibility Studies
Heart Arrest*
Humans
Implosive Therapy* / methods
Mindfulness*
Pilot Projects
Stress Disorders, Post-Traumatic* / diagnosis
Stress Disorders, Post-Traumatic* / therapy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04596891