Early versus Delayed Imaginal Exposure for the Treatment of Posttraumatic Stress Disorder Following Accidental Upper Extremity Injury

Abstract

Background The consequences following work-related injuries are far reaching, which are in part due to unrecognized and untreated posttraumatic stress disorder (PTSD). Imaginal exposure is a frequently used cognitive behavioral approach for the treatment of PTSD. This study examined the impact of early versus delayed treatment with imaginal exposure on amelioration of PTSD symptomatology in individuals who suffered upper extremity injuries. Methods Sixty individuals who suffered severe workrelated injuries received standard, non-randomly assigned psychological treatment for PTSD (e.g., prolonged imaginal exposure) either early (30-60 days) or delayed (greater than 120 days) following severe work-related upper extremity injury. Nine measures of various components of PTSD symptomatology were administered at onset of treatment, end of treatment, and at 6-month follow-up evaluations. Results Patients showed significant treatment outcomes at all three measurement intervals in both the early and delayed groups demonstrating that Prolonged Imaginal Exposure is an appropriate treatment for persons diagnosed with PTSD.In addition, there was no difference in return to work status between the early and the delayed treatment groups. However, the early treatment group required significantly fewer treatment sessions than the delayed treatment group. Conclusions Results supported the utility of imaginal exposure and the need for early assessment and referral for those diagnosed with PTSD following upper extremity injuries.

The Evidence Base for Interventions Targeting Individuals With Work-Related PTSD: A Systematic Review and Recommendations

“…One of them described short-term outcomes for the active treatment versus the waitlist condition (Högberg et al, 2007) and one reported long-term outcomes for the active treatment after the waitlist had also been provided with the intervention (Högberg et al, 2008); the latter study was selected to represent this data set in the RD analysis. Six reports stemmed from the same clinic (Grunert et al, 1989; Grunert, Devine, Smith, et al, 1992; Grunert, Matloub, Sanger, & Yousif, 1990; Grunert et al, 2007; Salyards, 2005; Weis, Grunert, & Christianson, 2012) delivering interventions to treat posttraumatic stress in individuals with industrial injuries. Their study participants were not identical but overlapped to some extent.…”

“…Their study participants were not identical but overlapped to some extent. While all of these studies are described in the narrative part of this review, Weis et al (2012) was selected for the first RD analysis. Grunert and his colleagues were also the only study group examining interventions for workers who had previously failed to RTW with standard PTSD treatment; three of their articles (Grunert et al, 1989; Grunert, Devine, Smith, et al, 1992; Grunert et al, 2007; whose samples did not overlap) provided the data for the second RD analysis.…”

“…For nine studies, the authors reported that their participants met criteria for a PTSD diagnosis or subthreshold PTSD, whereas two required the presence of posttraumatic distress (Bender et al, 2016;Grunert et al, 1989). Comorbidity was not extensively discussed: Six studies measured the presence of concurrent mental disorders (Bender et al, 2016;Gersons et al, 2000;Grunert et al, 2007;Högberg et al, 2007Högberg et al, , 2008Weis et al, 2012); major depressive disorder was an exclusion criterion for two studies (Högberg et al, 2007(Högberg et al, , 2008. In four studies, substance use disorder was an exclusion criterion for participation (Difede et al, 2007;Gersons et al, 2000;Högberg et al, 2007Högberg et al, , 2008.…”

“…Interventions. For most participants, the intervention included some form of exposure-either through revisiting trauma memories or through in vivo exposure to trauma reminders or both (Difede et al, 2007;Gersons et al, 2000;Grunert et al, 1989;Grunert, Devine, Smith, et al, 1992;Grunert et al, 1990;Grunert et al, 2007;Weis et al, 2012). While therapy protocols somewhat varied between studies, these interventions were categorized as TFCBT.…”

Interventions to improve work outcomes in work-related PTSD: a systematic review

“…The study by Gersons et al (2000) included a 3-month follow-up period, while Weis (1999) and Grunert et al (1989, 1992) conducted follow-up at 6 or 12 months [25,21,8,20]. The effects of follow-up measurements on generalizability are discussed.…”