Prolonged exposure therapy for combat-posttraumatic stress disorder: An examination of treatment effectiveness for veterans of the wars in Afghanistan and Iraq

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, United States
Journal of anxiety disorders (Impact Factor: 2.68). 11/2010; 25(3):397-403. DOI: 10.1016/j.janxdis.2010.11.002
Source: PubMed

ABSTRACT The Veteran's Health Administration (VHA) has launched a large-scale initiative to promote prolonged exposure (PE) therapy, an evidence-based treatment for PTSD. While existing randomized controlled trials (RCTs) unambiguously support the efficacy of PE in civilian and some military populations, there is a need to better understand the course of treatment for combat Veterans of the current wars receiving PE in normative mental healthcare settings. The current study investigates 65 Veterans receiving care at an urban VA medical center. All Veterans were diagnosed with PTSD via a structured interview and treated with PE. Measures of PTSD and depression were collected pre- and post-treatment and every two sessions during treatment. Dependent means t-tests were used to estimate pre- and post-treatment d-type effect sizes. Additionally, hierarchical linear models (HLM) were used to investigate treatment effects over time, relationships between patient characteristics and outcomes, and to provide estimates of R(2)-type effect sizes. Results indicate that PE in regular VA mental healthcare contexts can be as effective as when implemented in carefully conducted RCTs.

1 Follower
24 Reads
  • Source
    • "The size of the effects found are similar to clinical care effect sizes reported in the VA's implementation of individual PE and our own published individual therapy data (d = 0.86, Eftekhari et al., 2013; d = 1.13, Sripada et al., 2013), but are smaller than some of other recent reports in VA samples (e.g., d = 2.19, Rauch et al., 2009; d = 2.07, Tuerk et al., 2011). Differences in effect sizes between these studies likely related to the specific subsamples of study, as well as the level of experience with PE at various sites. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research has consistently demonstrated that Prolonged Exposure (PE) therapy is an effective treatment for posttraumatic stress disorder (PTSD). Traditionally, PE has been studied and delivered on an individual basis. However, the growing number of Veterans in need of PTSD treatment has led to increased interest in group therapies as an efficient way to provide access to care. The current study examined a group and individual hybrid treatment that was developed based on PE principles. Treatment was 12 weeks in length and consisted of 12 one-hour group sessions focused on in vivo exposures, and an average of approximately five-hour long individual imaginal exposure sessions. Data for this study were derived from 67 veterans who participated in 12 cohorts of the Group PE. Significant reductions in PTSD and depression symptoms were found in both completers and intent-to-treat sample analyses. The clinical implications of these findings are discussed. Published by Elsevier Ltd.
    Journal of Anxiety Disorders 12/2014; 30C:23-27. DOI:10.1016/j.janxdis.2014.12.008 · 2.96 Impact Factor
  • Source
    • "ROLONGED exposure therapy (PE), a type of exposure therapy, is an empirically supported treatment for PTSD and related psychopathology, such as depression, anger, and guilt (Cahill, Rauch, Hembree, & Foa, 2003; Foa et al., 1999; Foa et al., 2005; Hembree et al., 2005; Paunovic & Öst, 2001; Rauch, et al., 2009; Resick, Nishith, Weaver, Astin, & Feuer, 2002; Rothbaum, Astin, & Marsteller, 2005; Schnurr et al., 2007; Tuerk et al., 2011). In response to the need to provide effective treatments to men and women who have served in the Armed Forces, the most recent U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) treatment guidelines recommended exposure therapy as a first-line intervention for PTSD (Freidman, 2006; Institute of Medicine, 2007; VA DoD, 2010). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Prolonged exposure therapy (PE) is a treatment that has proven effectiveness in reducing the symptoms of posttraumatic stress disorder (PTSD) and related psychopathology. Providing PE to trauma survivors with PTSD, particularly related to combat trauma, often involves addressing guilt or shame related to their contextually appropriate use of violence and lethal force. In this paper, we present 4 clinical case vignettes in order to define the concept of perceived perpetration, and offer clinical suggestions for assessment and treatment with PE. Specifically, we examined issues such as identifying what type of traumatic events are appropriate for the use of PE, how to approach issues surrounding actions that could be perceived as perpetration, and attending to trauma-related guilt or shame.
    Cognitive and Behavioral Practice 11/2013; 20(4):461–470. DOI:10.1016/j.cbpra.2012.12.002 · 1.33 Impact Factor
  • Source
    • "Foa et al.'s (2005) RCT of Prolonged Exposure for sexual assault survivors found equivalent outcomes for expert therapists and newly trained therapists working in a community center. Karlin et al. (2010) reported that veterans treated with Prolonged Exposure or Cognitive Processing Therapy following an extensive therapist training program implemented in the Veteran Health Administration showed a 30% decrease in PTSD symptoms in completer analyses (see also Monson et al., 2006; Tuerk et al., 2011). Levitt, Malta, Martin, Davis, and Cloitre (2007) and Brewin et al. (2010) reported large improvements in outreach programs for survivors of 9/11 and the London bombings who suffered from PTSD. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Trauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area. A consecutive sample of 330 patients with PTSD (age 17-83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects. CT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience. The results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.
    Behaviour Research and Therapy 09/2013; 51(11):742-752. DOI:10.1016/j.brat.2013.08.006 · 3.85 Impact Factor
Show more