Prolonged exposure for the treatment of Spanish-speaking Puerto Ricans with posttraumatic stress disorder: a feasibility study

Abstract

BackgroundMost of the empirical studies that support the efficacy of prolonged exposure (PE) for treating posttraumatic stress disorder (PTSD) have been conducted on white mainstream English-speaking populations. Although high PTSD rates have been reported for Puerto Ricans, the appropriateness of PE for this population remains unclear. The purpose of this study was to examine the feasibility of providing PE to Spanish speaking Puerto Ricans with PTSD. Particular attention was also focused on identifying challenges faced by clinicians with limited experience in PE. This information is relevant to help inform practice implications for training Spanish-speaking clinicians in PE.ResultsFourteen patients with PTSD were randomly assigned to receive PE (n = 7) or usual care (UC) (n = 7). PE therapy consisted of 15 weekly sessions focused on gradually confronting and emotionally processing distressing trauma-related memories and reminders. Five patients completed PE treatment; all patients attended the 15 sessions available to them. In UC, patients received mental health services available within the health care setting where they were recruited. They also had the option of self-referring to a mental health provider outside the study setting. The Clinician-Administered PTSD Scale (CAPS) was administered at baseline, mid-treatment, and post-treatment to assess PTSD symptom severity. Treatment completers in the PE group demonstrated significantly greater reductions in PTSD symptoms than the UC group. Forty percent of the PE patients showed clinically meaningful reductions in PTSD symptoms from pre- to post-treatment.ConclusionsPE appears to be viable for treating Puerto Rican Spanish-speaking patients with PTSD. This therapy had good patient acceptability and led to improvements in PTSD symptoms. Attention to the clinicians' training process contributed strongly to helping them overcome the challenges posed by the intervention and increased their acceptance of PE.

A randomized clinical trial of prolonged exposure and applied relaxation for the treatment of Latinos with posttraumatic stress disorder

“…Based on the findings from a meta‐analysis of PE studies (Powers et al., 2010) and an earlier trial that evaluated PE among a sample of Latinos (Vera et al., 2011), it was determined that to detect an effect size of 0.6 or higher for the analysis of PTSD symptoms, a sample of 100 participants (i.e., 50 in each group) would allow us to have 80% power with 30% loss to follow‐up and a 5% significance level for a two‐sided test. Because dropout was lower than the estimated rate, 49 participants were allocated to each group.…”

“…To attain the goal of providing Latinos with quality mental health care in the 21st century, the APA (2020) stressed the importance of providing culturally and linguistically appropriate treatment. As an initial step to address these critical gaps in the treatment of Spanish‐speaking Latinos with PTSD, Vera and colleagues (2011) culturally adapted the PE manual for Spanish‐speaking Latinos and conducted a feasibility pilot study to examine whether the adapted intervention was acceptable to Latinos in PR, a population characterized by dominant Latino orientation. Pilot RCT study findings provided evidence in favor of the adapted PE intervention for Spanish‐speaking Latinos as a feasible and acceptable intervention.…”

Examining recipient and provider perceptions of mental health treatments and written exposure therapy for posttraumatic stress disorder with a Spanish-speaking sample.

“…Multiple PTSD treatments have evidenced efficacy among Latinx populations, including Spanish-language versions among Latinx immigrants (Vera et al, 2011). In studies supporting their efficacy with Latinx and Spanish-speaking populations, dropout remains high and may be higher than in primarily non-Latinx White samples (Dixon et al, 2016; Harris et al, 2018).…”

A Case Study of Interpreter-Mediated Prolonged Exposure Therapy for Posttraumatic Stress Disorder: Challenges and Recommendations for Effective Implementation

“…Despite the robust research supporting the use of PE across various trauma populations, the majority of the research conducted on PE has utilized Caucasian, English-speaking patients (Nayak et al, 2012). Thus, the applicability of PE to individuals from other backgrounds, spoken languages, and cultures is more limited, although preliminary evidence indicates that the treatment is also effective in non-Western trauma groups (Asukai, Saito, Tsurtua, Ogami, & Kishimoto, 2008; Vera et al, 2011; Zheng & Gray, 2014).…”