When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

“…We, however, found that the posttreatment PTSD symptom amelioration persisted up to six months. Second, TFT programmes may evoke serious adverse events or symptom exacerbations (Becker, Zayfert, & Anderson, 2004; van Minnen et al, 2010) and these risks are assumed to be higher in intensive treatment programmes and in more vulnerable PTSD patients with ICD-11 Complex PTSD symptoms such as the present population. We found no evidence for this assumption.…”

“…Additionally, and taking into account clinician-perceived barriers to PE in terms of serious adverse events and symptom exacerbation (van Minnen, Hendriks, & Olff, 2010), we also evaluated treatment safety. Finally, to examine which patients might benefit most from this iPE programme, we aimed to identify distinct treatment response trajectories and explored predictors of these response patterns.…”

Therapist rotation: a novel approach for implementation of trauma-focused treatment in post-traumatic stress disorder

“…The majority of the patients had suffered multiple childhood traumas, including childhood sexual abuse (71.2%) and childhood physical abuse (63%), and 93.2% had one or more comorbid disorder. This patient population thus represented a patient population in which therapists have shown to be hesitant to use exposure therapy (van Minnen et al, 2010). The effect size of the treatment was high [pre–post Cohen’s d  = 1.21; PTSD symptoms severity measured with the Clinician Administered PTSD Scale (CAPS IV) (Blake et al, 1995)].…”

“…For instance, in one study it was shown that prolonged exposure (PE) was hardly used by therapists in the USA (Becker et al, 2004), a finding that was replicated in Europe for both PE and eye movement desensitization and reprocessing (EMDR) (van Minnen, Hendriks, & Olff, 2010). Many therapists feel uncomfortable in directly addressing traumatic memories and evoke high levels of fear in the treatment sessions (Becker et al, 2004; Grimmett & Galvin, 2015).…”

“…It is known that not only patient-related characteristics, such as comorbidity (Becker et al, 2004; van Minnen et al, 2010), but also therapist-related factors, are strongly related to the underuse of TFTs (Harned, Dimeff, Woodcock, & Contreras, 2013; Hundt, Harik, Barrera, Cully, & Stanley, 2016; Laska, Smith, Wislocki, Minami, & Wampold, 2013), such as therapists’ negative beliefs or expectations about the application of TFT (N. R. Farrell, Deacon, Kemp, Dixon, & Sy, 2013; Meyer, Farrell, Kemp, Blakey, & Deacon, 2014; van Minnen et al, 2010) or therapists’ own anxiety sensitivity (Meyer et al, 2014), indicating that some therapists may simply be afraid to conduct this type of therapy. In addition to these hesitations to start a TFT, during the TFTs some therapists drift from the protocol (Waller, 2009) or deliver their (exposure) treatment in a suboptimal way, for instance by using anxiety-diminishing techniques (Hipol & Deacon, 2013), avoiding encouraging patients to carry out exposure exercises that elevate high levels of anxiety, or avoiding the application of (therapist-assisted) exposure in vivo during the treatment sessions (N. R. Farrell et al, 2013; Hipol & Deacon, 2013).…”