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

Spinal cord injury (SCI) increases risk for posttraumatic stress disorder (PTSD). This condition often co-occurs with pain, depression, anxiety, and sleep disturbance, reducing quality of life. Despite the clinical impact of these symptoms, early evidence-based psychological interventions have rarely been evaluated during inpatient rehabilitation. Brief Prolonged Exposure (Brief PE) is a 3-session adaptation of Prolonged Exposure designed to prevent or reduce PTSD.

Participants (n = 154, mean age = 50 years, range 18-87; 65% male) with traumatic or nontraumatic SCI were enrolled at a rehabilitation hospital; 148 were randomized to Brief PE (n = 75) or treatment as usual (TAU; n = 73). Brief PE participants received 3 60-minute sessions during their inpatient stay while TAU participants received standard psychosocial care. The primary outcome was PTSD symptom severity (PSSI-5) at baseline, 1, 3, and 6 months. Secondary outcomes included PTSD diagnosis/severity (PSSI-5/PDS-5), pain (NRS-11), depression (PHQ-9), anxiety (GAD-7), sleep disturbance (PROMIS-SD), resilience (CD-RISC-10), and quality of life (SCI-QOL).

PTSD symptoms declined significantly in both groups (P = .003), with no Group × Time effect (P = .33). History of premorbid depression predicted higher PTSD severity (IRR = 1.84, P = .002). At 6 months, PTSD prevalence was lower in Brief PE (5.9%) versus TAU (9.3%), though nonsignificant. Significant Group × Time effects for average and usual pain (P = .032; P = .036) favored Brief PE, with 27% and 33% reductions versus 0% and 5% for TAU. Among Brief PE participants, 96% completed all sessions, with high satisfaction.

Brief PE was feasible, acceptable, and produced greater pain reduction than TAU. PTSD symptoms were also lower, though not significantly, suggesting promise for early psychological intervention after SCI.