Differential effects of prolonged exposure on posttraumatic stress disorder symptoms in female veterans

We compared the effect of Prolonged Exposure (PE) on posttraumatic stress disorder (PTSD) symptom clusters and individual symptoms relative to a nonspecific comparison therapy (present-centered therapy; PCT) to identify the unique benefits of PE. We used data from a 12-site randomized clinical trial that found PE to be more effective than PCT for reducing PTSD symptom severity.

Participants were 284 female veterans and active duty soldiers with PTSD (M age = 44.8 years, range = 22-78; 45.4% non-White). Participants were randomized to 10 weekly sessions of PE or PCT and assessed before and after treatment and at 3- and 6-month follow-ups. The primary measure of PTSD symptoms and symptom clusters (reexperiencing, avoidance, numbing, and hyperarousal) was the Clinician-Administered PTSD Scale (CAPS; Weathers et al., 2001) but we also assessed self-reported PTSD using the PTSD Checklist-Specific Version (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993).

Almost all clinician-rated and self-reported symptoms improved from pre- to posttreatment in both conditions. In the analyses of clinician-rated PTSD, PE had greater benefit than PCT on avoidance and numbing clusters. PE also had greater benefit on most individual symptoms in these clusters as well as on distress related to reminders. In the analyses of self-reported PTSD, PE had greater benefit than PCT on all clusters and on most individual symptoms.

PE may be especially helpful for individuals with significant avoidance and numbing. Giving patients information about how a treatment can help with the symptoms that create the greatest burden can facilitate choosing the treatment that is best for them.