Prolonged Exposure for PTSD among OIF/OEF/OND Personnel: Massed vs. Spaced Trials
Edna Foa, PhD
Evaluate the efficacy of PE therapy for combat-related PTSD in an active-duty military population and determine whether a condensed delivery method maintains efficacy while improving efficiency.
Posttraumatic stress disorder is an often chronic and debilitating condition that is associated with many comorbid medical and psychiatric disorders. So as our nation’s war on terror rages on and the prevalence of PTSD among our men and women in the military increases—epidemiological studies indicate that 10% to 20% of military personnel returning from Iraq and Afghanistan show symptoms of PTSD—so does the need for increasingly efficient ways of effectively treating the disorder.
There is currently a large body of knowledge on how to treat PTSD effectively and efficiently using cognitive behavioral therapy (CBT), particularly Prolonged Exposure (PE). In fact, PE is one of two treatments with the most empirical support for efficacy in treating PTSD in civilian trauma survivors.
Now the developer of PE therapy, Edna Foa, PhD, of the Center for the Treatment & Study of Anxiety at the University of Pennsylvania, is heading a STRONG STAR clinical trial with two key objectives:
- evaluate the efficacy of Prolonged Exposure in treating combat-related PTSD in a military population; and
- see if this evidence-based therapy can be delivered even more efficiently so as to better serve the needs of service members.
What is PE therapy, and how effective is it?
PE is designed to help PTSD patients emotionally process traumatic events by providing education about PTSD, repeated and prolonged imaginal exposure to trauma memories, and repeated in vivo confrontation with trauma-related situations the patient may be avoiding. In treatment centers around the world, the therapy has proven efficacious in reducing PTSD and related psychopathology with various types of trauma. In addition to greatly reducing PTSD symptom severity, studies have shown that PE also reduces depression and general anxiety, guilt, anger, and anxiety sensitivity, and that it improves social functioning. Importantly, results of follow-up assessments consistently indicate that most people maintain their treatment gains over time.
What questions is STRONG STAR trying to answer?
Treatment studies with civilians have repeatedly found that PE yields clinically meaningful improvement following 8 to 12 sessions administered once or twice weekly over the course of 5 to 12 weeks. Although this is an efficient treatment regimen that can work well for civilians, it may still seem too lengthy for an active-duty service member awaiting a new assignment or deployment.
Therefore, Dr. Foa has designed a study to evaluate the efficacy and feasibility of delivering PE to an active-duty military population, both in its traditional format and in a treatment regimen that has been condensed to accommodate the time constraints of military life. Specifically, she will compare
- a standard PE outpatient treatment approach for PTSD consisting of 10 treatment sessions spaced over 8 weeks;
- the same amount of treatment delivered in a massed format (PE-M) consisting of 10 sessions of daily treatment over a 2-week period;
- treatment with another evidence-based form of psychotherapy, Present-Centered Therapy;
- study participants who have minimal contact with a mental health provider until delayed entry into a treatment program.
This study will deliver one of the premier psychotherapies for PTSD to a military population and demonstrate its efficacy in treating combat-related PTSD. And if the regimen of massed treatment delivered in a 2-week period is shown to be as effective as the standard 8-week treatment approach, it will offer a valuable new treatment option for military personnel.