Variations and How to Decide

This therapist guide presents the scaffold and structure for the Prolonged Exposure-Intensive Outpatient Program (PE-IOP). The program is focused on exposure as provided through individual imaginal exposure and group in vivo exposure. The format presented is based primarily on the model used in the Emory Healthcare Veterans Program (EHVP), but this chapter provides a focus on the most common variations in program design with a discussion of how to decide between the different potential variations. Relevant inclusions and exclusions are presented along with rationales.

IOP Assessment and Structure

This chapter presents key assessment issues and recommendations to assist in patient selection and examination of response across the prolonged exposure-intensive outpatient (PE-IOP) treatment program. The authors discuss key issues including dissociation, suicide and self-harm risk, anger, moral injury, complex trauma, personality disorder, guilt, and comorbidity. Specific patient populations are discussed, including military, sexual assault, and traumatic brain injury populations. Discussion of a process for screening, assessment, and treatment planning using an interdisciplinary treatment team is presented.

Posttraumatic Stress Disorder Treatment in Intensive Outpatient (IOP) Format

This chapter presents the rationale for why Prolonged Exposure for Intensive Outpatient Programs (PE-IOP) was created through an examination of some of the barriers to care that may appear in traditional outpatient psychotherapy for posttraumatic stress disorder (PTSD). Evidence for efficacy and effectiveness of PE-IOP for PTSD and related issues across patient populations is summarized, including those areas still in need of examination.

Daily Session Schedule

This chapter presents how all the pieces of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP) fit together to form a program. The authors discuss areas for variations and ways to improve efficiency. Each day of the PE-IOP program is described, with each component noted and the detailed specifics outlined. Suggested time markers for sessions are presented.

Integrative Interventions

In addition to the core of prolonged exposure in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), the program also includes integrative interventions designed to encourage positive coping, wellness, and maintenance of gains from PE-IOP. These integrative interventions can vary based on availability, cost, patient population, etc. While they can vary, program implementers should be cautious that the chosen interventions have a general rationale that fits the overall PE-IOP milieu by supporting approaching and not avoiding trauma memories and reminders and that emotions are not dangerous but a normal part of life. The authors discuss the rationale for inclusion of interactive interventions as well as how to decide what interventions to use.

Case Management

Case management plays a critical role in the Prolonged Exposure-Intensive Outpatient Program (PE-IOP) model. This chapter presents the logistics and rationale for case management as used in PE-IOP. The goal of case management is to provide necessary logistics to help the patient maximize therapeutic benefit from the PE-IOP program. Case management begins prior to program entry to assist with assessment and treatment planning and continues throughout the PE-IOP to ensure that the patient can fully engage with care (e.g., get where they need to go for in vivos, address financial concerns, etc.). Finally, planning for discharge and continued care begins at assessment and ends after patients return home to ensure that they can maintain the gains they made in PE-IOP.

Foundations of Prolonged Exposure

This chapter presents the foundations for prolonged exposure (PE) therapy as they have been developed in emotional processing theory to immerse the provider in theory that will guide all decisions during PE, whether they are using the intensive outpatient program (PE-IOP) in this manual or another model (e.g., PE-Primary Care, or standard PE). The authors present a discussion on how PE works and on the research supporting the theorized mechanisms of change. In addition, alternative treatments are described, including medication and considerations for patients who are already on medications when they are engaged in PE-IOP. The chapter ends with a discussion of why this PE-IOP model was developed and when it may be indicated for patient care.

Exposure in PE-IOP

This chapter presents in-depth details of how to implement the exposure component of the Prolonged Exposure-Intensive Outpatient Program (PE-IOP), including places where variation is acceptable and why. The authors present the logistics and rationale for individual sessions that include imaginal exposure and individualized trauma emotional processing. In addition, the authors present in vivo group exposure session logistics and rationale. The in vivo group includes the general psychoeducation components of PE, the in vivo exposure hierarchy creation, and the practice of in vivo exposure. The exposures may occur in a group or individually, escorted or non-escorted, as clinically indicated for the individual patient.