Brief Prolonged Exposure Therapy for Posttraumatic Stress After Spinal Cord Injury: A Randomized Controlled Trial

Topics in Spinal Cord Injury Rehabilitation · 2026-01-01

Background: Spinal cord injury (SCI) increases risk for posttraumatic stress disorder (PTSD). This condition often co-occurs with pain, depression, anxiety, and sleep disturbance, reducing quality of life. Despite the clinical impact of these symptoms, early evidence-based psychological interventions have rarely been evaluated during inpatient rehabilitation. Brief Prolonged Exposure (Brief PE) is a 3-session adaptation of Prolonged Exposure designed to prevent or reduce PTSD. Methods: Participants ( n = 154, mean age = 50 years, range 18-87; 65% male) with traumatic or nontraumatic SCI were enrolled at a rehabilitation hospital; 148 were randomized to Brief PE ( n = 75) or treatment as usual (TAU; n = 73). Brief PE participants received 3 60-minute sessions during their inpatient stay while TAU participants received standard psychosocial care. The primary outcome was PTSD symptom severity (PSSI-5) at baseline, 1, 3, and 6 months. Secondary outcomes included PTSD diagnosis/severity (PSSI-5/PDS-5), pain (NRS-11), depression (PHQ-9), anxiety (GAD-7), sleep disturbance (PROMIS-SD), resilience (CD-RISC-10), and quality of life (SCI-QOL). Results: PTSD symptoms declined significantly in both groups ( P = .003), with no Group × Time effect ( P = .33). History of premorbid depression predicted higher PTSD severity (IRR = 1.84, P = .002). At 6 months, PTSD prevalence was lower in Brief PE (5.9%) versus TAU (9.3%), though nonsignificant. Significant Group × Time effects for average and usual pain ( P = .032; P = .036) favored Brief PE, with 27% and 33% reductions versus 0% and 5% for TAU. Among Brief PE participants, 96% completed all sessions, with high satisfaction. Conclusion: Brief PE was feasible, acceptable, and produced greater pain reduction than TAU. PTSD symptoms were also lower, though not significantly, suggesting promise for early psychological intervention after SCI.

Vagus nerve stimulation therapy for treatment-resistant PTSD

Brain stimulation · 2025-03-15 · 10 citations

BACKGROUND: Posttraumatic stress disorder (PTSD) is common and debilitating, and many individuals do not respond to existing therapies. We developed a fundamentally novel neuromodulation-based therapy for treatment-resistant PTSD. This approach is premised on coupling prolonged exposure therapy, a first-line evidence-based cognitive behavioral therapy that directs changes within fear networks, with concurrent delivery of short bursts of vagus nerve stimulation (VNS), which enhance synaptic plasticity. METHODS: We performed a first-in-human prospective open-label early feasibility study (EFS) using a next-generation miniaturized system to deliver VNS therapy in nine individuals with moderate to severe treatment-resistant PTSD. All individuals received a standard 12-session course of prolonged exposure therapy combined with VNS. Assessments were performed before, 1 week after, and 1, 3, and 6 months after the completion of therapy. CLINICALTRIALS: gov registration: NCT04064762. RESULTS: VNS therapy resulted in significant, clinically-meaningful improvements in multiple metrics of PTSD symptoms and severity compared to baseline (CAPS-5, PCL-5, and HADS all p < 0.001 after therapy). These benefits persisted at 6 months after the cessation of therapy, suggesting lasting improvements. All participants showed loss of PTSD diagnosis after completing treatment. No serious or unexpected device-related adverse events were observed. CONCLUSIONS: These findings provide a demonstration of the safety and feasibility of VNS therapy for PTSD and highlight the potential of this approach. Collectively, these support the validation of VNS therapy for PTSD in a rigorous randomized controlled trial.

186: LONG-TERM PSYCHOLOGICAL OUTCOMES AFTER EXTRACORPOREAL MEMBRANE OXYGENATION: A META-ANALYSIS

Critical Care Medicine · 2025-01-01

Baseline Psychological Symptoms Among SCI Inpatients and Their Associations With SCI Characteristics and Preference for Specialized PTSD Treatment

Archives of Physical Medicine and Rehabilitation · 2025-04-01

First occurrence of <i>Daspletosaurus horneri</i> (Tyrannosauridae, Tyrannosaurinae) in the Dinosaur Park Formation of Dinosaur Provincial Park, Alberta (Treaty 7 Territory)

Historical Biology · 2025-07-26 · 1 citations

Closed-loop vagus nerve stimulation aids recovery from spinal cord injury

Nature · 2025-05-21 · 39 citations

Abstract Decades of research have demonstrated that recovery from serious neurological injury will require synergistic therapeutic approaches. Rewiring spared neural circuits after injury is a long-standing goal of neurorehabilitation 1,2 . We hypothesized that combining intensive, progressive, task-focused training with real-time closed-loop vagus nerve stimulation (CLV) to enhance synaptic plasticity 3 could increase strength, expand range of motion and improve hand function in people with chronic, incomplete cervical spinal cord injury. Here we report the results from a prospective, double-blinded, sham-controlled, randomized study combining gamified physical therapy using force and motion sensors to deliver sham or active CLV (ClinicalTrials.gov identifier NCT04288245). After 12 weeks of therapy composed of a miniaturized implant selectively activating the vagus nerve on successful movements, 19 people exhibited a significant beneficial effect on arm and hand strength and the ability to perform activities of daily living. CLV represents a promising therapeutic avenue for people with chronic, incomplete cervical spinal cord injury.

Clinical experience implanting a miniature externally powered vagus nerve stimulator

Neurotherapeutics · 2025-06-26 · 1 citations

Vagus nerve stimulation (VNS) is widely used to treat various neurological and psychiatric conditions, including epilepsy and treatment-resistant depression, as well as to enhance motor rehabilitation following stroke. Conventional VNS devices have demonstrated reliability over decades of use, though recent advancements in technology offer new opportunities to further enhance the device. Many emerging indications require only intermittent stimulation, allowing for the development of a miniature externally powered implantable stimulator (MEPS) that is approximately 50 times smaller than conventional devices, is implanted with a single incision, has no battery or leads, and enables paired stimulation. Our observations compiled from three clinical trials with the MEPS device tested the hypotheses that removing the implanted battery and reducing device size would (1) shorten the surgical procedure and (2) maintain or improve safety outcomes. Data were collected from individuals with stroke, spinal cord injury, or post-traumatic stress disorder. Operative time was significantly reduced, averaging 38 ​± ​1 ​min compared to 76 ​± ​3 ​min for conventional VNS, with no significant intraoperative complications and no revision surgeries. The MEPS device successfully delivered 481,995 stimulations during 2205 ​h of therapy. One participant underwent an MRI outside the study, indicating compatibility with standard imaging protocols. Device-related adverse events occurred at a low rate; all were mild and resolved before study end. Overall, the MEPS device demonstrated a favorable safety and performance profile in a select population, with fewer occurrences of certain adverse events, extending the strong safety record of conventional VNS systems.

Appraisal of Social Concerns: A Cognitive Assessment Instrument for Social Phobia

2024-04-04

&lt;p&gt;The current study describes the validation of a new cognitive assessment measure for social phobia, entitled the Appraisal of Social Concerns (ASC). Item content is relevant to a range of social situations. The ASC can be used to tailor interventions to patients' idiosyncratic concerns. Data are presented from both clinical (&lt;em&gt;n&lt;/em&gt;=71) and non‐clinical (&lt;em&gt;n&lt;/em&gt;=550) samples. Preliminary data indicate that the ASC has good internal consistency and test–retest reliability. The construct validity of the ASC is comparable to that of well‐established measures in use with social phobics. A strength of the ASC is its sensitivity to the effect of treatment. An exploratory factor analysis yielded three factors tapping concerns about negative evaluation, observable symptoms, and social helplessness. Subscale scores were strongly correlated. Preliminary findings suggest that the ASC is a psychometrically sound, time efficient instrument that can be used for both clinical and research purposes. Depression and Anxiety 19:217–224, 2004. © 2004 Wiley‐Liss, Inc.&lt;/p&gt;

FLOTO: Beyond Bandwidth - A Framework for Adaptable, Multi-sensor Data Collection in Scientific Research

Lecture notes in computer science · 2024-12-13 · 1 citations

The Fatigue and Altered Cognition Scale among SARS-CoV-2 Survivors: Psychometric Properties and Item Correlations with Depression and Anxiety Symptoms

Journal of Clinical Medicine · 2024-04-10 · 4 citations

Background/Objectives: This study examined the psychometric properties of the Fatigue and Altered Cognition Scale (FACs) among adult COVID-19 survivors and its unique ability to assess symptomology not accounted for by measures of depression and anxiety. Methods: COVID-19 survivors completed an online survey that included the FACs, a measure of brain fog and central fatigue with 20 items rated on a digital–analog scale. Useable data from 559 participants were analyzed to test the two-factor structure of the FACs, test for measurement invariance by sex and device was used to complete the survey (hand-held, computer), and item correlations with symptoms of depression and anxiety were examined. Results: The two-factor structure of the FACs replicated, supporting the separate assessments of brain fog and fatigue, χ2(164) = 1028.363, p &lt; 0.001, CFI = 0.934, TLI = 0.923, RMSEA = 0.097, SRMR = 0.053. The FACs exhibited invariance at the scalar level, indicating item and factor integrity regardless of sex and device type. Using a correlation &gt; 0.70 as a criterion (i.e., indicating more than 50% shared variance between two items), items on the FACs (assessing fatigue and lack of energy) were highly correlated with feeling tired or having little energy on the depression measure. No other items correlated with any anxiety symptom larger than 0.70. Conclusions: The FACs appears to be a psychometrically sound and efficient measure for use with COVID-19 survivors, assessing symptoms of brain fog and central fatigue that are not attributable to symptoms assessed by established measures of depression and anxiety.