Augmenting treatment efficiency in exposure therapy for PTSD: a randomized double-blind placebo-controlled trial of yohimbine HCl
Abstract: The alpha-2 adrenergic receptor antagonist, yohimbine, can facilitate fear extinction in animals and humans. One potential mechanism is increased noradrenergic activity and associated arousal in the presence of conditioned stimuli. Accordingly, yohimbine might augment prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD), where heightened exposure-oriented arousal is a theorized driver and empirical predictor of treatment success. A double-blind placebo-controlled randomized trial (NCT 01031979) piloted yohimbine augmentation in 26 males with combat-related PTSD. Participants were given one-time dose of yohimbine or placebo prior to the first imaginal exposure. Subsequently, both arms completed standard PE. The primary outcome was trauma-cued heart-rate reactivity a week after the drug/exposure visit, a highly specified, objective measure sensitive to incremental change. Secondary outcomes included arousal during the drug/exposure visit and slope of distress, PTSD, and depression over the course of PE. Consistent with hypothesis, yohimbine led to higher objective and subjective arousal during the drug/exposure visit and to lower trauma-cued heart-rate reactivity one-week later. One dose of yohimbine also led to greater between-session habituation and more rapid improvement on depression, but not PTSD, over the course of care. Results of this controlled pilot indicate support for continued investigation of yohimbine-augmented exposure therapy for PTSD.
Abstract: The unique demands of military life can adversely impact romantic relationships; however, research has mainly focused on these adverse outcomes at one-time point, overlooking changes over time or potential positive outcomes. Using a subsample of 3,845 male and female military personnel and veterans from a large UK dataset, this study examined positive and negative changes in relationship satisfaction between two-time points (2007–2009; 2014–2016). Most participants reported no change in their relationship satisfaction, suggesting stability − 8% reported a positive change and 10% a negative change. Positive change was associated with being in a long-term relationship, alcohol misuse remission, and persistent alcohol misuse. Negative change was associated with the onset of mental health problems (probable PTSD, CMD, or alcohol misuse) and having children under 18. Some factors, like increasing age, childhood family relationship adversity, and mental health problems, were associated with both positive and negative changes in relationship satisfaction. This study highlights the complexity of factors associated with relationship satisfaction among military personnel and veterans, with some experiencing positive changes, as well as negative changes over time.