Dissemination of exposure therapy in the treatment of PTSD

Department of Psychiatry, Columbia University, New York, New York, United States
Journal of Traumatic Stress (Impact Factor: 2.72). 10/2006; 19(5):597-610. DOI: 10.1002/jts.20173
Source: PubMed


Since the introduction of posttraumatic stress disorder (PTSD) into the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980), considerable research has demonstrated the efficacy of several cognitive-behavioral therapy (CBT) programs in the treatment of chronic PTSD. Among these efficacious treatments is exposure therapy. Despite all the evidence for the efficacy of exposure therapy and other CBT programs, few therapists are trained in these treatments and few patients receive them. In this article, the authors review extant evidence on the reasons that therapists do not use these treatments and recent research on the dissemination of efficacious treatments of PTSD.

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    • "Because of the complex symptomatology often found in patients with PTSD following CSA (Cloitre et al., 2009), this concern is especially salient in the treatment of this population. A number of authors have emphasized that there is currently no evidence to suggest that exposure-based treatment is related to symptom worsening on a large scale (e.g., Cahill et al., 2006; Van Minnen, Harned, Zoellner, & Mills, 2012). Only recently, an article on symptom worsening in a large sample of PTSD patients (n 0361) reported an overall improvement on PTSD and showed that worsening of PTSD symptoms was virtually non-existent from pre-to post-treatment assessments (Jayawickreme et al., 2014). "
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    ABSTRACT: Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD). However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD.
    Full-text · Article · Sep 2014 · European Journal of Psychotraumatology
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    • "In addition to reading materials and didactic presentations, the workshop included active training methods such as videos, role modeling, practice and role-play opportunities, and interaction among learners. These training strategies have been associated with improved knowledge and attitudes, expanded skill sets, and demystification of common trauma beliefs [8,18,21,34,35]. "
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    ABSTRACT: ABSTRACT: Most of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE. Fourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment. PE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.
    Full-text · Article · Oct 2011 · BMC Research Notes
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    • "Further, when symptom worsening occurred, it was not associated with either worse treatment outcomes or with increased dropout rates. Effective dissemination efforts for exposure therapy will need to confront misinformation about potential harm with discussion of research findings that debunk such myths (Cahill et al., 2006; Cook et al., 2004). Therapists may also hold beliefs that may lead them to doubt the applicability of RCTs to clinical practice (Gunter & Whittal, 2010). "
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    ABSTRACT: Over the past 9 years approximately 2 million U.S. military personnel have deployed in support of Operation Iraqi Freedom in Iraq and Operation Enduring Freedom in and around Afghanistan. It has been estimated that 5-17% of service members returning from these deployments are at significant risk for combat-related posttraumatic stress disorder (PTSD). Many of these returning war veterans will seek medical and mental health care in academic health centers. This paper reviews the unique stressors that are related to the development of combat-related PTSD. It also reviews evidence-based approaches to the assessment and treatment of PTSD, research needed to evaluate treatments for combat-related PTSD, and opportunities and challenges for clinical psychologists working in academic health centers.
    Preview · Article · Jun 2011 · Journal of Clinical Psychology in Medical Settings
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