Magazine article Clinical Psychiatry News

Prolonged Exposure Therapy Works in Community Settings

Magazine article Clinical Psychiatry News

Prolonged Exposure Therapy Works in Community Settings

Article excerpt

TORONTO -- Not only is prolonged exposure therapy effective in treating posttraumatic stress disorder, it appears to be easily and successfully transported to community clinics, Elizabeth Hembree, Ph.D., reported at the annual meeting of the International Society for Traumatic Stress Studies.

Dr. Hembree, of the University of Pennsylvania School of Medicine, Philadelphia, and her colleagues have been evaluating the effectiveness of prolonged exposure therapy (PE) for the treatment of posttraumatic stress disorder (PTSD) in community agencies in an 11-year program. It was clear that these treatments were effective in the hands of experienced, PhD-level cognitive-behavioral thereapists. But the question was whether the technique could be transferred to a community-care setting for use by counselors with diverse backgrounds.

Prolonged exposure therapy, based on cognitive-behavioral therapy (CBT), consists of four components:

* Psychoeducation about common reactions to traumatic events and the cause of chronic posttrauma problems.

* Breathing training to help patients relax.

* Imaginal exposure, consisting of repeated recounting/reliving of the traumatic memory.

* Repeated real-life exposure to situations and objects that remind the patient of the trauma but are low risk and safe. Patients typically go through 9-12 sessions with a trained therapist.

The first randomized control trial was started in 1994 in cooperation with Women Organized Against Rape (WOAR) in the Philadelphia area. The 173 participants in the study were adult women with chronic PTSD who had been raped, sexually assaulted, or had experienced childhood sexual abuse.

The study involved two sites: an academic clinic (the Center for the Treatment and Study of Anxiety at the University of Pennsylvania) and the WOAR center. Therapists at the academic clinic had Ph.D. degrees in psychology and were experts in CBT. Counselors at the community crisis center typically had masters' degrees in psychology or social work and varying levels of experience. Community therapists attended training in using prolonged exposure therapy at the Center for the Treatment and Study of Anxiety for 2 weeks. They also received 1 day of additional training twice a year.

Patients were randomized to receive prolonged exposure therapy alone, prolonged exposure therapy and cognitive restructuring, or were assigned to a wait list to act as a control group. …

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