Prolonged Exposure in the Treatment of PTSD Following an Apartment Fire

Abstract

Foa, Hembree, and Rothbaum’s Prolonged Exposure treatment manual has been found to be an effective treatment modality for posttraumatic stress disorder (PTSD) that is comparable with other evidence-based PTSD treatments. Although the manual details weekly 90-min sessions, this time frame is not always feasible for those clinicians who may be confined to a 50-min appointment. In addition, Foa et al.’s inclusion of audio and video for taped exposures is not always possible given some centers’ technological limitations and client finances. The current case summary details an adapted version of the manual that takes into account such limitations to treat a 26-year-old Jamaican-Canadian female who presented for treatment of PTSD following a fire destroying her home and possessions. Eighteen weekly 50- to 60-min sessions included components of psychoeducation, breathing retraining, in vivo exposures, imaginal exposures, and a trauma narrative (in replacement of audio/video exposures). From pre- to postassessment, significant gains were noted, including a reduction in intrusive thoughts and hyperarousal, and elimination of reexperiencing and sleep disturbances. At the conclusion of treatment, the client also demonstrated an ability to confront the trauma, memories, situations, activities, and places that she had avoided. Self-report measures further validated gains. Due to complicating factors, a follow-up evaluation was not able to be completed. Treatment complications, diversity factors, and implications for future work are discussed.

Keywords

posttraumatic stress disorder PTSD prolonged exposure trauma fire

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

Beck

A. T.

Steer

R. A.

(1993). Beck Anxiety Inventory manual. San Antonio, TX: The Psychological Corporation.

Beck

A. T.

Steer

R. A.

Brown

G. K.

(1996). Beck Depression Inventory–Second Edition manual. San Antonio, TX: The Psychological Corporation.

Briere

(2001). Detailed Assessment of Posttraumatic Stress: Professional manual. Lutz, FL: Psychological Assessment Resources.

Briere

(2011). Traumatic Symptoms Inventory—Second Edition manual. Lutz, FL: Psychological Assessment Resources.

Cahill

S. P.

Hembree

E. A.

Foa

E. B.

(2006). Dissemination of prolonged exposure therapy for posttraumatic stress disorder: Successes and challenges. In Neria

Gross

Marshall

Susser

(Eds.), Mental health in the wake of terrorist attacks (pp. 475-492). Cambridge, UK: Cambridge University Press.

Cahill

S. P.

Rauch

S. A.

Hembree

E. A.

Foa

E. B.

(2003). Effects of cognitive-behavioral treatments for PTSD on anger. Journal of Cognitive Psychotherapy, 17, 113-131.

Cahill

S. P.

Rothbaum

B. O.

Resick

P. A.

Follette

V. M.

(2009). Cognitive-behavioral therapy for adults. In Foa

E. B.

Keane

T. M.

Friedman

M. J.

Cohen

J. A.

(Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp. 139-222). New York, NY: Guilford Press.

Foa

E. B.

Hembree

E. A.

Cahill

S. P.

Rauch

S. A.

Riggs

D. S.

Feeny

N. C.

Yadin

(2005). Randomized trial of prolonged exposure for PTSD with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953-964.

10.

Foa

E. B.

Hembree

E. A.

Rothbaum

B. O.

(2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences—Therapist guide. New York, NY: Oxford University Press.

11.

Foa

E. B.

Jaycox

L. H.

(1999). Cognitive-behavioral theory and treatment of posttraumatic stress disorder. In Spiegel

(Ed.), Efficacy and cost-effectiveness of psychotherapy (pp. 23-61). Washington, DC: American Psychiatric Publishing.

12.

Foa

E. B.

Keane

T. M.

Friedman

M. J.

Cohen

J. A.

(2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press.

13.

Foa

E. B.

Kozak

M. J.

(1985). Treatment of anxiety disorders: Implications for psychopathology. In Tuma

A. H.

Maser

J. D.

(Eds.), Anxiety and the anxiety disorders (pp. 451-452). Hillsdale, NJ: Lawrence Erlbaum.

14.

Foa

E. B.

Kozak

M. J.

(1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.

15.

Foa

E. B.

Zoellner

L. A.

Feeny

N. C.

Hembree

E. A.

Alvarez-Conrad

(2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70, 1022-1028.

16.

Frye

L. A.

Spates

C. R.

(2012). Prolonged exposure, mindfulness, and emotion regulation for the treatment of PTSD. Clinical Case Studies, 11, 184-200.

17.

Galatzer-Levy

I. R.

Nickerson

Litz

B. T.

Marmar

C. R.

(2013). Patterns of lifetime PTSD comorbidity: A latent class analysis. Depression and Anxiety, 30, 489-496.

18.

Goldstein

N. E. S.

Kemp

K. A.

Leff

S. S.

Lochman

J. E.

(2012). Guidelines for adapting manualized interventions for new target populations: A step-wise approach using anger management as a model. Clinical Psychology, 19, 385-401.

19.

Hembree

E. A.

Foa

E. B.

Dorfan

N. M.

Street

G. P.

Kowalski

(2003). Do patients drop out prematurely from exposure therapy for PTSD? Journal of Traumatic Stress, 16, 555-562.

20.

Hembree

E.A.

Rauch

S.A.M.

Foa

E.B.

(2003). Beyond the manual: The insider’s guide to prolonged exposure therapy for PTSD. Cognitive and Behavioral Practice, 10, 22-30.

21.

Jaycox

L. H.

Foa

E. B.

Morral

A. R.

(1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185-192.

22.

Karlin

B. E.

Agarwal

(2013). Achieving the promise of evidence-based psychotherapies for posttraumatic stress disorder with other mental health conditions for veterans. Psychological Science in the Public Interest, 14, 62-64.

23.

Kazi

Freund

Ironson

(2008). Prolonged exposure treatment for posttraumatic stress disorder following the 9/11 attack with a person who escaped from the twin towers. Clinical Case Studies, 7, 100-117.

24.

Lopez

C. M.

Shealy

K. M.

Rheingold

A. A.

(2014). Empirically supported trauma treatment for an adult Latino man diagnosed with PTSD: Overcoming barriers to engagement. Clinical Case Studies, 13, 436-452.

25.

Powers

M. B.

Halpern

J. M.

Ferenschak

M. P.

Gillihan

S. J.

Foa

E. B.

(2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30, 635-641.

26.

Resick

P. A.

Nishith

Weaver

T. L.

Astin

M. C.

Feuer

C. A.

(2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867-879.

27.

Robjant

Fazel

(2010). The emerging evidence for narrative exposure therapy: A review. Clinical Psychology Review, 30, 1030-1039.

28.

Spielberger

C. D.

Gorsuch

R. L.

Lushene

Vagg

P. R.

Jacobs

G. A.

(1983). State-Trait Anxiety Inventory for Adults manual. Palo Alto, CA: Consulting Psychologists Press.

29.

Taylor

Thordarson

D. S.

Maxfield

Fedoroff

I. C.

Lovell

Ogrodniczuk

(2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.

30.

Twohig

M. P.

O’Donohue

W. T.

(2007). Treatment of posttraumatic stress disorder with exposure therapy during late term pregnancy. Clinical Case Studies, 6, 525-535.

31.

van Minnen

Arntz

Keijsers

G. P. J.

(2002). Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout. Behaviour Research and Therapy, 40, 439-457.