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Are 60-Minute Prolonged Exposure Sessions With 20-Minute Imaginal Exposure to Traumatic Memories Sufficient to Successfully Treat PTSD? A Randomized Noninferiority Clinical Trial

Nacasch, Nitsa ; Huppert, Jonathan D ; Su, Yi-Jen ; Kivity, Yogev ; Dinshtein, Yula ; Yeh, Rebecca ; Foa, Edna B

Behavior Therapy, May 2015, Vol.46(3), pp.328-341 [Peer Reviewed Journal]

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  • 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
  • Author/Creator: Nacasch, Nitsa ; Huppert, Jonathan D ; Su, Yi-Jen ; Kivity, Yogev ; Dinshtein, Yula ; Yeh, Rebecca ; Foa, Edna B
  • Language: English
  • Subjects: Posttraumatic Stress Disorder ; Prolonged Exposure ; Habituation ; Fear Activation ; Emotional Processing
  • Is Part Of: Behavior Therapy, May 2015, Vol.46(3), pp.328-341
  • Description: 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 ( = 19) or 60-minute ( = 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.
  • Identifier: ISSN: 0005-7894 ; E-ISSN: 1878-1888 ; DOI: 10.1016/j.beth.2014.12.002