Prolonged Exposure Therapy, Research Paper Example

Prolonged Exposure Therapy in the Treatment of Post Traumatic Stress Disorder

Prolonged Exposure therapy (PE) is a treatment modality frequently used with individuals suffering from Post Traumatic Stress Disorder (PTSD).  This modality is supported by the US Department of Veterans Affairs (DVA) as the preferred treatment modality for military veterans with PTSD.  This method of treatment has also been successfully used in other venues and with individuals with non-military related PTSD.

According to the new language proposed by the American Psychological Association, PTSD can occur when a person is exposed to one or more of several serious traumatic events including the threat of death, actual or threatened serious injury or sexual violation, or the witnessing of such events (DSM-5, 2010).

The symptoms of PTSD can include recurrent, involuntary dreams or distress recalling the event(s), dissociative reactions and even physiological reactions to reminders of the event(s).  There are a number of other symptoms that can manifest with PTSD.  Because of the unpleasantness of these symptoms, most PTSD sufferers experience persistent avoidance of internal and external stimuli that remind the sufferer of the traumatic event(s).  These stimuli can include smells, sounds, places or activities.  This persistent avoidance behavior can have significant negative effects on a person’s ability to function normally in life.

According to NREPP (2007) PE involves three core components.  The first facet of PE is cognitive psycho education.  In this phase, the patient learns facts about PTSD.  This helps the patient understand what the problem is and why the symptoms tend to occur.  The second phase of PE is called imaginal exposure.  In this part of treatment, the patient is encouraged to remember and visualize the traumatic event(s).  This method helps the patient develop control over internal stimuli such as thoughts and feelings.  A patient might be encouraged to talk about, and provide details of a traumatic event in a safe environment such as a counselor’s office.  The goal is to have the patient develop a new pattern of being able to recall the event with the understanding that it no longer can hurt them.

The third step in PE is called vivo exposure.  During this phase, the patient begins dealing with external stimuli.  This exposure occurs slowly and increases over time.  A simple example might be a patient who has a fear of water after having seen a surfing buddy eaten by a shark.  Vivo exposure might begin by looking at pictures of the ocean, followed by looking at the actual ocean from afar.  Eventually, the patient might stand in the sand, get near the water and at some point get wet.  Treating actual PTSD patients is obviously more complex, but this example illustrates the fundamental principle of vivo exposure.

The program used by the DVA’s National Center for PTSD uses a four-step process   (USDVA, 2010).  The fundamental process is the same but includes a step whereby the patient learns breathing techniques that help to improve relaxation and reduce anxiety.  The DVA website describes the therapy as including 8 to 15 sessions of 90 minutes each.  The site asserts that PE is the most effective treatment modality for PTSD.

In their article, Cukor et al. (2009) call PE interoceptive exposure therapy.  The techniques used and the treatment regimen were consistent with those used by the DVA.  The authors reported that 5 out of 7 patients showed improvement during the first few months following treatment, and that at the three-month follow-up, there were four patients who no longer met the criteria for PTSD.  This study had a very small sample size, but did produce positive results for the use of PE in treating PTSD.

In a more extensive study, Rothbaum (2006) lead a study with a sample size of 88.  The study examined the difference between the use of the medication Sertraline as a stand-alone treatment for PTSD and the use of the medication concurrently with PE.  The study found that patients taking the stand-alone medication showed improvement while taking the medication, but relapsed into their prior states after discontinuing the drug.  Conversely, patients who participated in PE while taking Sertraline not only improved during the treatment, but maintained their improvement even after discontinuing the medication.  This study showed that the cognitive component of PE had positive and long lasting effects.

PE is a common and effective treatment for PTSD patients and has implications across many patient groups.  Many people associate PTSD with wartime veterans.  One can certainly understand how a person who experiences some of the horrors of war might develop PTSD.  The condition is not however, limited to military people.  There are many other groups of people for whom PTSD is not uncommon.

Women (or men) who experience sexual violation such as incest or rape can develop PTSD.  Victims of early childhood domestic violence can develop behavioral and emotional problems later in life that can be included in the PTSD count.  PTSD can even present itself in the lives of people who deal with the aftereffects of trauma such as ambulance workers police officers and firemen.  There were hundreds of New York residents who suffered and were treated for PTSD after the 911 attacks on the twin towers.

With so many groups of people experiencing traumatic events, it is important to have top notch treatment methods available.  These methods need to be tested and proven effective.  In the case of PE, there is no question that the modality is effective.  Many studies have proven this fact.

References

(Cukor J Spitalnick J Difede J Rizzo A Rothbaum B 2009 Emerging treatments for PTSD)Cukor, J., Spitalnick, J., Difede, J., Rizzo, A., & Rothbaum, B. (2009). Emerging treatments for PTSD. Clinical Psychology Review, 29(9), 715-726. doi:doi:10.1016/j.cpr.2009.09.001

(Dsm-5 2010 Proposed revision: Post traumatic stress disorder)Dsm-5. (2010). Proposed revision: Post traumatic stress disorder. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=165

(Nrepp 200712 Prolonged exposure therapy for post traumatic stress disorders)Nrepp. (2007, December). Prolonged exposure therapy for post traumatic stress disorders. Retrieved from http://www.nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=200

(Rothbaum B 2006 Augmentation of Sertraline with prolonged exposure in the treatment of posttraumatic stress)Rothbaum, B. (2006). Augmentation of Sertraline with prolonged exposure in the treatment of posttraumatic stress. Journal of Traumatic Stress, 19(5), 625-638. Retrieved from http://web.ebscohost.com.ezproxy.apollolibrary.com/ehost/pdfviewer/pdfviewer?vid=5&hid=106&sid=2276231d-8560-412d-ae3a-28bfd1b8aa0f%40sessionmgr114

(Usdva 2010 Prolonged exposure therapy)USDVA. (2010). Prolonged exposure therapy. Retrieved from http://www.ptsd.va.gov/public/pages/prolonged-exposure-therapy.asp