Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Eline M Voorendonk; Sarita A Sanches; Marieke S Tollenaar; Elisabeth A Hoogendoorn; Ad de Jongh; Agnes van Minnen

doi:10.3389/fpsyg.2023.1215250

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Front Psychol. 2023 Jul 20:14:1215250. doi: 10.3389/fpsyg.2023.1215250. eCollection 2023.

Authors

Eline M Voorendonk^{1

2}, Sarita A Sanches^{3

4}, Marieke S Tollenaar⁵, Elisabeth A Hoogendoorn⁶, Ad de Jongh^{1

7

8

9}, Agnes van Minnen^{1

2}

Affiliations

¹ Research Department, PSYTREC, Bilthoven, Netherlands.
² Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands.
³ Phrenos Centre of Expertise for Severe Mental Illness, Utrecht, Netherlands.
⁴ Altrecht Institute for Mental Health Care, Utrecht, Netherlands.
⁵ Institute of Psychology, Department of Clinical Psychology and the Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.
⁶ Faculty of Science, Leiden University, Leiden, Netherlands.
⁷ Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands.
⁸ School of Psychology, Queen's University, Belfast, United Kingdom.
⁹ Institute of Health and Society, University of Worcester, Worcester, United Kingdom.

Abstract

Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities.

Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured.

Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 d_pre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively.

Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups.

Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.

Keywords: PTSD checklist for DSM-5; clinician-administered PTSD scale; intensive trauma-focused therapy; physical activity; post-traumatic stress disorder; randomized controlled trial.