The Impact of Prolonged Exposure Therapy on Posttraumatic Stress Disorder Symptom Clusters in Adults Maintained on...

Although prolonged exposure (PE) therapy has shown promise for improving overall posttraumatic stress disorder (PTSD) severity in individuals receiving treatment for opioid use disorder (OUD), its effect on individual PTSD symptom clusters has not been examined in this population. Thus, we examined PTSD symptom clusters (intrusion, avoidance, negative alterations in cognitions and mood [NACM], arousal and reactivity) in 82 adults who participated in one of two randomized trials wherein participants with PTSD who were receiving medications for OUD (MOUD) were randomized to: MOUD treatment as usual (TAU; n = 27), prolonged exposure therapy (PE; n = 27) or PE plus financial incentives contingent upon session attendance (PE+; n = 28). PTSD symptoms were assessed using the Clinician Administered PTSD Scale for DSM-5 at baseline and 4-, 8- and 12-week post-randomization. We compared the effect of experimental condition on PTSD symptom clusters. PTSD symptom clusters improved significantly (p's < 0.05) between baseline and week 12 (end of treatment) in all experimental conditions except for intrusion symptoms in TAU participants (p = 0.050). PE and PE+ participants reported greater improvements than TAU participants on intrusion symptoms (p's < 0.05). PE+ participants also experienced greater improvements on avoidance symptoms than TAU participants (p < 0.001). PE and PE+ participants achieved comparable reductions on all symptom clusters. Furthermore, participants in all experimental conditions improved similarly on NACM and arousal and reactivity symptom clusters. These results support the putative mechanisms of PE and suggest that PE+ may be well suited for improving more trauma-specific symptom clusters such as intrusion and avoidance in individuals receiving MOUD.