Prolonged Exposure May Aid Treatment of PTSD
> 6/9/2008 4:40:44 PM

 In the first weeks after a traumatic event, and individual may experience anxiety, flashbacks, and feelings of detachment, all of which are symptoms of acute stress disorder (ASD), a condition that by definition begins shortly after a trauma and does not exceed one month. If symptoms persist, the individual may develop post-traumatic stress disorder (PTSD), a more severe and longer-lasting condition that significantly affects an individual’s daily functioning, their social relationships, and their success at school or at work. Treating ASD early on may be vital to preventing PTSD, and in a recent Australian study published in the Archives of General Psychiatry, researchers from the University of New South Wales set out to compare two of the most common therapeutic strategies used to treat trauma survivors: prolonged exposure and cognitive restructuring. Their results indicate that prolonged exposure may prove effective at halting the progression from ASD to PTSD.

The two forms of treatment examined in the study use different approaches to address ASD. In prolonged exposure, an individual recalls details of their traumatic event with the goal of reliving those memories without any accompanying symptoms of distress, while cognitive restructuring involves an individual identifying and changing unhelpful beliefs related to the trauma and their reaction to the trauma. The study’s 90 subjects had recently been assaulted or involved in a car accident and met the criteria for ASD. A third of the subjects were randomly assigned to five weekly sessions of prolonged exposure, while another third received cognitive restructuring for the same length of time. The final third were included as a control group. Those receiving prolonged exposure reported fewer symptoms of distress throughout the study, and clinical tests of the subjects’ symptoms also indicated that a greater chance of improvement was associated with prolonged exposure. By the end of the therapy sessions, 33 percent of subjects receiving prolonged exposure met the criteria for PTSD, compared to 63 percent of those in the cognitive restructuring group and 77 percent of the control group. A follow-up six months later revealed that 37 percent of the prolonged exposure group had developed PTSD, while the rate among the cognitive restructuring group had held steady at 63 percent.

Prolonged exposure has been viewed with caution in the past, mostly due to reports that patients reliving traumatic experiences suffer further mental harm. In this study, however, subjects receiving prolonged exposure reported less distress than other subjects, and one of the study’s limiting characteristics, while unfortunate, also provides some evidence of the benefits of prolonged exposure. Many subjects did not complete the therapy sessions, but the dropout rate did not differ between the two treatments, and this indicates that distress associated with prolonged exposure did not cause an increase in the number of subjects abandoning their therapy. While prolonged exposure proved most effective overall, subjects receiving cognitive restructuring also saw improvement, and the researchers emphasize that either form of treatment will be more beneficial than no treatment at all.

Several limitations restrict this study’s findings, particularly its small size and high dropout rate, and because the researchers focused only on individuals who had experienced assault or a car crash, these results may not apply to other trauma victims. Researchers should continue studying the various therapies used to treat ASD and PTSD to identify those that work most effectively for people who have survived war, rape, and other traumas. Early intervention can improve the outcomes of these individuals, and with further study on the strategies most effective at helping specific groups of trauma victims, we may be able to prevent even more individuals with ASD from developing a persistent and debilitating condition.

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