***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: This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder ( PTSD ) . Veterans and a family member were r and omly assigned to 1 of 3 conditions : ( a ) waiting list , ( b ) 18 sessions of twice-weekly exposure therapy , or ( c ) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy ( BFT ) . Participation in exposure therapy  reduced PTSD positive symptoms ( e.g. , reexperiencing and hyperarousal ) but not PTSD negative symptoms . Positive symptom gains were maintained at 6-month follow-up . However , participation in BFT had no additional impact on PTSD symptoms OBJECTIVE The memory-enhancing drug methylene blue ( MB ) administered after extinction training improves fear extinction retention in rats and humans with claustrophobia . Robust findings from animal research , in combination with established safety and data showing MB-enhanced extinction in humans , provide a foundation to extend this work to extinction-based therapies for posttraumatic stress disorder ( PTSD ) such as prolonged exposure ( PE ) . METHODS Patients with chronic PTSD ( DSM-IV-TR ; N = 42 ) were r and omly assigned to imaginal exposure plus MB ( IE + MB ) , imaginal exposure plus placebo ( IE + PBO ) , or waitlist ( WL/st and ard PE ) from September 2011 to April 2013 . Following 5 daily , 50-minute imaginal exposure sessions , 260 mg of MB or PBO was administered . Waitlist controls received PE following 1-month follow-up . Patients were assessed using the independent evaluator-rated PTSD Symptom Scale-Interview version ( primary outcome ) , patient-rated PTSD , trauma-related psychopathology , and functioning through 3-month follow-up . RESULTS Both IE + MB and IE + PBO showed strong clinical gains that did not differ from st and ard PE at 3-month follow-up . MB-augmented exposure specifically enhanced independent evaluator-rated treatment response ( number needed to treat = 7.5 ) and quality of life compared to placebo ( effect size d = 0.58 ) . Rate of change for IE + MB showed a delayed initial response followed by accelerated recovery , which differed from the linear pattern seen in IE + PBO . MB effects were facilitated by better working memory but not by changes in beliefs . CONCLUSIONS The findings provide preliminary efficacy for a brief IE treatment for PTSD and point to the potential utility of MB for enhancing outcome . Brief interventions and better tailoring of MB augmentation strategies , adjusting for observed patterns , may have the potential to reduce dropout , accelerate change , and improve outcomes . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01188694 Abstract This r and omized controlled trial was design ed to determine if art therapy in conjunction with Cognitive Processing Therapy ( CPT ) was more effective for reducing symptoms of combat posttraumatic stress disorder ( PTSD ) than CPT alone . Veterans ( N = 11 ) were r and omized to receive either individual CPT , or individual CPT in conjunction with individual art therapy .  PTSD Checklist – Military Version and Beck Depression Inventory – II scores improved with treatment in both groups with no significant difference in improvement between the experimental and control groups . Art therapy in conjunction with CPT was found to improve trauma processing and veterans considered it to be an important part of their treatment as it provided healthy distancing , enhanced trauma recall , and increased access to emotions BACKGROUND Posttraumatic stress disorder ( PTSD ) is prevalent among military veterans and is associated with significant negative health outcomes . However , stigma and other barriers to care prevent many veterans from pursuing traditional mental health treatment . We developed a group-based Integrative Exercise ( IE ) program combining aerobic and resistance exercise , which is familiar to veterans , with mindfulness-based practice s suited to veterans with PTSD . This study aim ed to evaluate the effects of IE on PTSD symptom severity and quality of life , as well as assess the feasibility and acceptability of IE . METHODS Veterans ( N = 47 ) were r and omized to either IE or waitlist control ( WL ) .  Veterans in IE were asked to attend three 1-h group exercise sessions for 12 weeks . RESULTS Compared with WL , veterans r and omized to IE demonstrated a greater reduction in PTSD symptom severity ( d = -.90 ) , a greater improvement in psychological quality of life ( d = .53 ) and a smaller relative improvement in physical quality of life ( d = .30 ) Veterans ' ratings of IE indicated high feasibility and acceptability . LIMITATIONS The sample was relatively small and recruited from one site . The comparison condition was an inactive control . CONCLUSIONS This initial study suggests that IE is an innovative approach to treating veterans with symptoms of PTSD  that reduces symptoms of posttraumatic stress and improves psychological quality of life . This approach to recovery may exp and the reach of PTSD treatment into non-traditional setting s and to veterans who may prefer a familiar activity , such as exercise , over medication or psychotherapy Rationale To improve outcomes for patients undergoing extinction-based therapies ( e.g. , exposure therapy ) for anxiety disorders such as post-traumatic stress disorder ( PTSD ) , there has been interest in identifying pharmaceutical compounds that might facilitate fear extinction learning and recall . Oxytocin ( OT ) is a mammalian neuropeptide that modulates activation of fear extinction-based neural circuits and fear responses . Little is known , however , about the effects of OT treatment on conditioned fear responding and extinction in humans . Objectives The purpose of the present study was to assess the effects of OT in a fear-potentiated startle task of fear conditioning and extinction . Methods A double-blind , placebo-controlled study of 44 healthy human participants was conducted . Participants underwent a conditioned fear acquisition procedure , after which they were r and omized to treatment group and delivered OT ( 24 IU ) or placebo via intranasal ( IN ) spray . Forty-five minutes after treatment , participants underwent extinction training . Twenty-four hours later , subjects were tested for extinction recall . Results Relative to placebo , the OT group showed increased fear-potentiated startle responding during the earliest stage of extinction training relative to placebo ; however , all treatment groups showed the same level of reduced responding by the end of extinction training . Twenty-four hours later , the OT group showed significantly higher recall of extinction relative to placebo . Conclusions The current study provides preliminary evidence that OT may facilitate fear extinction recall in humans . These results support further study of OT as a potential adjunctive treatment for extinction-based therapies in fear-related disorders OBJECTIVE The authors examined the effectiveness of virtual reality exposure augmented with D-cycloserine or alprazolam , compared with placebo , in reducing  posttraumatic stress disorder ( PTSD ) due to military trauma . METHOD After an introductory session , five sessions of virtual reality exposure were augmented with D-cycloserine ( 50 mg ) or alprazolam ( 0.25 mg ) in a double-blind , placebo-controlled r and omized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD . RESULTS PTSD symptoms significantly improved from pre- to posttreatment across all conditions and were maintained at 3 , 6 , and 12 months . There were no overall differences in symptoms between D-cycloserine and placebo at any time . Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment ; the alprazolam group showed a higher rate of PTSD ( 82.8 % ) than the placebo group ( 47.8 % ) . Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only . At posttreatment , the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes . CONCLUSIONS A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans , although there was no control condition for the virtual reality exposure . There was no advantage of D-cycloserine for PTSD symptoms in primary analyses . In secondary analyses , alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning . D-cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo , findings that are consistent with those in the animal literature Abstract Although trauma-focused cognitive behavioral therapy ( TF-CBT ) with exposure is an effective treatment for posttraumatic stress disorder ( PTSD ) , not all patients recover . Addition of breathing biofeedback to exposure in TF-CBT is suggested as a promising complementary technique to improve recovery of PTSD symptoms . Patients ( n = 8) with chronic PTSD were r and omized to regular TF-CBT or TF-CBT with complementary breathing biofeedback to exposure . PTSD symptoms were measured before , during and after TF-CBT with the Impact of Event Scale-Revised . The results show that breathing biofeedback is feasible and can easily be complemented to TF-CBT . Although PTSD symptoms significantly decreased from pre to post treatment in both conditions , there was a clear trend towards a significantly faster ( p = .051 ) symptom reduction in biofeedback compared to regular TF-CBT . The most important limitation was the small sample size . The hastened clinical improvement in the biofeedback condition supports the idea that breathing biofeedback may be an effective complementary component to exposure in PTSD patients . The mechanism of action of breathing biofeedback may relate to competing working memory re sources decreasing vividness and emotionality , similar to eye movement desensitization and reprocessing . Future research is needed to examine this Exposure to combat experiences is associated with increased risk of developing Post Traumatic Stress Disorder . Prolonged exposure therapy and cognitive processing therapy have garnered a significant amount of empirical support for PTSD treatment ; however , they are not universally effective with some patients continuing to struggle with residual PTSD symptoms . Heart rate variability ( HRV ) is a measure of the autonomic nervous system functioning and reflects an individual ’s ability to adaptively cope with stress . A pilot study was undertaken to determine if veterans with PTSD ( as measured by the Clinician-Administered PTSD Scale and the PTSD Checklist ) would show significantly different HRV prior to an intervention at baseline compared to controls ; specifically , to determine whether the HRV among veterans with PTSD is more depressed than that among veterans without PTSD . The study also aim ed at assessing the feasibility , acceptability , and potential efficacy of providing HRV biofeedback as a treatment for PTSD . The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective , feasible , and acceptable for veterans . Veterans with combat-related PTSD displayed significantly depressed HRV as compared to subjects without PTSD . When the veterans with PTSD were r and omly assigned to receive either HRV biofeedback plus treatment as usual ( TAU ) or just TAU , the results indicated that HRV biofeedback significantly increased the HRV while reducing symptoms of PTSD . However , the TAU had no significant effect on either HRV or symptom reduction . A larger r and omized control trial to vali date these findings appears warranted Behavioral exposure therapy of anxiety disorders is believed to rely on fear extinction . Because pre clinical studies have shown that glucocorticoids can promote extinction processes , we aim ed at investigating whether the administration of these hormones might be useful in enhancing exposure therapy . In a r and omized , double-blind , placebo-controlled study , 40 patients with specific phobia for heights were treated with three sessions of exposure therapy using virtual reality exposure to heights . Cortisol ( 20 mg ) or placebo was administered orally 1 h before each of the treatment sessions . Subjects returned for a posttreatment assessment 3–5 d after the last treatment session and for a follow-up assessment after 1 mo . Adding cortisol to exposure therapy result ed in a significantly greater reduction in fear of heights as measured with the acrophobia question naire ( AQ ) both at posttreatment and at follow-up , compared with placebo . Furthermore , subjects receiving cortisol showed a significantly greater reduction in acute anxiety during virtual exposure to a phobic situation at posttreatment and a significantly smaller exposure-induced increase in skin conductance level at follow-up . The present findings indicate that the administration of cortisol can enhance extinction-based psychotherapy OBJECTIVE Despite the success of empirically supported treatments for posttraumatic stress disorder ( PTSD ) , sleep impairment frequently remains refractory after treatment . This single-site , r and omized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD ( cognitive processing therapy [ CPT ] ) . METHOD Participants completed either 3 weeks of hypnosis  ( n = 52 ) or a symptom monitoring control condition ( n = 56 ) before beginning st and ard CPT . Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis result ed in improvements in sleep , PTSD , and depression . An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT . RESULTS After the initial phase of treatment ( hypnosis or symptom monitoring ) , the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression , but not PTSD . After CPT , both conditions demonstrated significant improvement in sleep and PT 
    Output:
    
Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction .
Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction .
Conclusions : Currently , it is not possible to formulate evidence -based clinical recommendations regarding adjuvants interventions .