Expanding the Reach of Effective PTSD Treatment Into Primary Care: Prolonged Exposure for Primary Care

Abstract

For the STRONG STAR Consortium Posttraumatic stress disorder (PTSD) is a costly mental health issue in the United States and throughout the world. Effective treatments are available; however, most people with PTSD never access these treatments. Prolonged exposure (PE) therapy has emerged as an effective, first-line treatment for PTSD and is provided in specialty mental health in eight to 15 sessions, each lasting 90 minutes. Most people with PTSD do not enter specialty mental health to access this service. Over the past 15 years, provision of mental health care in primary care has increased due to patient preference for care in this setting and the ability to overcome many access barriers (stigma, longer sessions, insurance coverage, etc.). While medications for PTSD are available in primary care, effective brief psychotherapeutic PTSD treatment options have only recently been established. PE-PC (prolonged exposure for primary care) is a brief version of PE therapy for PTSD with efficacy in a primary care (PC) setting in reducing PTSD, depression, and related mental disorder symptoms. PE-PC has four 30-minute sessions and focuses on imaginal exposure to the trauma memory, in vivo exposure to trauma-related avoidance, and emotional processing of the memory. Dissemination efforts are currently underway to expand availability.

Implementing Prolonged Exposure Therapy for PTSD in a Context of Ongoing Adversity: A Clinical Case Study

“…Adapted versions of PE have been used in different studies to ascertain feasibility and effectiveness, for example, the use of 60-min exposure sessions compared with 90-min exposure sessions (Nacasch et al, 2015). Rauch et al (2017) also evaluated the feasibility of a four-session PE model in primary health care settings. Finally, Willis et al (2015), without jeopardizing adequate fidelity, adapted minor elements of PE, such as not listening to exposure audio recordings at home, as participants did not have the financial resources.…”

Condensed internet-delivered prolonged exposure provided soon after trauma: A randomised pilot trial

“…PE-PC is a brief treatment that comprises of four 30-minute sessions that include imaginal exposure to the trauma memory, in vivo exposure to trauma-related avoidance, and emotional processing of the traumatic memory. Several trials have shown its efficacy in reducing PTSD, depression, and symptoms of related mental disorders ( Cigrang et al, 2017 ; Fedynich et al, 2019 ; Rauch et al, 2017 ).…”

The Impact of COVID‐19 on Psychotherapy Participation Among Individuals With Posttraumatic Stress Disorder Enrolled in Treatment Research

“…Participants were enrolled in one of nine PTSD treatment trials: (a) trauma‐informed guilt reduction therapy (TrIGR; Norman et al., 2019 ) or supportive care ( N = 5; blind not broken), (b) N‐acetylcysteine plus cognitive behavioral therapy (CBT) for AUD (Kadden, 1995 ) or placebo plus CBT for AUD ( N = 6), (c) transdiagnostic CBT or treatment as usual (TAU; N = 31), (d) written exposure therapy (Sloan & Marx, 2019 ) or prolonged exposure (PE; Foa et al., 2007 , 2019 ; N = 4), (e) PE delivered in 60‐ or 90‐min sessions ( N = 11), (f) PE for primary care (Rauch et al., 2017 ) or TAU ( N = 19), (g) PE with or without topiramate ( N = 14), (h) PE with two types of peer support ( N = 36), and (i) PE with or without technology enhancements ( N = 35).…”