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Prolonged exposure reaffirmed as first-line therapy for PTSD

Researchers reported that prolonged exposure therapy led to clinically significant reductions in posttraumatic stress disorder and depressive symptoms in a diverse cohort of male and female veterans, supporting its use as a first-line treatment for PTSD.

"This article reports on the largest evaluation to date of the effectiveness of [prolonged exposure] with veterans, examining its impact in a highly diverse sample of veterans treated by VA clinicians in real-world clinical settings," the researchers wrote in JAMA Psychiatry.

Afsoon Eftekhari, PhD, of the National Center for PTSD, Dissemination and Training Division at the VA Palo Alto Health Care System, and colleagues evaluated the effectiveness of prolonged exposure psychotherapy in a sample of 1,931 veterans of the wars of Iraq and Afghanistan, as well as veterans of previous conflicts, who were exposed to both combat and non-combat-related trauma. The patients, who received eight to 15 sessions of prolonged exposure during the study period, were treated at VA facilities throughout the United States by clinicians (n=804) who had participated in an experimental training workshop sponsored by the Department of Veterans Affairs.

Intent-to-treat analyses showed that the reductions in PTSD and depressive symptoms — as reflected in PTSD Checklist and Beck Depression Inventory II scores — were comparable to other efficacy trials. Prolonged exposure therapy had benefited all subgroups, as well, the researchers said. The proportion of veterans who had PTSD decreased from 87.6% to 46.2%. The treatment completion rate was 72%, which is also consistent with other clinical trials of prolonged exposure therapy for PTSD.

"These findings indicate that the effectiveness of [prolonged exposure] can be successfully transitioned to treatment of veterans in real-world treatment settings," the researchers wrote. "Moreover, they confirm that [prolonged exposure], a treatment originally developed for female survivors of sexual assault, can be an effective treatment for male and female veterans of different eras who have experienced a range of traumatic events."

Disclosure: The researchers report no relevant financial disclosures.