Summary: Increasing exposure therapy with ten minutes of aerobic exercise reduces the severity of PTSD symptoms for up to six months after completing a nine-week treatment.
Source: University of New South Wales
Exposure therapy is one of the main treatments for post-traumatic stress disorder (PTSD), but up to half of patients do not respond to it.
But now a study by psychologists at UNSW Sydney has found that augmenting therapy with 10 minutes of aerobic exercise led to patients reporting a greater reduction in the severity of PTSD symptoms six months after the end of the nine-week treatment.
In the first known single-blind randomized controlled trial of its kind, researchers in Sydney recruited 130 adults with clinically diagnosed PTSD and divided them into two groups. People in both groups received nine 90-minute exposure therapy sessions. At the end of each session, one group was given 10 minutes of aerobic exercise, while members of the control group received 10 minutes of passive stretching.
People in the aerobic exercise group reported, on average, less severity of PTSD symptoms—as measured on the CAPS-2 scale—than those whose exposure therapy was supplemented with stretching exercises during exercise. six-month follow-up. Interestingly, there were no clear differences between the two groups one week after the treatment program ended, suggesting that the benefits take time to develop.
The findings were reported in The Lancet Psychiatry.
Scientia Professor Richard Bryant oversaw the clinical research that took place between 2012 and 2018. He says the goal of exposure therapy in the treatment of PTSD is extinction learning, where a patient learns to assimilate something he has until now associated with trauma, with a sense of security.
For example, a person who has been sexually abused may associate some of the stimuli that were present at the time of the trauma – such as nighttime, sexual activity, the smell of aftershave, etc. – to the threat. Exposure therapy would focus on these triggers and try to demonstrate that they offer no threat, in the hope that after repeated and gradual exposure, extinction learning would be embedded in the brain of the victim.
“Extinction learning isn’t about unlearning the bad experience,” says Professor Bryant. “It’s a new learning that inhibits the old.
“Previous studies have shown that very short bursts of aerobic exercise can be helpful because they actually promote extinction learning in rats, and have also been shown to promote it in humans under conditions experimental.”
But the theory had not been tested in clinical conditions until now. Professor Bryant and his colleagues say they believe short, intense exercise promotes a particular growth molecule in the brain called brain-derived neurotrophic factor, or BDNF.
“Why that’s really important is that it actually promotes synaptic plasticity in the brain, which is really important for learning. And we know that underlies extinction learning. So , if we can make this BDNF more active in the brain, at the time of exposure therapy, theoretically this should lead to better quenching.
More studies needed
To Professor Bryant’s knowledge, this is the first time that the benefits of aerobic exercise in conjunction with exposure therapy have been observed in a clinical setting. But while he was pleasantly surprised by the results, he says the study needs to be replicated a number of times before this therapeutic modification is recommended, standard practice, or used to treat ailments. other psychological conditions.
“‘I would really like to point out that this is the first trial that shows this in an anxiety disorder and I don’t think we should get too excited about it,’ he says.
“But as with all these things, you always need several tries to believe it. So I’m definitely not telling people to burn out and start exercising after all your exposure therapy, because I think it’s premature after a try. But that being said, it’s very encouraging.
Professor Bryant says there is a large trial replicating the method taking place in Melbourne at the moment, which he and his peers will follow with interest.
About this news about PTSD research and exercise
Author: Lachlan Gilbert
Source: University of New South Wales
Contact: Lachlan Gilbert – University of New South Wales
Image: Image is in public domain
Original research: Access closed.
“Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomized clinical trial” by Richard A Bryant et al. Lancet Psychiatry
Augmenting trauma-focused psychotherapy for post-traumatic stress disorder with brief aerobic exercise in Australia: a randomized clinical trial
Although exposure therapy is central to most first-line post-traumatic stress disorder (PTSD) psychotherapies, many patients do not respond to this treatment. We sought to investigate the effects of brief aerobic exercise on the effectiveness of exposure therapy in reducing the severity of PTSD.
We performed a randomized, parallel, single-blind, controlled trial in Sydney, NSW, Australia. We included adults (aged ≥ 18 years) with clinician-diagnosed PTSD. We excluded participants aged 70 years or older, with imminent suicidal risk (reporting a suicidal plan), the presence of psychosis or substance dependence, a history of moderate to severe head trauma, or the presence a physical disorder or impairment that may be exacerbated by aerobic exercise (eg, back pain). We randomly assigned participants (1:1) to nine weekly 90-minute sessions of exposure therapy for PTSD with 10 minutes of aerobic exercise or to the exposure therapy control group with 10 minutes of passive stretching. . The primary outcome was PTSD severity as measured by the Clinician-Administered PTSD Scale 2 (CAPS-2), independently assessed at baseline, 1 week post-treatment, and 6 months post-treatment (time point of the main result).
Between December 12, 2012, and July 25, 2018, we recruited 130 participants with PTSD, with 65 (50%) participants randomly assigned to exposure therapy with exercise and 65 (50%) to exposure therapy. exposure with passive stretching, including 79 (61%) women and 51 (39%) men, with a mean age of 39·1 years (SD 14·4; range 18–69). 99 (76%) participants were white, 14 (11%) were Asian, and 17 (13%) were listed as other. At the 6-month follow-up assessment, participants in the exposure therapy with exercise group showed greater reductions in CAPS-2 scores compared to those in the exposure therapy with stretching group (mean difference 12 1 [95% CI 2·4–21·8]; p=0·023), resulting in a moderate effect size of 0·6 (0·1–1·1). No adverse events associated with the intervention were reported. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry, ACTRN12612000185864.
Brief aerobic exercise has the potential to increase long-term gains from exposure therapy for PTSD, which is consistent with evidence from animal and human studies on the role of exercise in modulating extinction learning processes. This strategy could offer a simple and affordable way to increase treatment gains for exposure therapy in people with PTSD.
Australian National Health and Medical Research Council.
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