Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

TLDR

In a randomized trial of 171 female assault survivors with chronic PTSD, participants were assigned to 9–12 sessions of prolonged exposure alone, prolonged exposure plus cognitive restructuring, or wait‑list, delivered at academic or community clinics with pre‑ and post‑treatment and 3‑, 6‑, and 12‑month follow‑ups. Both prolonged exposure conditions significantly reduced PTSD and depression relative to wait‑list, improved social functioning in completers, and yielded comparable outcomes regardless of site or therapist experience, with gains maintained at follow‑up and no added benefit from cognitive restructuring.

Abstract

Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.