In the Journals

Two-week prolonged exposure therapy as effective as 8-week therapy for PTSD

Edna B. Foa
Edna B. Foa

Clinical trial results showed that a 2-week, massed course of prolonged exposure therapy was noninferior to an 8-week spaced course among active military personnel with PTSD, and reduced severity of symptoms more than minimal-contact control.

“Knowledge about the efficacy of prolonged exposure therapy among active duty military personnel is limited to case studies. One barrier to implementation of prolonged exposure therapy in the military is treatment length (8-15 weeks), which can conflict with military obligations,” Edna B. Foa, PhD, from the department of psychiatry, School of Medicine, University of Pennsylvania, and colleagues wrote in JAMA. “A shorter course of therapy could hasten amelioration of PTSD, with the added benefit of facilitating military readiness.”

In a randomized control trial, researchers compared the effects of four different therapies on PTSD symptom severity in 370 military personnel with PTSD who had recently returned from active duty.

Participants received either massed therapy (prolonged exposure therapy plus cognitive behavioral therapy) administered in 10 sessions over 2 weeks (n = 110); spaced prolonged exposure therapy in 10 sessions over 8 weeks (n = 109); present-centered therapy in 10 sessions over 8 weeks (n=107) or minimal-contact control via telephone once weekly for 4 weeks (n = 40). Foa and colleagues measured PTSD symptom severity before and after treatment, and at 2-week, 12-week and 6-month follow-up to determine the efficacy of massed therapy at 2 weeks posttreatment vs. minimal-contact control at week 4; noninferiority of massed therapy vs. spaced therapy at 2 weeks and 12 weeks posttreatment; and efficacy of spaced therapy vs. present-centered therapy at posttreatment.

Of 370 participants, researchers used data from 366 participants and 216 completed the study. PTSD symptom severity scores from baseline to 2-week follow-up were significantly lower for massed therapy compared with minimal-contact control (difference, 3.7; 95% CI, 0.72-6.68; P=.02), and participants receiving massed therapy had lower average scores than those receiving minimal-contact control at 2-week follow-up (17.62 vs. 21.41; difference 3.79; 95% CI, 1.41 to 6.17; P=.002). Difference in mean symptom severity scores between massed therapy and spaced therapy was 0.79 at 2-week follow-up (P=.049 for noninferiority) and 0.55 at 12-week follow-up (P=.03 for noninferiority), indicating the scores met the criteria for noninferiority at both 2-week and 12-week follow-up. There was no significant difference observed between present-centered therapy and spaced therapy.

“This study not only addresses the pressing need for an effective treatment option for PTSD but also encourages a more speedy treatment and recovery, allowing affected service members to return to active duty sooner and enabling veterans to reintegrate into civilian life more quickly,” Foa said in a press release. “Our findings are good news – about half of those treated achieved remission and many others demonstrated substantial relief from their symptoms. This is critical for the hundreds of thousands of post-9/11 combat veterans affected by PTSD and can do so much to improve lives and assist with military readiness.”

Charles Hoge
Charles W. Hoge

The results of this study answer important questions about the best recovery mechanisms in PTSD therapies, according to an editorial written by Charles W. Hoge, MD, from Walter Reed Army Institute of Research, and Kathleen M. Chard, PhD, from the Trauma Recovery Center at Cincinnati VA Medical Center.

“While the field evolves, clinicians and patients should feel reassured that a range of good options, both trauma- and non–trauma-focused, is available for treating patients with PTSD,” Hoge and Chard wrote. “Clinicians should consider not only how they optimize delivery of core components of trauma-focused care, but also how to enhance the nonspecific benefits of therapeutic encounters. Furthermore, based on findings reported by Foa et al, clinicians can have confidence in offering trauma-focused therapies in compressed time frames if patients prefer this approach. – by Savannah Demko

Disclosures: Foa reports receiving research funding from the Department of Defense, Department of Veterans Affairs and NIH, and receiving royalties for books on PTSD treatment. Please see the study for other authors’ relevant financial disclosures. Hoge and Chard report no relevant financial disclosures.

Edna B. Foa
Edna B. Foa

Clinical trial results showed that a 2-week, massed course of prolonged exposure therapy was noninferior to an 8-week spaced course among active military personnel with PTSD, and reduced severity of symptoms more than minimal-contact control.

“Knowledge about the efficacy of prolonged exposure therapy among active duty military personnel is limited to case studies. One barrier to implementation of prolonged exposure therapy in the military is treatment length (8-15 weeks), which can conflict with military obligations,” Edna B. Foa, PhD, from the department of psychiatry, School of Medicine, University of Pennsylvania, and colleagues wrote in JAMA. “A shorter course of therapy could hasten amelioration of PTSD, with the added benefit of facilitating military readiness.”

In a randomized control trial, researchers compared the effects of four different therapies on PTSD symptom severity in 370 military personnel with PTSD who had recently returned from active duty.

Participants received either massed therapy (prolonged exposure therapy plus cognitive behavioral therapy) administered in 10 sessions over 2 weeks (n = 110); spaced prolonged exposure therapy in 10 sessions over 8 weeks (n = 109); present-centered therapy in 10 sessions over 8 weeks (n=107) or minimal-contact control via telephone once weekly for 4 weeks (n = 40). Foa and colleagues measured PTSD symptom severity before and after treatment, and at 2-week, 12-week and 6-month follow-up to determine the efficacy of massed therapy at 2 weeks posttreatment vs. minimal-contact control at week 4; noninferiority of massed therapy vs. spaced therapy at 2 weeks and 12 weeks posttreatment; and efficacy of spaced therapy vs. present-centered therapy at posttreatment.

Of 370 participants, researchers used data from 366 participants and 216 completed the study. PTSD symptom severity scores from baseline to 2-week follow-up were significantly lower for massed therapy compared with minimal-contact control (difference, 3.7; 95% CI, 0.72-6.68; P=.02), and participants receiving massed therapy had lower average scores than those receiving minimal-contact control at 2-week follow-up (17.62 vs. 21.41; difference 3.79; 95% CI, 1.41 to 6.17; P=.002). Difference in mean symptom severity scores between massed therapy and spaced therapy was 0.79 at 2-week follow-up (P=.049 for noninferiority) and 0.55 at 12-week follow-up (P=.03 for noninferiority), indicating the scores met the criteria for noninferiority at both 2-week and 12-week follow-up. There was no significant difference observed between present-centered therapy and spaced therapy.

“This study not only addresses the pressing need for an effective treatment option for PTSD but also encourages a more speedy treatment and recovery, allowing affected service members to return to active duty sooner and enabling veterans to reintegrate into civilian life more quickly,” Foa said in a press release. “Our findings are good news – about half of those treated achieved remission and many others demonstrated substantial relief from their symptoms. This is critical for the hundreds of thousands of post-9/11 combat veterans affected by PTSD and can do so much to improve lives and assist with military readiness.”

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Charles Hoge
Charles W. Hoge

The results of this study answer important questions about the best recovery mechanisms in PTSD therapies, according to an editorial written by Charles W. Hoge, MD, from Walter Reed Army Institute of Research, and Kathleen M. Chard, PhD, from the Trauma Recovery Center at Cincinnati VA Medical Center.

“While the field evolves, clinicians and patients should feel reassured that a range of good options, both trauma- and non–trauma-focused, is available for treating patients with PTSD,” Hoge and Chard wrote. “Clinicians should consider not only how they optimize delivery of core components of trauma-focused care, but also how to enhance the nonspecific benefits of therapeutic encounters. Furthermore, based on findings reported by Foa et al, clinicians can have confidence in offering trauma-focused therapies in compressed time frames if patients prefer this approach. – by Savannah Demko

Disclosures: Foa reports receiving research funding from the Department of Defense, Department of Veterans Affairs and NIH, and receiving royalties for books on PTSD treatment. Please see the study for other authors’ relevant financial disclosures. Hoge and Chard report no relevant financial disclosures.