title: Are 60-minute prolonged exposure sessions with 20-minute imaginal exposure to traumatic memories sufficient to successfully treat PTSD? A randomized noninferiority clinical trial.
abstract: The study aims to determine whether 60-minute sessions of prolonged exposure (PE) that include 20 minutes of imaginal exposure (IE) are noninferior to the standard 90-minute sessions that include 40 minutes of IE in treating posttraumatic stress disorder (PTSD) and to explore the relationship of treatment outcome to within- and between-session habituation and change in negative cognitions. Thirty-nine adult veterans with chronic PTSD were randomly assigned to 90-minute (n=19) or 60-minute (n=20) sessions of PE. PTSD symptoms were assessed by an unaware independent evaluator before and after treatment and at 6-month follow-up. Self-reports of depression and negative cognitions were assessed before and after treatment. Participants in both conditions showed significant reductions in PTSD symptoms. Sixty-minute sessions were found to be noninferior to 90-minute sessions in reducing PTSD symptoms, as the upper bound of the 95% confidence interval for the difference between conditions in the PTSD Symptom Scale-Interview (posttreatment: 6.00; follow-up: 6.77) was below the predefined noninferiority margin (7.00). Participants receiving shorter sessions showed less within- and between-session habituation than those receiving longer sessions, but no group differences in reductions in negative cognitions were found. The current findings indicate that the outcomes of 60-minute sessions of PE do not differ from those of 90-minute sessions. In addition, change in trauma-related cognitions and between-session habituation are both potential mechanisms of PE.
authors.affiliation: Tel-Aviv Brull Community Mental Health Center.
authors.forename: Nitsa
authors.initials: N
authors.lastname: Nacasch
authors.affiliation: The Hebrew University of Jerusalem.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Huppert
authors.affiliation: National Taiwan University.
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Su
authors.affiliation: The Hebrew University of Jerusalem.
authors.forename: Yogev
authors.initials: Y
authors.lastname: Kivity
authors.affiliation: Tel-Aviv Brull Community Mental Health Center.
authors.forename: Yula
authors.initials: Y
authors.lastname: Dinshtein
authors.affiliation: University of Pennsylvania.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Yeh
authors.affiliation: University of Pennsylvania. Electronic address: foa@mail.med.upenn.edu.
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
mesh_terms: D000328:Adult; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: emotional processing; fear activation; habituation; posttraumatic stress disorder; prolonged exposure