The Effect of Imaginal Exposure Length on Outcome of Treatment for PTSD ∗

GGZ Nijmegen, Outpatient Clinic of Anxiety Disorders, Nijmegen, The Netherlands.
Journal of Traumatic Stress (Impact Factor: 2.72). 08/2006; 19(4):427-38. DOI: 10.1002/jts.20146
Source: PubMed


The effects of prolonged imaginal exposure sessions (60 minutes; n=60) were compared with those of shorter exposure sessions (30 minutes, n=32) for patients with chronic posttraumatic stress disorder (PTSD). Consistent with the authors' hypothesis, patients who received 30-minute imaginal exposure sessions showed less within-session habituation than patients who received 60-minute exposure sessions. However, no differences between patients who received 60-minute and 30-minute exposure sessions emerged on improvement in PTSD-symptoms, state anxiety, depression, and end-state functioning, both at posttreatment and at 1-month follow-up. No group differences were found with regard to between-sessions habituation, number of sessions, and dropout rate. Results suggest that 30-minute imaginal exposure sessions are as effective as 60-minute exposure sessions and that within-session habituation may not be a necessary condition for successful treatment of PTSD. Future research is needed to replicate these findings and extend them to other clinical populations.

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Available from: Agnes Van minnen, Oct 10, 2015
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    • "Furthermore, exposure-based therapy is deemed the most appropriate psychotherapy to manage PTSD by the International Consensus group on Depression and Anxiety (Ballenger et al., 2000). Exposure-based therapy has been shown to be effective for PTSD in victims of rape, physical assault, combat/terrorism, childhood sexual and physical abuse, motor vehicle accidents, refugees and mixed trauma (Bryant et al., 2008; Foa et al., 2005; McDonagh et al., 2005; Nacasch et al., 2010, van Minnen et al., 2006). A recent meta-analysis of prolonged exposure for PTSD found large effect sizes for prolonged exposure compared to control conditions. "
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    ABSTRACT: Integrative treatments for co-occurring posttraumatic stress (PTSD) and substance use disorders have been shown to be safe and effective. Improvement in PTSD symptoms can positively impact substance use outcomes. Interventions that include exposure-based techniques, which are considered the treatment of choice for PTSD, have not been well studied in substance abusing populations. Concurrent Treatment of PTSD and Substance Use Disorders with Prolonged Exposure (COPE) is a manualized psychotherapy that combines both imaginal and in vivo exposure techniques for PTSD with cognitive behavioral techniques for substance use disorders. Preliminary studies using COPE demonstrate promise and feasibility. This article explores the clinical considerations when implementing exposure-based therapy for PTSD in substance abusing individuals.
    Journal of Dual Diagnosis 10/2011; 7(4):194-206. DOI:10.1080/15504263.2011.620421 · 0.80 Impact Factor
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    • "A one-size-fits-all approach of the typical 45–60 min exposure duration over the course of 7 to 10 imaginal exposure sessions may be too much for some and too little for others. We are just starting to understand these parameters, with some preliminary evidence showing that not all patients need exposure at this duration (e.g., 30 min may suffice) or number of sessions (e.g., 3–5 sessions may be possible; Basoglu, Livanou, Salcioglu, 2003; van Minnen & Foa, 2006). Yet, even here, we do not know the vital question of who is most likely to benefit from longer or shorter length of exposure or number of treatment sessions. "
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    ABSTRACT: Prolonged exposure, a cognitive behavioral therapy including both in vivo and imaginal exposure to the traumatic memory, is one of several empirically supported treatments for chronic posttraumatic stress disorder (PTSD). In this article, we provide a case illustration in which this well-validated treatment did not yield expected clinical gains for a client with PTSD and co-occurring major depression. After providing an overview of the literature, theory, and treatment protocol, we discuss the clinical cascade effect that underlying ruminative processes had on the treatment of this case. Specifically, we highlight how ruminative processes, focusing on trying to understand why the traumatic event happened and why the client was still suffering, resulted in profound emotional distress in session and in a lack of an "optimal dose" of exposure during treatment.
    Cognitive and Behavioral Practice 08/2011; 18(3):338-349. DOI:10.1016/j.cbpra.2010.05.008 · 1.33 Impact Factor
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    • "). Stimuli are presented in graded exposure using a fear hierarchy. It has been argued that exposure to feared stimulus activates the underlying fear structure of the disorder, and allows for modification of the pathological elements of the structure (Foa & Kozak, 1986; van Minnen & Foa, 2006) Exposure can be real or imagined. A scenario from the fear hierarchy can be imagined whilst practising relaxation, i.e., " imaginal " exposure (Riva, Molinari, & Vincelli, 2001). "
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