Assessing peer support in prolonged exposure outcomes for veterans with betrayal traumas

Prolonged exposure (PE) is an efficacious treatment, but the high dropout rate has implored researchers to find ways to retain patients. One such effort, the PE + Peers program, integrates a previous PE graduate to provide the current patient advice and emotional support during in vivo exposure homework during the first weeks of treatment. This program has helped veterans who previously dropped out of PE return to treatment and see significant success. However, survivors of traumatic events featuring betrayals of trust, such as sexual violence, may have unique difficulty trusting other people joining them in their psychotherapy. The present study reviews data from a randomized trial of the PE + Peers program. We compared treatment course and outcomes for combat veterans (n = 13) with survivors of military sexual trauma (n = 23).

We analyzed uptake, number of sessions, and baseline and posttreatment measures of posttraumatic stress.

Both groups showed similar retention rates (military sexual trauma = 67.6%; combat = 72.2%) and number of sessions needed (M_{military sexual trauma} = 8.24, M_combat = 8.72, p = .693). A repeated measures analysis of covariance showed a significant decrease in symptoms over time, F(1, 49) = 6.44, p = .014, but no significant Time × Group interaction, F(1, 49) = 0.00, p = .964.

PE + Peers appears effective and acceptable for those with several negative prognostic factors, including previous dropout and traumas marked by betrayals of trust. Replicating this program in populations outside the military and for those seeking treatment for the first time is promising. (PsycInfo Database Record (c) 2026 APA, all rights reserved).