Emotional Processing of Imaginal Exposures Predicts Symptom Improvement: Therapist Ratings Can Assess Trajectory in Prolonged Exposure for Posttraumatic Stress Disorder

Chapter 1 presents an overview of the treatment program, and explores what posttraumatic stress disorder (PTSD) is, what prolonged exposure therapy for adolescents (PE-A) entails, emotional processing theory, and outlines the treatment program's structure.

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Introduction

Reclaiming Your Life from a Traumatic Experience: Workbook ◽

10.1093/med:psych/9780195308488.003.0001 ◽

2007 ◽

pp. 1-10

Author(s):

Barbara Olasov Rothbaum ◽

Edna B. Foa ◽

Elizabeth A. Hembree

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Treatment Program ◽

Emotional Processing ◽

Stress Disorder ◽

Prolonged Exposure ◽

Risks And Benefits ◽

Processing Theory

Chapter 1 introduces and defines Posttraumatic Stress Disorder (PTSD), Prolonged Exposure (PE) Therapy, and Emotional Processing Theory, along with a background to the development of the PE treatment program, its risks and benefits, alternative treatments, the role of medications, and an outline of the program and its structure.

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Foundations of Prolonged Exposure

Prolonged Exposure Therapy for PTSD ◽

10.1093/med-psych/9780190926939.003.0001 ◽

2019 ◽

pp. 1-22

Author(s):

Edna B. Foa ◽

Elizabeth A. Hembree ◽

Barbara Olasov Rothbaum ◽

Sheila A. M. Rauch

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Emotional Distress ◽

Emotional Processing ◽

Stress Disorder ◽

Prolonged Exposure ◽

Traumatic Events ◽

Ptsd Symptoms ◽

Imaginal Exposure

Foundations of prolonged exposure (PE) include (1) education about common reactions to trauma, what maintains trauma-related symptoms, and how PE reduces posttraumatic stress disorder (PTSD) symptoms; (2) repeated in vivo confrontation with situations, people, or objects that the patient is avoiding because they are trauma-related and cause emotional distress such as anxiety, shame, or guilt; and (3) repeated, prolonged imaginal exposure to the trauma memories followed by processing the details of the event, the emotions, and the thoughts that the patient experienced during the trauma. The aim of in vivo and imaginal exposure is to enhance emotional processing of traumatic events by helping the patient face the trauma memories and reminders and process the emotions and thoughts, as well as the details of the trauma that emerge during revisiting experiences.

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Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice

Psychological Medicine ◽

10.1017/s0033291721001628 ◽

2021 ◽

pp. 1-10

Author(s):

Shira Maguen ◽

Erin Madden ◽

Nicholas Holder ◽

Yongmei Li ◽

Karen H. Seal ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Cognitive Processing ◽

Comparative Effectiveness ◽

Stress Disorder ◽

Prolonged Exposure ◽

Patient Treatment ◽

Cognitive Processing Therapy ◽

Symptom Improvement ◽

Evidence Based

Abstract Background While evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) is a first-line treatment, its real-world effectiveness is unknown. We compared cognitive processing therapy (CPT) and prolonged exposure (PE) each to an individual psychotherapy comparator group, and CPT to PE in a large national healthcare system. Methods We utilized effectiveness and comparative effectiveness emulated trials using retrospective cohort data from electronic medical records. Participants were veterans with PTSD initiating mental healthcare (N = 265 566). The primary outcome was PTSD symptoms measured by the PTSD Checklist (PCL) at baseline and 24-week follow-up. Emulated trials were comprised of ‘person-trials,’ representing 112 discrete 24-week periods of care (10/07–6/17) for each patient. Treatment group comparisons were made with generalized linear models, utilizing propensity score matching and inverse probability weights to account for confounding, selection, and non-adherence bias. Results There were 636 CPT person-trials matched to 636 non-EBP person-trials. Completing ⩾8 CPT sessions was associated with a 6.4-point greater improvement on the PCL (95% CI 3.1–10.0). There were 272 PE person-trials matched to 272 non-EBP person-trials. Completing ⩾8 PE sessions was associated with a 9.7-point greater improvement on the PCL (95% CI 5.4–13.8). There were 232 PE person-trials matched to 232 CPT person-trials. Those completing ⩾8 PE sessions had slightly greater, but not statistically significant, improvement on the PCL (8.3-points; 95% CI 5.9–10.6) than those completing ⩾8 CPT sessions (7.0-points; 95% CI 5.5–8.5). Conclusions PTSD symptom improvement was similar and modest for both EBPs. Although EBPs are helpful, research to further improve PTSD care is critical.

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