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
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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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    • "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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    • "). 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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