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


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.

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    • "A large effect size decrease in self-rated PTSD symptoms was reported for both genders in intent-to-treat analyses with no statistical difference (d female 1.4 and d male 1.3). These pre–post effect sizes for improvement are comparable with results from other recent uncontrolled studies of PE with mostly male veterans treated in VA settings [for example, d 1.45 in Goodson et al., 2013 (n 115); d 1.39 in Meyers et al., 2013 (n 31); d 1.00 in Sripada et al., 2013 (N 51); d 1.70 in Thorp et al., 2012 (N 11); d 1.19 in Tuerk et al., 2011 (N 65); d 2.29 in Tuerk et al., 2013 (N 60); d 3.64 in Wolf et al., 2012 (N 10); and d 1.27 in Yoder et al., 2012 (N 61)]. "
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    ABSTRACT: As the proportion of women serving in the United States military continues to increase, more female veterans are being treated for posttraumatic stress disorder (PTSD) in Department of Veterans Affairs (VA) health care settings. Prolonged Exposure (PE) therapy is an evidence-based treatment for PTSD and is often used in VA settings. However, only a few studies have investigated the effectiveness of PE specifically for female veterans with appropriate power. Results of these studies have varied, with similar effects between female and male veterans on par with civilian effects, and more recently, better outcomes for female veterans receiving PE compared with male veterans. The current study contextualizes the evidence from those studies and considers new data regarding clinical outcomes pre- and posttreatment for a large (N = 325) sample of male and female veterans treated with PE in a PTSD specialty clinic. Results indicate a large statistically significant decrease in PTSD as measured by PTSD Checklist (PCL) scores for both male and female veterans treated with PE (d = 1.33). No difference in effectiveness and no difference in treatment completion rates were found between male and female veterans. Our findings support the effectiveness of PE for the treatment of PTSD in female as well as male veterans. Results are compared and contrasted to previous findings in the literature taking into account heterogeneity in methodological and ecological factors among the studies. Emphasis is placed on context of care issues to further the empirical conversation regarding meeting the mental health needs of female veterans. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Jun 2015 · Psychological Services
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    • "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. "
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    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.
    Full-text · Article · Dec 2014 · Journal of Anxiety Disorders
    • "In a meta-analytic review by Bradley et al. (2005), nonresponse rates to PTSD treatments were shown to be as high as 67 % for PE intervention. Also, several study reviews highlighted that many trauma-exposed victims could not engage in exposure-based therapies that involve repeated confrontations of the traumatic situation causing high levels of anxiety, due to a lack of adequate required coping skills needed to benefit from these treatment modalities (Foa et al. 2007; Follette and Vijay 2009; Owens et al. 2012; Resick et al.2002; Sharpless and Barber 2011; Tuerk et al. 2011; Vujanovic et al. 2011). One meta-analytic review of outcome PTSD literature found that treatment dropout rates for PE and CPT range from 0 to 50 % among various population samples (Schottenbauer et al. 2008). "
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    ABSTRACT: Mindfulness is a strategy that has become increasingly considered as a potential treatment for posttraumatic stress disorder (PTSD). The aim of this study was to review and synthesize extant research on mindfulness, current mindfulness-based interventions, and evidence-based treatments for PTSD. A theoretical foundation for classical mindfulness and a preliminary protocol integrating classical mindfulness and prolonged exposure for the treatment of PTSD was introduced. We conducted a systematic search of relevant databases according to predefined criteria. Studies were eligible for inclusion if they sought to define mindfulness, employed mindfulness-based interventions for PTSD, or included evidence-based treatments for PTSD. Original Buddhist texts and resources were used to develop, support, and differentiate classical mindfulness from existing mindfulness-based interventions for PTSD. We identified a non-sufficient and inconclusive operationalization of the concept of mindfulness. Furthermore, there is limited research on the application of mindfulness for PTSD, and the few existing studies have demonstrated mixed results. The proposed integration of classical mindfulness with prolonged exposure appears to address specific limitations to current interventions for PTSD. A definition for classical mindfulness was drawn from the classic Buddhist teachings. The mastery and application of the components of classical mindfulness provide a potentially more effective way to use mindfulness for the treatment of PTSD. Although, classical mindfulness has yet to be empirically investigated or supported.
    No preview · Article · Dec 2013 · Mindfulness
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