Factors associated with choice of exposure therapy for PTSD.

Abstract

Exposure therapy, despite its demonstrated efficacy for chronic PTSD, remains underutilized across clinical settings. One suggested cause is that traumatized clients may not prefer exposure treatment. This paper reviews the current literature on factors associated with treatment preference for exposure therapy. Contrary to expectations, exposure-based therapy is not only perceived as a viable therapy but is well regarded among current therapy choices by potential clients. In particular, we highlight the central role of client beliefs about the need to talk about problems, the efficacy of treatment, and perceived need for help as crucial factors potentially impacting preference for exposure therapy. Importantly, fear of exposure treatment does not appear to play a significant role. To increase utilization, clinicians should provide clients information to address factors believed to increase preference for effective treatment. KeywordsExposure Therapy; Posttraumatic stress disorder; Preference In the U.S. population, lifetime prevalence rates of posttraumatic stress disorder (PTSD) range from 7% to 8% Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995) and 12-month rates approach 4% (Kessler, Chiu, Demler, & Walters, 2005). Prevalence rates among returning military veterans are estimated to reach as high as 19.9% (Hoge et al., 2004). Despite this high prevalence, only 7.1% of individuals with PTSD make treatment contact within the first year of trauma exposure (Wang, Berglund, Olfson, Pincus, Wells, & Kessler, 2005). Further, the median time to seek treatment for PTSD is twelve years after disorder onset, with only 65.3% eventually seeking treatment and only 34.4% seeing a mental health specialist (Wang et al., 2005). Thus, it is of paramount importance that we begin to better understand how to help individuals with PTSD seek clinically appropriate care.The need for such care is likely to increase in coming years given the large number of active military conflicts and peace-keeping missions currently underway. Indeed, in order to address the expected increased numbers of veterans needing empirically-supported PTSD treatment (Hoge et al., 2004; Tanaelian & Jaycox, 2008), the United States Department of Defense (DoD) and the Veterans Administration (VA) have created Mental Health Centers of Excellence and funded large-scale initiatives aimed at training practitioners to deliver evidenced-based PTSD treatment. This training largely focuses on cognitive behavioral interventions such as exposure therapy. Although a number of psychotherapies have strong efficacy data (e.g., Bradley, Green, Russ, Dutra, & Westen, 2005), the recent Institute of Medicine (IOM, 2007) report on PTSD treatment concluded that the only sufficiently validated treatment for PTSD at the present time is exposure therapy. Indeed, the efficacy of exposure treatment has been strongly replicated across gender and types of trauma (e.g., Foa Marks et al., 1998;Resick et al., 2003;Rothbaum et al., 2005;Schnurr et al., 2007;Tarrier et al., 1999;Tay...

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