The effect of imaginal exposure length on outcome of treatment for PTSD

Abstract

The effects of prolonged imaginal exposure sessions (60 minutes; n=60) were compared with those of shorter exposure sessions (30 minutes, n=32) for patients with chronic posttraumatic stress disorder (PTSD). Consistent with the authors' hypothesis, patients who received 30-minute imaginal exposure sessions showed less within-session habituation than patients who received 60-minute exposure sessions. However, no differences between patients who received 60-minute and 30-minute exposure sessions emerged on improvement in PTSD-symptoms, state anxiety, depression, and end-state functioning, both at posttreatment and at 1-month follow-up. No group differences were found with regard to between-sessions habituation, number of sessions, and dropout rate. Results suggest that 30-minute imaginal exposure sessions are as effective as 60-minute exposure sessions and that within-session habituation may not be a necessary condition for successful treatment of PTSD. Future research is needed to replicate these findings and extend them to other clinical populations.

Considerations in treatment integrity: Implications and recommendations for PTSD research

“…For example, exposure conducted for 30 minutes in Session 4 may be considered adherent, whereas a similar duration during a treatment-termination session may be considered nonadherent. Some measures (e.g., Schnurr et al, 2007) have incorporated duration of PE as a factor, though to date, these results have not been reported (but see van Minnen & Foa, 2006) most likely due to these reports focusing on main outcome rather than on process and integrity research.…”

“…In trauma and PTSD trials, expert judges have often been used (Bryant, Moulds, Guthrie, Dang, & Nixon, 2003;Foa et al, 2005;Monson et al, 2006;Schnurr et al, 2003Schnurr et al, , 2007, though not always (Blanchard et al, 2003;Kazak et al, 2004;Paivio et al, 2004;van Minnen & Foa, 2006).…”

“…It can also ensure treatment discriminability, i.e., that different treatment conditions within a study are in fact different. The measurement of adherence can also be used to assess the frequency with which an element was administered as well as its timing and duration (e.g., van Minnen & Foa, 2006). Importantly, adherence and competence measures can be used to ascertain and confirm the role of presumed mechanisms of change involved in effective intervention.…”

Posttraumatic growth in exposure therapy for PTSD

“…The first session included a presentation of the treatment rationale, education about the disorder, and information gathering. The subsequent sessions contained 30 minutes of imaginal exposure, as this proved as effective as the original 60 minutes (van Minnen & Foa, 2006). Patients were asked to close their eyes and talk about the traumatic event in the first person and in the present tense, recollecting as many sensory details as vividly as possible, i.e., as if the trauma was happening "here and now."…”

The Comorbidity of Post-Traumatic-Stress Disorder (PTSD) and Substance Use Disorders

“…Furthermore, a longitudinal study conducted among 65 patients 5-10 years after receiving PE demonstrated maintenance of effects with only 17.5 % of patients meeting diagnostic criteria for PTSD (Resick et al 2012). PE has demonstrated effectiveness in addressing PTSD among a variety of traumatic stress populations, including victims of rape, physical assault, refugees, motor vehicle accidents, combat, terrorism, childhood abuse, and mixed trauma types (Foa et al 2005;McDonagh et al 2005;van Minnen and Foa 2006;Bryant et al 2008;Nacasch et al 2011;Resick et al 2012). Despite that fact that PE is one of the most effective treatments for PTSD, the majority of integrated treatment interventions developed to date generally do not include PE components.…”