{"id":4909,"date":"2026-05-01T10:49:07","date_gmt":"2026-05-01T17:49:07","guid":{"rendered":"https:\/\/17thfloor.vip\/?page_id=4909"},"modified":"2026-05-22T16:03:37","modified_gmt":"2026-05-22T23:03:37","slug":"irb-peer-reports","status":"publish","type":"page","link":"https:\/\/17thfloor.vip\/index.php\/irb-peer-reports\/","title":{"rendered":"IRB & Peer Reports"},"content":{"rendered":"\t\t
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IRB and Peer Report<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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A preliminary investigation of the d\u0113hp\u00ae Integrative Treatment approach in the clinical\nmanagement of post-traumatic stress disorder<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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Bob Bohanske, Ph.D.<\/p>

\u00a0<\/p>

Southwest Behavioral & Health Services<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t

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Bhupin Butaney, Ph.D.<\/p>

\u00a0<\/p>

Scottsdale Psychology Group<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Introduction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Post-Traumatic Stress Disorder (PTSD) is a debilitating condition in which individuals exposed to a life-<\/p>

threatening situation experience impairment in functioning. Exposure to stressor events can lead to involuntary<\/p>

re-experiencing of the trauma (i.e., intrusive memories, flashbacks, and nightmares), persistent avoidance of<\/p>

reminders or situations that evoke the feared response, alterations in cognition or mood, and hyperarousal and<\/p>

hyper-reactivity. Recent large-scale sampling of adults in the United States estimated that 89.7% of individuals<\/p>

have been exposed to a traumatic event as defined by DSM-5, with 8.3% of individuals meeting full criteria for<\/p>

a formal diagnosis of PTSD at some point in their life-time (Kilpatrick et al., 2013). Despite the high prevalence<\/p>

of PTSD and significant impairment in psychosocial functioning, effective treatment options remain limited.<\/p>

\u00a0<\/p>

Only two medications (sertraline and paroxetine) have been approved by the FDA as treatments for PTSD with<\/p>

no new medications approved since 2001 (Krystal et al., 2017; McIntyre, 2018). Though these medications<\/p>

reduce the severity of symptoms for some individuals, nearly 47% treated do not experience meaningful<\/p>

improvement (Brady et al., 2000). Another challenge for pharmacological interventions is the variability in<\/p>

symptoms associated with trauma, as well as the high rate of comorbidity with related disorders that involve<\/p>

depression, alcohol or substance use, sexual dysfunction, and sleep disturbance. Pharmacological approaches, as a result, treat many symptoms with separate medications, requiring multiple medications to be prescribed<\/p>

simultaneously. Polypharmacy can, unfortunately, lead to greater side-effects, treatment non-adherence, or other<\/p>

health related complications.<\/p>

\u00a0<\/p>

Non-pharmacological treatment options for PTSD are available. The Gold Standard <\/i>approach to treat PTSD has been exposure-based treatments. Exposure-based therapies are the most empirically supported treatments for PTSD (Foa, Rothbaum, & Furr, 2003; Lancaster, Teeters, Gros, & Back, 2016). These approaches involve<\/p>

exposing the patient to reminders of the trauma and preventing avoidance until the individual can learn to<\/p>

associate these cues with safety through extinction of the feared conditioned response. The extinction of<\/p>

conditioned fear depends on the process for consolidation of new memories during the exposure period (Noble,<\/p>

Souza, & McIntyre, 2019). The problem with those diagnosed with PTSD, however, is their inability to<\/p>

extinguish conditioned fears, which explains the ongoing physiological, affective, cognitive, and behavioral<\/p>

activation in situations absent for traumatic stressors, as if<\/i> these stressors were present (Noble, Souza, &<\/p>

McIntyre, 2019). Another challenge with exposure-based approaches is the high dropout rates from treatment,<\/p>

which can be as high as 50%; further, nonresponse rates for those who remain in treatment can exceed 50% on<\/p>

some measures used to assess outcome (Schottenbauer, et al., 2008).<\/p>

\u00a0<\/p>

In addition to the problem with dropout and nonresponse to treatment, exposure-based approaches can worsen<\/p>

the condition in some cases. A few studies have found that 10% of individuals become worse as a result of<\/p>

exposure treatment (Krakow et al., 2001; Tarrier, Pilgram, et al., 1999). Zayfert and Black (2000) studied<\/p>

reasons for dropouts and reported that 11% of those who had dropped out of treatment did so because they had<\/p>

become actively suicidal or engaged in associated behaviors. They also found that 17% of individuals who<\/p>

dropped out of treatment did so because they did not want to engage in imaginal exposure.<\/p>

\u00a0<\/p>

Some researchers have argued for the use of exposure-based treatments with adjunctive use of Vagal Nerve<\/p>

Stimulating (VNS) Devices (Noble et al., 2017; McIntyre, 2018). Medical devices that stimulate the vagal nerve<\/p>

have received FDA approval for the treatment of epilepsy (1997) and treatment resistant depression (2000).<\/p>

These devices (either subcutaneous or above the skin) deliver intermittent electrical impulses to the vagus<\/p>

nerve. Several studies have demonstrated positive improvements to treatment resistant depression, including<\/p>

comorbid anxious distress through stimulation of the vagus nerve (Nahas, Marangell, et al., 2005). The vagus<\/p>

nerve plays a central role in the parasympathetic nervous system (PNS), which oversees several important<\/p>

functions such as mood, immune response, digestion, and heart rate. Stimulation of the vagus nerve has also<\/p>

been found to increase memory consolidation and allow for extinction of learned, conditioned fear responses<\/p>

(Nobel et al., 2017). Response and remission rates for these devices used for resistant depression, however, have<\/p>

been modest. Response rates range between 15-37%, while remission rates range between 17% and 33% (Rush<\/p>

et al., 2005; Sackeim et al., 2001;<\/span> Breit, Kupferberg, Rogler, & Hasler, 2018).<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Variance in Outcomes<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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There are several reasons why response to exposure-based interventions may vary. Severity of symptoms<\/p>

pretreatment or having a comorbid diagnosis of depression predict those who were more likely to have residual<\/p>

symptoms posttreatment and poorer outcomes overall (Taylor et al., 2001). Those who report higher anxiety<\/p>

(van Minnen & Hagenaars, 2002) or report trauma related anger (Foa, Riggs, Massie, & Yarczower, 1995) also<\/p>

tend to have worse outcomes post-treatment. Pitman et al. (1991) point to shame and guilt as factors that can<\/p>

lead to complications when using exposure-based treatments, while Beutler, Consoli, & Lane (2005) argue that<\/p>

patients high in reactance do not respond as favorably to directive treatments.<\/p>

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Studies have also examined factors that lead to improved treatment outcomes. Elkin et al. (1999) found that<\/p>

patients who have a preference for a certain type of therapy, and were matched with this preference, were less<\/p>

likely to drop out of treatment and to report higher therapeutic alliance. Because research has found that some<\/p>

patients prefer not to undergo exposure treatment (Zayfert & Black, 2000; Schottenbauer, et al., 2008), it is<\/p>

necessary to have alternative treatment options that do not rely on exposure.<\/p>

\u00a0<\/p>

Wampold et al. (2010) concludes, following an extensive review of the outcomes of various treatments that: \u201c\u2026<\/p>

until such time that there is sufficient evidence to conclude that one particular treatment for PTSD is superior to<\/p>

others or that some well-defined ingredient is critical to successful treatments of PTSD, it is not consistent with<\/p>

the research evidence to privilege some treatments over others.\u201d(pp 932).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Alternative Treatment Approaches<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Osteopathic approaches do not involve forced exposure to traumatic events or memories. When an osteopathic<\/p>

practitioner stimulates mechanoreceptors in the facia, a form of indirect somataemotional release occurs<\/p>

(Minasny, 2009). This technique is also used by therapists who practice craniosacral therapy, myofascial<\/p>

therapy, and other manual manipulation therapies. These manual therapies stimulate the parasympathetic<\/p>

nervous system (PNS). The central nervous system (CNS) responds to proprioceptive input by decreasing<\/p>

muscle tonal quality, leading to states of deep relaxation (Schleip, 2003; Minasny, 2009). In essence, touch leads<\/p>

to relaxation and down regulation of the sympathetic nervous system (SNS) response through activation of the<\/p>

parasympathetic nervous system response. This relaxed state allows for ideomotor movements (Dorko, 2003),<\/p>

unconscious or involuntary movements caused by prior expectations, suggestions, or preconceptions to manifest<\/p>

during the manipulations (Haggard et al., 2004). In this way, atypical ideomotor movements may be somatic<\/p>

expressions of the stress response and experienced trauma. Ideomotor reflexes reoccur until discharge of<\/p>

excitation through repetition. The ideomotor action can then be replaced with corrective normal movements<\/p>

(Minasny, 2009). When this occurs, the expectation is that the CNS correlates are also resolved or corrected.There is modest empirical support for the use of these alternative treatments with patients diagnosed with PTSD (Davis, Hanson, & Gilliam, 2016). The findings, however, are often mixed and the study designs are often criticized on the grounds of scientific rigor.<\/p>

\u00a0<\/p>

The effectiveness of osteopathic approaches may be related to the extent that they rely on activation of the<\/p>

vagus nerve and enervation of its efferent and afferent pathways that connect visceral areas with the CNS. The<\/p>

vagus nerve extends from the brain stem through the neck down to the stomach and colon (Porges, 2011). The<\/p>

vagus nerve passes through the medulla oblongata between the olive and interior cerebella peduncle. Extending<\/p>

to the heart, it provides the main parasympathetic influence on reducing heart rate. Vagal efferent preganglionic<\/p>

neurons stem from the dorsal motor nucleus of the vagal nerve located within the medulla and innervate parts of<\/p>

the gut. The nucleus tractus solitari (NTS) directs vagal sensory information to the locus coeruleus, rostral<\/p>

ventrolateral medulla, amygdala, and the thalamus (Berthoud & Neuhuber, 2000). From the NTS, information<\/p>

can reach the prefrontal cortex (PFC) and orbito-prefrontal cortex. Both cortical areas provide inhibitory<\/p>

influence over limbic area functions, including fight\/flight responding. Overall, there is good empirical evidence<\/p>

to support polyvagal theory (<\/span>Breit, Kupferberg, Rogler, & Hasler, 2018).<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Polyvagal Theory Applied to Trauma<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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According to Polyvagal Theory (Porges, 2011), the vagus nerve is a component of the Autonomic Nervous<\/p>

System (ANS) and has two distinct branches, a dorsal and ventral branch. The dorsal branch, a phylogenetically<\/p>

earlier branch, controls the subdiaphragmatic visceral organs including the digestive tract. When activated, the<\/p>

Dorsal Vagus Complex (DVC) serves an inhibitory function through the parasympathetic nervous system<\/p>

(PNS). In the presence of a life-threatening situation, activation of the DVC leads to the \u201cfreeze\u201d or \u201cshut<\/p>

down\u201d response of the visceral organ systems associated with the DVC. In essence, keeping the body and<\/p>

system in a state of hyperarousal and vigilance.<\/p>

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The Ventral Vagus System (VVS), comprising the ventral branch of the vagus nerve, also acts on the PNS but<\/p>

controls the supradiaphragmatic visceral organs including the heart and lungs. When activated in the face of<\/p>

perceived threat, the VVS serves to initiate a fight or flight response. This branch is also associated with social<\/p>

affiliative and prosocial behaviors (Porges, 2001). It allows for a greater range of behaviors through its impact<\/p>

on limbic structures via the orbitofrontal cortex. Animal research has found synchronization between<\/p>

orbitofrontal activity and activity of the VVS (Groves & Brown, 2005); the orbitofrontal area has connections to<\/p>

sensory areas and limbic system structures involved in emotion and memory.<\/p>

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Stressful or traumatic events can disrupt the rhythmic afferent and efferent flow within the ANS, which balances<\/p>

between the vagus\u2014parasympathetic functions and the adrenal-sympathetic functions. When life threatening<\/p>

events occur that are not processed or resolved, the memory of these events remains remembered within<\/p>

subcortical areas of the central nervous system and expressed, in part, through hyper-activation of the fight-<\/p>

flight response (an anxiety-based process) of the VVC. If the threat is extreme, the DVC system remains<\/p>

hyperactive and results in associated systems to \u201cshut down\u201d or \u201cfreeze\u201d (i.e., not participate in activities of<\/p>

living, feigning death, such as not leaving the house, eating, or relating to others at premorbid levels). One<\/p>

unique treatment that more directly operates along these principles is the dehp Integrative Treatment (DIT). The<\/p>

dehp Integrative Treatment (DIT) has been used to treat patients with trauma, complex and other psychological<\/p>

disorders that involve anxiety and mood. The neuro-somatic technique(s) or method used to activate interaction<\/p>

and movement through its three stages involves manipulation of specific cranial nerves or areas of the body<\/p>

which are stimulated through physical touch or manipulations. The dehp method, however, offers more than<\/p>

manipulation and alignment. It operates more closely with polyvagal theory and offers an approach that does<\/p>

not require conscious remembering or processing of traumatic material like in PE or CPT.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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d\u0113hp Integrative Treatment (dIT):<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The d\u0113hp Integrative Treatment (dIT) is <\/b>a specific series of proprietary applications that reinstate the necessary<\/p>

neuro-somatic interaction needed to process stress, trauma, compound trauma and experiences in general. The<\/p>

goal of dIT is to establish neuro-somatic interaction in three stages or domains, resulting in the capacity for<\/p>

organic boundaries, emotional expressions, and emotional states. Neuro-somatic interaction involves<\/p>

information exchange occurring physically and cognitively while experiencing stimulation that creates a relaxed<\/p>

state and polyvagal tone. When experience or communication is not integrative, these three stages or domains<\/p>

manifest behaviors instead of boundaries, reactions instead of expressions, and disassociation instead of<\/p>

awareness of emotional states. The proprietary neuro-somatic technique(s) or method used in dIT activates<\/p>

interaction and movement through the three stages enabling the capacity for integrative expressions of<\/p>

experience.<\/p>

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For the dIT therapist, the process <\/b>involves recognizing the stage or stages of development activated during a<\/p>

neuro-somatic interaction. Specific cranial nerves and body areas are stimulated through physical touch or<\/p>

manipulations. As manipulations take place, the individual communicates images that spontaneously emerge<\/p>

during the process. This specifically designed associative semantic linking activity provides emergent visualimagery. Strings of symbols that violate the rules of syntax are not considered integrative expressions. There is no mandate prior to or during the session to focus on specific memories or set of experiences. Eventually,<\/p>

memories and experiences emerge spontaneously that are more integrated and organized, and may be more<\/p>

directly associated with traumatic experiences. Initially, these communications are expressed in session and<\/p>

appear as unrelated and random material (e.g., colors or random images). The dIT therapist is writing salient<\/p>

communications. To facilitate the process of organizing and integrating the initial linguistic or unformulated<\/p>

material, the client is read the salient pieces of communication as a descriptive narrative rather than an<\/p>

interpretive narrative at the end of the session. There is then opportunity at the end of each session to elaborate<\/p>

or explore associated material from the session that spontaneously emerged in the client\u2019s mind during the<\/p>

session. This allows the client to reflect on the associated material determined salient by the therapist and<\/p>

generally leads to more formulated or structured memories of past experiences in future sessions. As the<\/p>

spontaneous, emergent material is more integrated and formulated, emotional content is experienced concurrent<\/p>

with the visual or linguistic material. Over the course of the 10-12 sessions of dIT, a cohesive narrative emerges<\/p>

through the course of multiple sessions that reflect the integration within the three stages within the<\/p>

developmental levels as defined in its proprietary materials and method. The success of the treatment is<\/p>

determined with the absence of PTSD related symptoms and a return to premorbid functioning. The treatment is<\/p>

designed to work with treatment resistant patients who continue to experience PTSD related symptoms despite<\/p>

pharmacological and\/or traditional psychotherapeutic interventions for PTSD.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Purpose of the current study<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Understanding the concept of (PTSD) as a unique disorder continues to present with a multitude of<\/p>

misconceptions and alternative theories. What is PTSD, what is trauma, what is a stress disorder, what is an<\/p>

effective approach to treating the common problem\u2019s that often accompany such labels\u2019, the questions seem<\/p>

endless. Such questions will be challenged further with the pending release of the ICD-11 and its revised<\/p>

diagnostic criteria. Barbano, et.el. (2019), found that, \u201csignificantly fewer individuals would be diagnosed with<\/p>

PTSD using the proposed ICD-11 criteria\u201d. In their study of over 3863 patients across 11 longitudinal studies 47<\/p>

to 57 fewer cases would qualify under the proposed criteria. One thing is clear, the costs of care and treatment<\/p>

continue to rise.<\/p>

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A recent estimate of the treatment costs for veterans returning from deployment to Afghanistan and Iraq found<\/p>

4.0-6.2 billion dollars (Kaysen et al 2019) in the first two years state side. This says little about the emotionaland functional cost to veterans and their families.<\/p>

\u00a0<\/p>

The professional community is in greater need of therapies that work, effectively, efficiently and without the<\/p>

prerequisite of clear definitions of etiology. In fact the causes appear to vary by individual as do the success of<\/p>

various interventions.<\/p>

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The d\u0113hp Integrated Treatment appears to be a brief intervention (as opposed to the various prolonged exposure<\/p>

treatments) yet without formal review and evaluation it remains of limited availability to the majority of those<\/p>

in need. The present study is a first step in evaluating the effectiveness of the dIT approach.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Methodology<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The current pilot study was undertaken at the dIT program offices. Consecutive admissions were offered<\/p>

participation in the study without expectation of required continuation. Participants were admitted who<\/p>

presented with a primary diagnosis, meeting the criteria for PTSD as described in the ICD-10.<\/p>

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With such a major variation in symptoms associated with the PTSD diagnosis, existing \u201cPTSD Scales\u201d<\/p>

dependent on such classifications were ignored in favor of functional measures. Participants were administered<\/p>

the PCOMS outcome measures, ORS\/SRS (the Outcome Rating Scale and Session Rating scale), The Outcome<\/p>

Rating Scale (ORS; Miller & Duncan, 2000) and the Session Rating Scale (SRS; Miller, Duncan, & Johnson,<\/p>

2000) are both four-item measures developed to track outcome (relief from symptoms resulting in distress) and<\/p>

the therapeutic alliance, respectively.<\/p>

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The WHO-DAS 12, Self -administered version, this questionnaire asks about difficulties due to health\/mental<\/p>

health conditions. Health conditions include diseases or illnesses, other health problems that may be short or<\/p>

long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs. It assesses disability<\/p>

across six domains, including understanding and communicating, getting around, self-care, getting along with<\/p>

people, life activities (i.e., household, work, and\/or school activities), and participation in society.<\/p>

The PHQ-9. (Patient Health Questionnaire). PHQ-9 a common measure of symptom-related difficulty often<\/p>

related to sick days, and increased health care utilization.<\/p>

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ORS\/SRS measures were obtained at each visit, the WHO-DAS and PHQ-9 were administered at the admission<\/p>

and discharge visits only.<\/p>

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Trained dIT clinical staff (licensed behavioral health professionals) counselors and social workers provided the<\/p>

treatment interventions following a prescribed protocol.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Results<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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The original sample consisted of 63 participants. Over the course of the study 13 participants were excluded, 9<\/p>

did not complete the discharge study forms 4 did not complete treatment.<\/p>

Data was obtained on the remaining 50 participants:<\/p>

\u00a0<\/p>

The sample was made up of 44 females (88%) and 6 males (12%). 28 were white (56%) 12 Hispanic (24%) and<\/p>

6 black (12%) 4 participants (8%) did not chose an ethnicity.<\/p>

All participants completed an initial evaluation session (an extended visit) to gather initial history, needs and<\/p>

study data. The average patient was seen for 5.6 sessions (range 2-20), and was open as an active case for an<\/p>

average of 38.8 days (range 5-130).<\/p>

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Outcomes:<\/p>

Initial PHQ-9 scores indicated 46% of the study participants scored in the moderate severe to severe range with<\/p>

only one client falling in the \u201cnone\u201d ranking. Post treatment only 16 % remained in the moderate severe to<\/p>

severe range with 34 participants now endorsing the \u201cnone\u201d ranking. This represents an effect size (Cohens d)<\/b><\/p>

of 0.95 <\/b>as measured by the changes on the PHQ-9.<\/p>

\u00a0<\/p>

Severity of symptoms in the sample was also measured with the WHO-DAS 12. Initial scores showed 72% of<\/p>

the participants self-identified with a significant disability with a score greater than 10. Post treatment scores<\/p>

dropped to 40% of the sample. Total sample average dropped from an average score of 16.8 to an average of<\/p>

9.7. This represents an effect size d= 0.79<\/b>.<\/p>

\u00a0<\/p>

Self-report of progress as rated on the Outcome Rating Scale demonstrates a clinically significant change of<\/p>

72% and an overall Reliable Change score of 82% with a no-change of 12%. There were no cases that<\/p>

demonstrated deterioration. This represents a significant effect size of d = 1.4.<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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Discussion<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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As with all pilot studies the questions raised for further research often outweigh the preliminary findings. The<\/p>

present study provides some hope and encouragement into the efforts of the dIT approach. Without attempting<\/p>

to provide an explanation of the treatment technique there does appear to be a very significant effect size (d<\/p>

=1.4) in this limited sample. A full 88% of the sample presented with clinically significant levels of distress as<\/p>

they reported via the ORS at intake. Discharge scores suggest that 72% of the sample made clinically significant<\/p>

changes and a total of 82 % made reliable change (RCI) as self-reported over the course of treatment. On the<\/p>

WHO-DAS 12 measure of daily function over 76% , at intake reported they had to cutback or reduce<\/p>

participation in their daily activities, which dropped to 16% at the completion of treatment.<\/p>

\u00a0<\/p>

When compared to a TAU (Treatment as Usual) sample from a large community behavioral health center<\/p>

(CBHC) over the same time period the dIT approach appears to have achieved an overall RCI of 82% compared<\/p>

to 48% in the CBHC. Of note this was accomplished in an average of 5.6 sessions spread over an average 38.8<\/p>

day period. This compares to 9.8 sessions over a 214 day period at the CBHC (N =170).<\/p>

\u00a0<\/p>

In his comprehensive review of outcome studies on PTSD, Schottenbauer (2008) reflects on several points that<\/p>

may contribute to the understanding of the dIT results. He notes that \u201cLambert and colleagues have developed a<\/p>

system for identifying patients at risk for dropout or no response, \u2026and a system for providing feedback to the<\/p>

therapist regarding patient progress, \u201c<\/p>

\u00a0<\/p>

And recommends application of this technique to PTSD treatment. (pp. 148). The dIT approach utilizes the<\/p>

PCOMS method which is a derivative of the Lambert system. Utilization of such an ongoing \u201cfeedback\u201d system<\/p>

has been demonstrated to contribute to reliable change.<\/p>

\u00a0<\/p>

The initial dIT outcomes compare with the Accelerated Resolution Therapy (ART) a brief treatment approach<\/p>

for PTSD with very similar effect sizes and efficiency (Kip, 2012). As new approaches which allow for greater<\/p>

diversity in treatments available we hope to see greater access to the ever increasing numbers of individuals<\/p>

who continue to be distressed and less functional in their daily activities.<\/p>

\u00a0<\/p>

As a result of the initial positive results of the current pilot study it would be recommended that a closer look at<\/p>

recidivism post treatment be accomplished. Follow-up efforts could begin on this initial cohort. Follow-up<\/p>

should be built into future studies.<\/p>

\u00a0<\/p>

dIT should be evaluated in a series of random control trials where additional measures of effectiveness may be<\/p>

obtained. A diversity of populations as well as various co-occurring disorders should be considered.dIT should be encouraged to establish training materials and opportunities for professional behavioral health<\/p>

staff.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

\n\t\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t

References<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t\t\t\t\t

Barbano, A.C., van der Mei, W.F., Bryant, R.A., et.el, (2019). Clinical implications of the proposed ICD-<\/p>

11 PTSD diagnostic criteria. Psychological Medicine,49(3), 483-490.<\/p>

\u00a0<\/p>

doi.org\/10.1017\/S0033291718001101<\/p>

\u00a0<\/p>

Beutler, L. E., Consoli, A. J., & Lane, G. (2005). Systematic Treatment Selection and Prescriptive<\/p>

Psychotherapy. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration., 2nd ed.<\/i><\/p>

(pp. 121\u2013143). New York, NY: Oxford University Press.<\/p>

https:\/\/doi.org\/10.1093\/med:psych\/9780195165791.003.0006<\/p>

\u00a0<\/p>

Brady, K., Pearlstein, T., Asnis, G. M., Baker, D., Rothbaum, B., Sikes, C. R., & Farfel, G. M. (2000). Efficacy<\/p>

and safety of sertraline treatment of posttraumatic stress disorder: A randomized controlled trial. JAMA: Journal<\/p>

of the American Medical Association, 283(14), 1837\u20131844. https:\/\/doi-<\/p>

org.mwu.idm.oclc.org\/10.1001\/jama.283.14.1837<\/p>

\u00a0<\/p>

Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). Vagus Nerve as Modulator of the Brain\u2013Gut Axis in<\/p>

Psychiatric and Inflammatory Disorders. Frontiers in Psychiatry. 9. 10.3389\/fpsyt.2018.00044.<\/p>

\u00a0<\/p>

Davis, L., Hanson, B. & Gilliam, S. (2016). Pilot study of the effects of mixed light touch manual therapies on<\/p>

active duty soldiers with chronic post-traumatic stress disorder and injury to the head. Journal of Bodywork &<\/p>

Movement Therapies, 20(1), 42-51. doi:10.1016\/j.jbmt.2015.03.006<\/p>

\u00a0<\/p>

Dorko.B.(2003). The analgesia of movement: ideomotoric activity and manual care. Journal of Osteopathic<\/p>

Medicine, 6, 93-95. Doi: 10.1016\/s1443-8461(03)80022-9.<\/p>

\u00a0<\/p>

Elkin, I., Yamaguchi, J. L., Arnkoff, D. B., Glass, C. R., Sotsky, S. M., & Krupnick, J. L. (1999). \u201cPatient\u2013<\/p>

treatment fit\u201d and early engagement in therapy. Psychotherapy Research<\/i>, 9<\/i>(4), 437\u2013451.<\/p>

https:\/\/doi.org\/10.1093\/ptr\/9.4.437<\/p>

\u00a0<\/p>

Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the<\/p>

efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy<\/i>, 26<\/i>(3), 487\u2013499.<\/p>

https:\/\/doi.org\/10.1016\/S0005-7894(05)80096-6<\/p>

\u00a0<\/p>

Foa, E. B., Rothbaum, B. O., & Furr, J. M. (2003). Augmenting exposure therapy with other CBT procedures.<\/p>

Psychiatric Annals<\/i>, 33<\/i>(1), 47\u201353. https:\/\/doi.org\/10.3928\/0048-5713-20030101-08<\/p>

\u00a0<\/p>

Groves, D. & Brown, V . (2005). Vagal nerve stimulation: a review of its applications and potential mechanisms<\/p>

that mediate it clinical effects. Neurosci Biobehav Rev, 29, 493-500.<\/p>

\u00a0<\/p>

Haggard, P. Cartedge, P. Dafyddim, & Oakley, O. (2004) Anomalous control: when free wullis not conscious.<\/p>

Conscious Cognition, 13, 646-654.<\/p>

\u00a0<\/p>

Kaysen, D.L., Bedaed-Gilliagan, M.A., Jaxon, A.J.(2019) Use of prolonged exposure and sertraline in the<\/p>

treatment of posttraumatic stress disorder in veterans. JAMA Psychiatry, 76(2) 109-110. Doi<\/p>

10.101\/jamapsychiatry 2018.3410<\/p>

\u00a0<\/p>

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013).<\/p>

National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM\u2010<\/span>5 criteria.<\/p>

Journal of Traumatic Stress<\/i>, 26<\/i>(5), 537\u2013547. https:\/\/doi.org\/10.1002\/jts.21848<\/p>

\u00a0<\/p>

Kip, K. E., Elk, C. A., Sullivan, K. L., Kadel, R., Lengacher, C. A., Long, C. J., Rosenzweig, L., et al. (2012).<\/p>

Brief Treatment of Symptoms of Post-Traumatic Stress Disorder (PTSD) by Use of Accelerated Resolution<\/p>

Therapy (ART\u00ae). Behavioral Sciences<\/i>, 2<\/i>(2), 115\u2013134. MDPI AG. Retrieved from<\/p>

http:\/\/dx.doi.org\/10.3390\/bs2020115<\/p>

\u00a0<\/p>

Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., \u2026 Prince, H. (2001). Imagery<\/p>

rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A<\/p>

randomized controlled trial. JAMA: Journal of the American Medical Association<\/i>, 286<\/i>(5), 537\u2013545.<\/p>

https:\/\/doi.org\/10.1001\/jama.286.5.537<\/p>

\u00a0<\/p>

Krystal, J. H., Davis, L. L., Neylan, T. C., Raskind, M. A., Schnurr, P. P., Stein, M. B., \u2026 Huang, G. D. (2017).<\/p>

It is time to address the crisis in the pharmacotherapy of posttraumatic stress disorder: A consensus statement of<\/p>

the PTSD Psychopharmacology Working Group. Biological Psychiatry<\/i>, 82<\/i>(7), e51\u2013e59.<\/p>

https:\/\/doi.org\/10.1016\/j.biopsych.2017.03.007<\/p>

\u00a0<\/p>

Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of<\/p>

Evidence-Based Assessment and Treatment. Journal of clinical medicine, 5(11), 105. doi:10.3390\/jcm5110105<\/p>

\u00a0<\/p>

McIntyre, C. (2018). Is there a role for vagus nerve stimulation in the treatment of posttraumatic stress disorder?<\/p>

Bioelectronics in Medicine, 1(2), 95-99. Doi 10.2217\/bem-2018-0002<\/p>

\u00a0<\/p>

Minasny, B. (2009). Understanding the process of fascial unwinding. International Journal of Therapeutic<\/p>

Massage and Bodywork, 2(3), 10-17.<\/p>

\u00a0<\/p>

Nahas, Z., Marangell, L. B., Husain, M. M., Rush, A. J., Sackeim, H. A., Lisanby, S. H., \u2026 George, M. S.<\/p>

(2005). Two-Year Outcome of Vagus Nerve Stimulation (VNS) for Treatment of Major Depressive Episodes.<\/p>

The Journal of Clinical Psychiatry<\/i>, 66<\/i>(9), 1097\u20131104. https:\/\/doi.org\/10.4088\/JCP.v66n0902<\/p>

\u00a0<\/p>

Noble L, Gonzalez I, Meruva V , Callahan K, Belfort B, Ramanathan K, Meyers E, Kilgard M, Rennaker R, &<\/p>

McIntyre C (2017). Effects of vagus nerve stimulation on extinction of conditioned fear and posttraumatic stress<\/p>

disorder symptoms in rats. Translational Psychiatry. doi: 10.1038\/tp.2017.191 PMID: 28892066.<\/p>

\u00a0<\/p>

Noble LJ, Souza RR, McIntyre CK. (2019). Vagus nerve stimulation as a tool for enhancing extinction in<\/p>

exposure-based therapies. Psychopharmacology, 236(1): 355-367. doi: 10.1007\/s00213-018-4994-5.<\/p>

\u00a0<\/p>

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment,<\/i><\/p>

communication, and self-regulation<\/i>. New York, NY: W W Norton & Co. Retrieved from<\/p>

https:\/\/login.mwu.idm.oclc.org\/login?url=http:\/\/search.ebscohost.com\/login.aspx?<\/p>

direct=true&AuthType=cookie,ip,url,uid,athens&db=psyh&AN=2011-04659-000&site=ehost-live&scope=site<\/p>

\u00a0<\/p>

Rush AJ, Marangell LB, Sackeim HA, et al. (2005). Vagus nerve stimulation for treatment resistant depression:<\/p>

A randomized, controlled acute phase trial. Biologic Psychiatry, 58, 347\u201354.<\/p>

\u00a0<\/p>

Sackeim, H. A., Rush, A. J., George, M. S., Marangell, L. B., Husain, M. M., Nahas, Z., \u2026 Goodman, R. R.<\/p>

(2001). Vagus nerve stimulation (VNSTM) for treatment-resistant depression: Efficacy, side effects, and<\/p>

predictors of outcome. Neuropsychopharmacology<\/i>, 25<\/i>(5), 713\u2013728. https:\/\/doi.org\/10.1016\/S0893-<\/p>

133X(01)00271-8<\/p>

\u00a0<\/p>

Schleip R. (2003). Fascial Plasticity: A new neurobiological explanation Part 1. Journal of Bodywork movement<\/p>

therapy, 2, 1-6.<\/p>

\u00a0<\/p>

Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V ., & Gray, S. H. (2008). Nonresponse and dropout<\/p>

rates in outcome studies on PTSD: Review and methodological considerations. Psychiatry: Interpersonal and<\/i><\/p>

Biological Processes<\/i>, 71<\/i>(2), 134\u2013168. https:\/\/doi.org\/10.1521\/psyc.2008.71.2.134<\/p>

\u00a0<\/p>

Tarrier, N., Pilgrim, H., Sommerfield, C., Faragher, B., Reynolds, M., Graham, E., & Barrowclough, C. (1999).<\/p>

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress<\/p>

disorder. Journal of Consulting and Clinical Psychology<\/i>, 67<\/i>(1), 13\u201318. https:\/\/doi.org\/10.1037\/0022-<\/p>

006X.67.1.13<\/p>

\u00a0<\/p>

Taylor, S., Fedoroff, I. C., Koch, W. J., Thordarson, D. S., Fecteau, G., & Nicki, R. M. (2001). Posttraumatic<\/p>

stress disorder arising after road traffic collisions: Patterns of response to cognitive\u2013behavior therapy. Journal of<\/i><\/p>

Consulting and Clinical Psychology<\/i>, 69<\/i>(3), 541\u2013551. https:\/\/doi.org\/10.1037\/0022-006X.69.3.541<\/p>

\u00a0<\/p>

van Minnen, A., & Hagenaars, M. (2002). Fear activation and habituation patterns as early process predictors of<\/p>

response to prolonged exposure treatment in PTSD. Journal of Traumatic Stress<\/i>, 15<\/i>(5), 359\u2013367.<\/p>

https:\/\/doi.org\/10.1023\/A:1020177023209<\/p>

\u00a0<\/p>

Wampold, B.E., Imel, Z.E., Laska, K.M., et al. (2010) Determining what works in the treatment of PTSD.<\/p>

Clinical Psychology Review<\/i>, 30(8), 923-933. doi: 10.1016\/j.cpr.2010.06.005<\/p>

\u00a0<\/p>

Zayfert, C., & Black, C. (2000). Implementation of empirically supported treatment for PTSD: Obstacles and<\/p>

innovations. The Behavior Therapist<\/i>, 23<\/i>(8), 161\u2013168.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

IRB and Peer Report A preliminary investigation of the d\u0113hp\u00ae Integrative Treatment approach in the clinical management of post-traumatic stress disorder Bob Bohanske, Ph.D. \u00a0 Southwest Behavioral & Health Services […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-4909","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/pages\/4909","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/comments?post=4909"}],"version-history":[{"count":14,"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/pages\/4909\/revisions"}],"predecessor-version":[{"id":4983,"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/pages\/4909\/revisions\/4983"}],"wp:attachment":[{"href":"https:\/\/17thfloor.vip\/index.php\/wp-json\/wp\/v2\/media?parent=4909"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}