Trial Outcomes & Findings for Estrogen and Fear in PTSD (NCT NCT04192266)

NCT ID: NCT04192266

Last Updated: 2026-01-09

Results Overview

Functional Magnetic Resonance Imaging (fMRI) will be used to assess Blood Oxygen Level Dependent (BOLD) signal activation in the amygdala before and after completion of the experimental task. Change in activation will be reported using beta weights; positive beta weights mean greater activation and negative beta weights mean less activation in the specific brain region being monitored

Recruitment status

COMPLETED

Study phase

PHASE3

Target enrollment

83 participants

Primary outcome timeframe

Before and after treatment on Experimental day 2

Results posted on

2026-01-09

Participant Flow

A total of 123 participants were screened for eligibility. Of these, 83 participants met inclusion criteria and were enrolled in the study. Among the enrolled participants, 19 withdrew before randomization. The remaining 64 participants were randomized and began study participation.

Participant milestones

Participant milestones
Measure
Prolonged Exposure (PE) Therapy With Estradiol
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Overall Study
STARTED
31
33
Overall Study
COMPLETED
28
31
Overall Study
NOT COMPLETED
3
2

Reasons for withdrawal

Reasons for withdrawal
Measure
Prolonged Exposure (PE) Therapy With Estradiol
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Overall Study
Withdrawal by Subject
3
2

Baseline Characteristics

Estrogen and Fear in PTSD

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=31 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=33 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Total
n=64 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Age, Categorical
Between 18 and 65 years
31 Participants
n=8 Participants
33 Participants
n=7 Participants
64 Participants
n=15 Participants
Age, Categorical
>=65 years
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Sex: Female, Male
Female
31 Participants
n=8 Participants
33 Participants
n=7 Participants
64 Participants
n=15 Participants
Sex: Female, Male
Male
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
6 Participants
n=8 Participants
4 Participants
n=7 Participants
10 Participants
n=15 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
25 Participants
n=8 Participants
29 Participants
n=7 Participants
54 Participants
n=15 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Race/Ethnicity, Customized
American Indian or Alaska Native
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Race/Ethnicity, Customized
Asian
4 Participants
n=8 Participants
3 Participants
n=7 Participants
7 Participants
n=15 Participants
Race/Ethnicity, Customized
Native Hawaiian or Other Pacific Islander
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Race/Ethnicity, Customized
Black or African American
4 Participants
n=8 Participants
6 Participants
n=7 Participants
10 Participants
n=15 Participants
Race/Ethnicity, Customized
White
19 Participants
n=8 Participants
22 Participants
n=7 Participants
41 Participants
n=15 Participants
Race/Ethnicity, Customized
More than One Race
3 Participants
n=8 Participants
1 Participants
n=7 Participants
4 Participants
n=15 Participants
Race/Ethnicity, Customized
Unknown or Not Reported
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Race/Ethnicity, Customized
Other
1 Participants
n=8 Participants
1 Participants
n=7 Participants
2 Participants
n=15 Participants
Region of Enrollment
United States
31 participants
n=8 Participants
33 participants
n=7 Participants
64 participants
n=15 Participants
Marital Status
Single
23 Participants
n=8 Participants
20 Participants
n=7 Participants
43 Participants
n=15 Participants
Marital Status
Living with Partner
6 Participants
n=8 Participants
7 Participants
n=7 Participants
13 Participants
n=15 Participants
Marital Status
Married
2 Participants
n=8 Participants
3 Participants
n=7 Participants
5 Participants
n=15 Participants
Marital Status
Divorced
0 Participants
n=8 Participants
3 Participants
n=7 Participants
3 Participants
n=15 Participants
Marital Status
Widowed
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Marital Status
Separated
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Marital Status
Unknown or Not Reported
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Highest Education Level Completed
Graduate School
7 Participants
n=8 Participants
11 Participants
n=7 Participants
18 Participants
n=15 Participants
Highest Education Level Completed
College Graduate
11 Participants
n=8 Participants
13 Participants
n=7 Participants
24 Participants
n=15 Participants
Highest Education Level Completed
Partial College
13 Participants
n=8 Participants
8 Participants
n=7 Participants
21 Participants
n=15 Participants
Highest Education Level Completed
High School Graduate
0 Participants
n=8 Participants
1 Participants
n=7 Participants
1 Participants
n=15 Participants
Highest Education Level Completed
Partial High School
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Highest Education Level Completed
Junior High School
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Highest Education Level Completed
Less than 7 years of school
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants
Current Employment Status
Not applicable
5 Participants
n=8 Participants
1 Participants
n=7 Participants
6 Participants
n=15 Participants
Current Employment Status
Full-time employment
11 Participants
n=8 Participants
18 Participants
n=7 Participants
29 Participants
n=15 Participants
Current Employment Status
Part-time employment
5 Participants
n=8 Participants
6 Participants
n=7 Participants
11 Participants
n=15 Participants
Current Employment Status
Student/Dependent on spouse
10 Participants
n=8 Participants
8 Participants
n=7 Participants
18 Participants
n=15 Participants
Current Employment Status
Recipient of public/private assistance
0 Participants
n=8 Participants
0 Participants
n=7 Participants
0 Participants
n=15 Participants

PRIMARY outcome

Timeframe: Before and after treatment on Experimental day 2

Population: Data were not collected from 4 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out and 1 participant had data acquisition errors. Data were not collected from 3 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 participants dropped out and 1 participant experienced an adverse event and the visit was not completed.

Functional Magnetic Resonance Imaging (fMRI) will be used to assess Blood Oxygen Level Dependent (BOLD) signal activation in the amygdala before and after completion of the experimental task. Change in activation will be reported using beta weights; positive beta weights mean greater activation and negative beta weights mean less activation in the specific brain region being monitored

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=27 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in Amygdala Activation as Measured by Functional Magnetic Resonance Imaging (fMRI) Blood Oxygen Level Dependent (BOLD) Signal
0.534 beta weights
Standard Error 0.201
-0.0037 beta weights
Standard Error 0.159

PRIMARY outcome

Timeframe: Before and after treatment on Experimental day 2

Population: Data were not collected from 4 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out and 1 participant had data acquisition errors. Data were not collected from 3 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 participants dropped out and 1 participant experienced an adverse event and the visit was not completed.

Functional Magnetic Resonance Imaging (fMRI) will be used to assess Blood Oxygen Level Dependent (BOLD) signal activation in the dorsal anterior cingulate cortex (dACC) before and after completion of the experimental task. Change in activation will be reported using beta weights; positive beta weights mean greater activation and negative beta weights mean less activation in the specific brain region being monitored

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=27 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in Dorsal Anterior Cingulate Cortex (dACC) Activation as Measured by Functional Magnetic Resonance Imaging (fMRI) Blood Oxygen Level Dependent (BOLD) Signal
0.292 beta weights
Standard Error 0.213
-0.0276 beta weights
Standard Error 0.219

PRIMARY outcome

Timeframe: Before and after treatment on Experimental day 2

Population: Data were not collected from 4 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out and 1 participant had data acquisition errors. Data were not collected from 3 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 participants dropped out and 1 participant experienced an adverse event and the visit was not completed.

Functional Magnetic Resonance Imaging (fMRI) will be used to assess Blood Oxygen Level Dependent (BOLD) signal activation in the ventromedial prefrontal cortex (vmPFC) before and after completion of the experimental task. Change in activation will be reported using beta weights; positive beta weights mean greater activation and negative beta weights mean less activation in the specific brain region being monitored

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=27 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in Ventromedial Prefrontal Cortex (vmPFC) Activation as Measured by Functional Magnetic Resonance Imaging (fMRI) Blood Oxygen Level Dependent (BOLD) Signal
0.512 beta weights
Standard Error 0.247
-0.118 beta weights
Standard Error 0.209

PRIMARY outcome

Timeframe: Before and after treatment on Experimental day 2

Population: Data were not collected from 4 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out and 1 participant had data acquisition errors. Data were not collected from 3 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 participants dropped out and 1 participant experienced an adverse event and the visit was not completed.

Functional Magnetic Resonance Imaging (fMRI) will be used to assess Blood Oxygen Level Dependent (BOLD) signal activation in the hippocampus before and after completion of the experimental task. Change in activation will be reported using beta weights; positive beta weights mean greater activation and negative beta weights mean less activation in the specific brain region being monitored.

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=27 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in Hippocampus Activation as Measured by Functional Magnetic Resonance Imaging (fMRI) Blood Oxygen Level Dependent (BOLD) Signal
0.341 beta weights
Standard Error 0.158
-0.0606 beta weights
Standard Error 0.178

SECONDARY outcome

Timeframe: Pre - Treatment Experimental Day 2 recall

Population: Data were not collected from 13 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out, 5 participants had data acquisition errors, and 5 participants had unusable data. Data were not collected from 11 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 dropped out, 2 had data acquisition errors, 1 participant experienced an adverse event and the visit was not completed, and 6 participants had unusable data.

Skin Conductance Response (SCR) assesses the stress/seat level, or level of anxiety in a particular moment, or in response to a specific cue. SCR are reported in microsiemens, a positive value indicates an increase of response to the condition stimulus relative to 3 seconds prior to its onset. A negative value indicates a decrease in response to the condition stimulus relative to 3 seconds prior to its onset.

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=18 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=22 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Skin Conductance Response (SCR) During Recall
-0.0741 microsiemens
Standard Deviation 0.0821
-0.195 microsiemens
Standard Deviation 0.0659

SECONDARY outcome

Timeframe: Post- Treatment Experimental Day 2 recall

Population: Data were not collected from 13 participants in the Prolonged Exposure (PE) Therapy With Active Pill arm because 3 participants dropped out, 5 participants had data acquisition errors, and 5 participants had unusable data. Data were not collected from 11 participants in the Prolonged Exposure (PE) Therapy With Placebo arm because 2 dropped out, 2 had data acquisition errors, 1 participant experienced an adverse event and the visit was not completed, and 6 participants had unusable data.

Skin Conductance Response (SCR) assesses the stress/seat level, or level of anxiety in a particular moment, or in response to a specific cue. SCR will be reported in microsiemens

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=18 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=22 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Skin Conductance Response (SCR) During Recall
0.000479 microsiemens
Standard Deviation 0.0167
0.0894 microsiemens
Standard Deviation 0.0457

SECONDARY outcome

Timeframe: Baseline, 1 month post intervention

Population: Data were not collected from 7 participants in the PE therapy with Estradiol arm: 2 dropped out, 2 are missing baseline and post treatment scores because CAPS was not part of the study at the time and 2 are missing baseline scores because CAPS was not part of the study at this time. Data were not collected from 3 participants in the PE therapy with Placebo arm: 2 dropped out and 1 is missing both baseline and post treatment scores because CAPS measure was not part of the study at that time.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS) measures PTSD symptom severity. CAPS has a total score from 0 to 80, with higher scores indicating more severe PTSD symptoms. The change in score will be reported as the \[(Score at 1 month post intervention) - (Score at Baseline)\] - A negative value indicates a reduction in PTSD symptom severity

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=24 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in PTSD Symptom Assessed by the Clinician-Administered PTSD Scale for DSM-5 (CAPS)
-14.83 score on a scale
Standard Error 1.848
-18.23 score on a scale
Standard Error 1.848

SECONDARY outcome

Timeframe: Baseline, 3 months post intervention

Population: Data were not collected from 8 participants in the PE therapy with Estradiol arm: 3 dropped out, 4 are missing baseline scores because CAPS was not part of the study at this time and 1 did not complete the 3 month follow up visit. Data were not collected from 3 participants in the PE therapy with Placebo arm: 2 dropped out and 1 is missing baseline scores because CAPS measure was not part of the study at that time.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS) measures PTSD symptom severity. CAPS has a total score from 0 to 80, with higher scores indicating more severe PTSD symptoms. The change in score will be reported as the \[(Score at 3 month post intervention) - (Score at Baseline)\] - A negative value indicates a reduction in PTSD symptom severity

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=23 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=30 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in PTSD Symptom Assessed by the Clinician-Administered PTSD Scale for DSM-5 (CAPS)
-21.04 score on a scale
Standard Error 1.5572
-22.3 score on a scale
Standard Error 1.8944

SECONDARY outcome

Timeframe: Baseline, 6 months post intervention

Population: Data were not collected from 8 participants in the PE therapy with Estradiol arm: 3 dropped out, 4 are missing baseline scores because CAPS was not part of the study at this time and 1 did not complete the 6 month follow up visit. Data were not collected from 4 participants in the PE therapy with Placebo arm: 2 dropped out and 1 is missing baseline scores because CAPS measure was not part of the study at that time and 1 did not complete the 6 month follow up visit.

The Clinician-Administered PTSD Scale for DSM-5 (CAPS) measures PTSD symptom severity. CAPS has a total score from 0 to 80, with higher scores indicating more severe PTSD symptoms. The change in score will be reported as the \[(Score at 6 month post intervention) - (Score at Baseline)\] - A negative value indicates a reduction in PTSD symptom severity

Outcome measures

Outcome measures
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=23 Participants
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=29 Participants
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Change in PTSD Symptom Assessed by the Clinician-Administered PTSD Scale for DSM-5 (CAPS)
-22.83 score on a scale
Standard Error 1.7812
-23.62 score on a scale
Standard Error 1.9095

Adverse Events

Prolonged Exposure (PE) Therapy With Estradiol

Serious events: 0 serious events
Other events: 17 other events
Deaths: 0 deaths

Prolonged Exposure (PE) Therapy With Placebo

Serious events: 0 serious events
Other events: 18 other events
Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Other adverse events
Measure
Prolonged Exposure (PE) Therapy With Estradiol
n=31 participants at risk
A single 2mg dose of estradiol (a form of estrogen) will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Estradiol: 2.0 mg of estradiol will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions (Session 2- 6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Prolonged Exposure (PE) Therapy With Placebo
n=33 participants at risk
A single 2mg placebo pill will be taken at home by the study participant 5-6 hours before each of 5 prolonged exposure (PE) therapy treatment sessions (sessions 2 to 6). PE therapy is a validated treatment for PTSD. Placebo oral tablet: 2.0 mg placebo pills will be taken by mouth by the study participant 5-6 hours before each of 5 PE treatment sessions ( Sessions 2-6) Prolonged Exposure (PE) therapy: There will be an introductory Prolonged Exposure (PE) therapy session, followed by 5 imaginal exposure sessions, such that there will be 2 sessions per week conducted for a total of 6 sessions over 3 weeks. The PE sessions are 60 minutes long and consist of imaginal exposure. Specifically, the patient is instructed to imagine the trauma and recount it aloud for about 25-30 minutes. In the following 15 minutes, the patient processes her reactions to revisiting the traumatic event by discussing related thoughts and feelings. The session ends with in vivo exposure homework to be completed that same day as the session. In the last session, imaginal exposure is conducted one last time for the same duration as previous sessions. The therapist and patient review treatment progress and discuss applications of treatment principles to daily life.
Gastrointestinal disorders
nausea and/or vomiting and/or diarrhea
12.9%
4/31 • Number of events 4 • Up to 6 months
12.1%
4/33 • Number of events 4 • Up to 6 months
Respiratory, thoracic and mediastinal disorders
COVID illness or post COVID vaccine symptoms
12.9%
4/31 • Number of events 4 • Up to 6 months
15.2%
5/33 • Number of events 7 • Up to 6 months
Psychiatric disorders
Emotional distress, fatigue
9.7%
3/31 • Number of events 5 • Up to 6 months
6.1%
2/33 • Number of events 3 • Up to 6 months
Psychiatric disorders
Anxiety
6.5%
2/31 • Number of events 2 • Up to 6 months
9.1%
3/33 • Number of events 4 • Up to 6 months
Reproductive system and breast disorders
Issues related to menstrual cycle
6.5%
2/31 • Number of events 2 • Up to 6 months
6.1%
2/33 • Number of events 2 • Up to 6 months
Injury, poisoning and procedural complications
Arm bruising and ache
6.5%
2/31 • Number of events 2 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
Injury, poisoning and procedural complications
Injury
3.2%
1/31 • Number of events 2 • Up to 6 months
0.00%
0/33 • Up to 6 months
Social circumstances
General distress due to Interpersonal Conflict
3.2%
1/31 • Number of events 1 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
Reproductive system and breast disorders
Changes in libido
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
General disorders
Weight gain
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
Reproductive system and breast disorders
Polyp in uterus found after routine medical checkup
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
Nervous system disorders
Concussion
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
General disorders
Allergic Reaction
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
Musculoskeletal and connective tissue disorders
Body aches
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
Nervous system disorders
Brain fog and nausea
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
General disorders
Fever, nausea, and insomnia
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
Gastrointestinal disorders
Gastrointestinal illness
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
Immune system disorders
Lymphangitis
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months
General disorders
Neck pain
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
Nervous system disorders
Tremulousness, headache, nausea
3.2%
1/31 • Number of events 1 • Up to 6 months
0.00%
0/33 • Up to 6 months
Respiratory, thoracic and mediastinal disorders
Upper respiratory infection
0.00%
0/31 • Up to 6 months
3.0%
1/33 • Number of events 1 • Up to 6 months

Additional Information

Mohammed R Milad, PhD

The University of Texas Health Science Center at Houston

Phone: 713-486-2754

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place