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Randomized Controlled Trial
. 2009 Fall;15(3):255-63.
doi: 10.1111/j.1755-5949.2009.00100.x.

Mechanisms of efficacy of CBT for Cambodian refugees with PTSD: improvement in emotion regulation and orthostatic blood pressure response

Devon E Hinton  1 , Stefan G Hofmann, Mark H Pollack, Michael W Otto
Affiliations
Randomized Controlled Trial

Mechanisms of efficacy of CBT for Cambodian refugees with PTSD: improvement in emotion regulation and orthostatic blood pressure response

Devon E Hinton et al. CNS Neurosci Ther. 2009 Fall.

Abstract

Based on the results of a randomized controlled trial, we examined a model of the mechanisms of efficacy of culturally adapted cognitive-behavior therapy (CBT) for Cambodian refugees with pharmacology-resistant posttraumatic stress disorder (PTSD) and comordid orthostatic panic attacks (PAs). Twelve patients were in the initial treatment condition, 12 in the delayed treatment condition. The patients randomized to CBT had much greater improvement than patients in the waitlist condition on all psychometric measures and on one physiological measure-the systolic blood pressure response to orthostasis (d = 1.31)-as evaluated by repeated-measures MANOVA and planned contrasts. After receiving CBT, the Delayed Treatment Group improved on all measures, including the systolic blood pressure response to orthostasis. The CBT treatment's reduction of PTSD severity was significantly mediated by improvement in orthostatic panic and emotion regulation ability. The current study supports our model of the generation of PTSD in the Cambodian population, and suggests a key role of decreased vagal tone in the generation of orthostatic panic and PTSD in this population. It also suggests that vagal tone is involved in emotion regulation, and that both vagal tone and emotion regulation improve across treatment.

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Conflict of interest statement

Mark Pollack has been on advisory boards and has done consultation for AstraZeneca, Brain Cells Inc, Bristol Myers Squibb, Cephalon, Dov Pharmaceuticals, Forest Laboratories, GlaxoSmithKline, Janssen, Jazz Pharmaceuticals, Labopharm, Eli Lilly & Co, Medavante, Neurocrine, Neurogen, Novartis, Otsuka Pharmaceuticals, Pfizer, Predix, Roche, Laboratories, Sanofi, Sepracor, Solvay, Tikvah Therapeutics, Transcept Inc, UCB Pharma, Wyeth. He has received research grants from Astra‐Zeneca, Bristol Myers Squibb, Cephalon, Cyberonics, Forest Laboratories, GlaxoSmithKline, Janssen, Eli Lilly, NARSAD, NIDA, NIMH, Pfizer, Roche Laboratories, Sepracor, UCB Pharma, Wyeth. He has done presentations with support from Bristol Myers Squibb, Forest Laboratories, GlaxoSmithKline, Janssen, Lilly, Pfizer, Solvay, Wyeth. He has equity in Medavante, Mensante Corporation, Mindsite, Targia Pharmaceuticals and receives copyright royalties for the SIGH‐A, SAFER.

Figures

Figure 1
Figure 1
A model of the generation of PTSD among Cambodian refugees.
Figure 2
Figure 2
A model of how CBT improves PTSD among Cambodian refugees.
See this image and copyright information in PMC

References

    1. Kiernan B. The Pol Pot regime: Race, power, and genocide in Cambodia under the Khmer Rouge. New Haven , CT : Yale University Press, 2002;1975–1979.
    1. Hinton DE, Chhean D, Pich V, Pollack MH, Orr SP, Pitman RK. Assessment of posttraumatic stress disorder in Cambodian refugees using the clinician‐administered PTSD scale: Psychometric properties and symptom severity. J Trauma Stress 2006;19:405–411. - PubMed
    1. Hinton DE, Ba P, Peou S, Um K. Panic disorder among Cambodian refugees attending a psychiatric clinic: Prevalence and subtypes. Gen Hosp Psychiatry 2000;22:437–444. - PMC - PubMed
    1. Hinton DE, Pich V, So V, Pollack MH, Pitman RK, Orr SP. The psychophysiology of orthostatic panic in Cambodian refugees attending a psychiatric clinic. J Psychopathol Behav Assess 2004;26:1–13.
    1. Hinton DE, Hofmann SG, Pitman RK, Pollack MH, Barlow DH. The panic attack‐posttraumatic stress order model: Applicability to orthostatic panic among Cambodian refugees. Cogn Behav Ther 2008;37:101–108. - PMC - PubMed

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