***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Little is known about the efficacy of " next step " strategies for patients with post-traumatic stress disorder ( PTSD ) who remain symptomatic despite treatment . This study prospect ively examines the relative efficacy of augmentation of continued prolonged exposure therapy ( PE ) with paroxetine CR versus placebo for individuals remaining symptomatic despite a course of PE . METHOD Adult out patients meeting DSM-IV criteria for PTSD were recruited from February 2003 to September 2005 at 4 academic centers . Phase I consisted of 8 sessions of individual PE over a 4- to 6-week period . Participants who remained symptomatic , defined as a score of > or= 6 on the Short PTSD Rating Interview ( SPRINT ) and a Clinical Global Impressions-Severity of Illness scale ( CGI-S ) score > or= 3 , were r and omly assigned to the addition of paroxetine CR or matched placebo to an additional 5 sessions of PE ( Phase II ) . RESULTS Consistent with prior studies , the 44 Phase I completers improved significantly with initial PE  ( SPRINT : paired t = 7.6 , df = 41 , p < .0001 ; CGI-S : paired t = 6.37 , df = 41 , p < .0001 ) . Counter to our hypothesis , however , we found no additive benefit of augmentation of continued PE with paroxetine CR compared to pill placebo for the 23 r and omly assigned patients , with relatively minimal further gains overall in Phase II . CONCLUSION Although replication with larger sample s is needed before definitive conclusions can be drawn , our data do not support the addition of paroxetine CR compared with placebo to continued PE for individuals with PTSD who remain symptomatic after initial PE , suggesting that the development of novel treatment approaches for PTSD refractory to PE is needed . CLINICAL TRIALS REGISTRATION Clinical Trials.gov identifier NCT00215163 To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results OBJECTIVE To examine the potential benefits of adding a selective serotonin reuptake inhibitor , sertraline , versus placebo , to trauma-focused cognitive-behavioral therapy ( TF-CBT ) for improving posttraumatic stress disorder and related psychological symptoms in children who have experienced sexual abuse . METHOD Twenty-four 10- to 17-year-old female children and adolescents and their primary caretakers were r and omly assigned to receive TF-CBT + sertraline or TF-CBT + placebo for 12 weeks . RESULTS Both groups experienced significant improvement in posttraumatic stress disorder and other clinical outcomes from pre- to posttreatment with no significant group x time differences between groups except in Child Global Assessment Scale ratings , which favored the TF-CBT + sertraline group . CONCLUSIONS Only minimal evidence suggests a benefit to adding sertraline to TF-CBT . A drawback of adding sertraline was determining whether TF-CBT or sertraline caused clinical improvement for children with comorbid depression . Current evidence therefore supports an initial trial of TF-CBT or other evidence -supported psychotherapy for most children with PTSD symptoms before adding medication We examined the feasibility , acceptability , and therapeutic efficacy of a culturally adapted cognitive – behavior therapy ( CBT ) for twelve Vietnamese refugees with treatment-resistant posttraumatic stress disorder ( PTSD ) and panic attacks . These patients were treated in two separate cohorts of six with staggered onset of treatment . Repeated measures Group × Time ANOVAs and between-group comparisons indicated significant improvements , with large effect sizes ( Cohen 's d ) for all outcome measures : Harvard Trauma Question naire ( HTQ ; d=2.5 ) ; Anxiety Sensitivity Index ( ASI ; d=4.3 ) ; Hopkins Symptom Checklist-25 ( HSCL-25 ) , anxiety subscale ( d=2.2 ) ; and Hopkins Symptom Checklist-25 , depression subscale ( d=2.0 ) scores . Likewise , the severity of ( culturally related ) headache- and orthostasis-cued panic attacks improved significantly across Background : To date , there have been no studies comparing cognitive behavior therapy ( CBT ) with Rogerian therapy in post-traumatic stress disorder . Method : Sixty out patients with DSM-IV chronic post-traumatic stress disorder were r and omized into two groups for 16 weekly individual sessions of CBT or Rogerian supportive therapy ( ST ) at two centers . No medication was prescribed . Measures included the Post-Traumatic Stress Disorder Checklist Scale ( PCLS ) , the Hamilton Anxiety Scale , Beck Depression Inventory , and Quality of Life . The general criterion of improvement ( GCI ) was a score of less than 44 on the PCLS . Results : Forty-two patients were evaluated at post-test , 38 at week 52 and 25 at week 104 . At post-test , the rate of patients leaving the trial due to worsening or lack of effectiveness was significantly higher in the ST group ( p = 0.004 ) . At this point , no between-group difference was found on the GCI and any of the rating scales . Intent-to-treat analysis found no difference for the GCI , but patients in the CBT group showed greater improvement on the PCLS and Hamilton Anxiety Scale . Naturalistic follow-up showed sustained improvement without between-group differences at weeks 52 and 104 . Conclusions : CBT retained significantly more patients in treatment than ST , but its effects were equivalent to those of ST in the completers . CBT was better in the dimensional intent-to-treat analysis at post-test Abstract This study evaluated the benefits of add-on hypnotherapy in patients with chronic PTSD . Thirty-two PTSD patients treated by SSRI antidepressants and supportive psychotherapy  were r and omized to 2 groups : 15 patients in the first group received Zolpidem 10 mg nightly for 14 nights , and 17 patients in the  hypnotherapy group were treated by symptom-oriented hypnotherapy , twice-a-week 1.5-hour sessions for 2 weeks . All patients completed the Stanford Hypnotic Susceptibility Scale , Form C , Beck Depression Inventory , Impact of Event Scale , and Visual Subjective Sleep Quality Question naire before and after treatment . There was a significant main effect of the hypnotherapy treatment with PTSD symptoms as measured by the Posttraumatic Disorder Scale . This effect was preserved at follow-up 1 month later . Additional benefits for the hypnotherapy group were decreases in intrusion and avoidance reactions and improvement in all sleep variables assessed The present study was design ed to determine whether augmenting sertraline with prolonged exposure ( PE ) would result in greater improvement than continuation with sertraline alone . Outpatient men and women with chronic PTSD completed 10 weeks of open label sertraline and then were r and omly assigned to five additional weeks of sertraline alone ( n = 31 ) or sertraline plus 10 sessions of twice-weekly PE ( n = 34 ) . Results indicated that sertraline led to a significant reduction in PTSD severity after 10 weeks but was associated with no further reductions after five more weeks . Participants who received PE showed further reduction in PTSD severity . This augmentation effect was observed only for participants who showed a partial response to medication OBJECTIVE The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder ( PTSD ) . This study compared the efficacy of a selective serotonin reup-take inhibitor ( SSRI ) , fluoxetine , with a psychotherapeutic treatment , eye movement desensitization and reprocessing ( EMDR ) , and pill placebo and measured maintenance of treatment gains at 6-month follow-up . METHOD Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were r and omly assigned to EMDR , fluoxetine , or pill placebo . They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up . The primary outcome measure was the Clinician-Administered PTSD Scale , DSM-IV version , and the secondary outcome measure was the Beck Depression Inventory-II . The study ran from July 2000 through July 2003 . RESULTS The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms , but this benefit accrued primarily for adult-onset trauma survivors . At 6-month follow-up , 75.0 % of adult-onset versus 33.3 % of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group . For most childhood-onset trauma patients , neither treatment produced complete symptom remission . CONCLUSIONS This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma . It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma . Future research should assess the impact of lengthier intervention , combination treatments , and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma Concentration camp survivors from Bosnia-Herzegovina , now refugees in the Netherl and s , were given early outpatient treatment for posttraumatic stress disorder ( PTSD ) for 6 months . They were tested with the  Watson Question naire  before entering therapy , after 6 months and 3 years later when a structured interview design ed to obtain information on psychosocial status was administered . Data were analyzed with PCA-STAT 1.1 statistical package . The treatment was effective on a short-term basis with some long-term effects .  Elderly people were no more vulnerable to the onset of PTSD than younger ones but were more resistant to therapy . Psychosocial factors had neither protective nor risk value for the development of PTSD in this group The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components -- cognitive therapy only ( CPT-C ) and written accounts (WA)--for the treatment of posttraumatic stress disorder ( PTSD ) and comorbid symptoms . The intent-to-treat ( ITT ) sample included 150 adult women with PTSD who were r and omized into 1 of the 3 conditions . Each condition consisted of 2 hr of therapy per week for 6 weeks ; blind assessment s were conducted before treatment , 2 weeks following the last session , and 6 months following treatment . Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment . Secondary measures assessed anxiety , anger , shame , guilt , and dysfunctional cognitions . Independent ratings of adherence and competence were also conducted . Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression , the primary measures , and improved on other indices of adjustment . However , there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition There has been growing interest in the concept of resilience and the question as to whether psychotropic medications or psychosocial treatments might have resilience-enhancing effects . This pilot study investigates resilience in a sample of patients with post-traumatic stress disorder ( PTSD ) before and after treatment . Effects of treatment with tiagabine , fluoxetine , sertraline alone , and sertraline with cognitive behavioural therapy on resilience were assessed using the Connor-Davidson Resilience Scale ( CD-RISC ) . Changes in resilience after treatment were measured and response to treatment was predicted from demographic , resilience and baseline disability measures . Changes in resilience following treatment were statistically significant . Items that showed the greatest change related to confidence , control , coping , knowing where to turn for help and adaptability . Items showing the least change related to religious and existential aspects of resiliency , effort , acting on a hunch , decision-making and goals . In linear and logistic regression models , gender , baseline CD-RISC score , baseline Sheehan Disability Scale score and an individual item from the CD-RISC scale , ‘ Sense of Humor ’ , were significant predictors of response to treatment . Treatment of PTSD significantly improved resilience and reduced symptoms in this sample . Further controlled studies are 
    Output:
    
There is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone .