Brief Prolonged Exposure Therapy for Posttraumatic Stress After Spinal Cord Injury: A Randomized Controlled Trial.

Area of Science:

• Neuroscience
• Psychology
• Rehabilitation Medicine

Background:

• Spinal cord injury (SCI) significantly elevates the risk of developing posttraumatic stress disorder (PTSD).
• Co-occurring symptoms like pain, depression, anxiety, and sleep disturbances negatively impact the quality of life for SCI survivors.
• Early evidence-based psychological interventions during inpatient rehabilitation for SCI remain under-evaluated.

Purpose of the Study:

• To evaluate the feasibility, acceptability, and efficacy of a brief, 3-session adaptation of Prolonged Exposure therapy (Brief PE) for preventing or reducing PTSD symptoms in individuals with SCI.
• To assess the impact of Brief PE on PTSD severity, pain, depression, anxiety, sleep disturbance, resilience, and quality of life.

Main Methods:

• A randomized controlled trial involving 154 participants with SCI, with 148 randomized to either Brief PE (n=75) or treatment as usual (TAU; n=73).
• Brief PE consisted of three 60-minute sessions during inpatient rehabilitation, while TAU received standard psychosocial care.
• Primary outcome was PTSD symptom severity (PSSI-5), with secondary outcomes including PTSD diagnosis/severity, pain (NRS-11), depression (PHQ-9), anxiety (GAD-7), sleep disturbance (PROMIS-SD), resilience (CD-RISC-10), and quality of life (SCI-QOL) assessed at baseline, 1, 3, and 6 months.

Main Results:

• PTSD symptoms decreased significantly in both Brief PE and TAU groups, with no significant difference between groups.
• A history of premorbid depression was a predictor of higher PTSD severity.
• The Brief PE group showed statistically significant reductions in average and usual pain compared to the TAU group.
• At 6 months, PTSD prevalence was lower in the Brief PE group (5.9%) versus TAU (9.3%), although this difference was not statistically significant.
• High adherence (96%) and satisfaction were reported for the Brief PE intervention.

Conclusions:

• Brief Prolonged Exposure (Brief PE) is a feasible and acceptable early psychological intervention for individuals with spinal cord injury (SCI).
• Brief PE demonstrated superior pain reduction compared to treatment as usual (TAU) in SCI patients.
• While not reaching statistical significance, the observed trend of lower PTSD symptoms suggests Brief PE holds promise for improving psychological outcomes following SCI.