Using Prolonged Exposure With an Older Male U.S. Veteran With Childhood Sexual Abuse-Related PTSD

Abstract

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.

Keywords

PTSD trauma older adults sexual abuse prolonged exposure psychotherapy

Get full access to this article

View all access options for this article.

References

Allers

C. T.

Benjack

K. J.

Allers

N. T.

(1992). Unresolved childhood sexual abuse: Are older adults affected? Journal of Counseling & Development, 71, 14-17. doi:10.1002/j.1556-6676.1992.tb02163.x

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

Banyard

V. L.

Williams

L. M.

Siegel

J. A.

(2004). Childhood sexual abuse: A gender perspective on context and consequences. Child Maltreatment, 9, 223-238.

Beck

Steer

Brown

(1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Blevins

C. A.

Weathers

F. W.

Davis

M. T.

Witte

T. K.

Domino

J. L.

(2015). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. Journal of Traumatic Stress, 28, 489-498. doi:10.1002/jts.22059

Briere

Elliott

D. M.

(2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27, 1205-1122.

Cavanagh

M.-R.

Read

New

(2004). Sexual abuse inquiry and response: A New Zealand training programme. New Zealand Journal of Psychology, 33, 137-144.

Cook

J. M.

Dinnen

O’Donnell

(2011). Older women survivors of interpersonal violence: A systematic review of the quantitative literature. Journal of Women’s Health, 20, 1075-1081.

Cook

J. M.

Dinnen

Simiola

Bernardy

Rosenheck

Hoff

(2014). Residential treatment for posttraumatic stress disorder in the Department of Veterans Affairs: A national perspective on perceived effective ingredients. Traumatology: An International Journal, 20, 43-49.

10.

Cook

J. M.

McCarthy

Thorp

S. R.

(2017). Older adults with PTSD: Brief state of research and evidence-based psychotherapy case illustration. American Journal of Geriatric Psychiatry, 25, 522-530.

11.

Crumbaugh

J. C.

(1968). Cross-validation of Purpose-In-Life test based on Frankl’s concepts. Journal of Individual Psychology, 24(1), 74-81. Retrieved from http://search.ebscohost.com.visn1kis.idm.oclc.org/login.aspx?direct=true&AuthType=ip,athens&db=psyh&AN=1968-11401-001&site=ehost-live

12.

Crumbaugh

J. C.

Maholick

L. T.

(1964). An experimental study in existentialism: The psychometric approach to Frankl’s concept of noogenic neurosis. Journal of Clinical Psychology, 20, 200-207. Retrieved from http://search.ebscohost.com.visn1kis.idm.oclc.org/login.aspx?direct=true&AuthType=ip,athens&db=pbh&AN=15847158&site=ehost-live

13.

Cutajar

M. C.

Mullen

P. E.

Ogloff

J. R. P.

Thomas

S. D.

Wells

D. L.

Spataro

(2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect, 34, 813-822.

14.

DeViva

J. C.

McCarthy

Bieu

R. K.

Santoro

G. M.

Rinaldi

Gehrman

Kulas

(2018). Group cognitive-behavioral therapy for insomnia delivered to veterans with posttraumatic stress disorder receiving residential treatment is associated with improvements in sleep independent of changes in posttraumatic stress disorder. Traumatology, 24, 293-300. Retrieved from https://doi-org.visn1kis.idm.oclc.org/10.1037/trm0000152

15.

Dinnen

Simiola

Cook

J. M.

(2015). Trauma and posttraumatic stress disorder in older adults: A systematic review of the psychotherapy treatment literature. Aging & Mental Health, 19, 144-150.

16.

Donohoe

(2010). Uncovering sexual abuse: Evaluation of the effectiveness of the victims of violence and abuse prevention programme. Journal of Psychiatric and Mental Health Nursing, 17, 9-18. doi:10.1111/j.1365-2850.2009.01479.x

17.

Foa

Hembree

Rothbaum

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

18.

Foa

Kozak

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

19.

Gagnon

Hersen

(2000). Unresolved childhood sexual abuse and older adults: Late-life vulnerabilities. Journal of Clinical Geropsychology, 6, 187-198. doi:10.1023/A:1009589115942

20.

Gellis

L. A.

Gehrman

P. R.

(2011). Cognitive behavioral treatment for insomnia in veterans with long-standing posttraumatic stress disorder: A pilot study. Journal of Aggression, Maltreatment & Trauma, 20, 904-916. doi:10.1080/10926771.2011.613448

21.

Gielkens

E. M.

Sobczak

Rossi

Rosowsky

van Alphen

S. J. P.

(2018). EMDR as a treatment approach of PTSD complicated by comorbid psychiatric, somatic, and cognitive disorders: A case report of an older woman with a borderline and avoidant personality disorder. Clinical Case Studies, 17, 328-347. doi:10.1177/1534650118790413

22.

Gielkens

E. M. J.

van Alphen

Sobczak

Segal

D. L.

(2014). Brief eclectic psychotherapy for an older Dutch woman with late-onset posttraumatic stress disorder complicated by a cerebral vascular accident. Clinical Case Studies, 13, 423-435. doi:10.1177/1534650113517933

23.

Groth

A. N.

Burgess

A. W.

(1980). Male rape: Offenders and victims. The American Journal of Psychiatry, 137, 806-810. doi:10.1176/ajp.137.7.806

24.

Hembree

E. A.

Foa

E. B.

Dorfan

N. M.

Street

G. P.

Kowalski

Xin

. (2003). Do Patients Drop Out Prematurely from Exposure Therapy for PTSD? Journal of Traumatic Stress, 16(6), 555-562. Retrieved from http://search.ebscohost.com.visn1kis.idm.oclc.org/login.aspx?direct=true&AuthType=ip,athens&db=pbh&AN=11463380&site=ehost-live

25.

Hyer

Woods

M. G.

(1998). Phenomenology and treatment of trauma in later life. In Follette

V. M.

Ruzek

J. I.

Abueg

F. R.

(Eds.), Cognitive-behavioral therapies for trauma. (pp. 383-414). New York, NY: Guilford Press. Retrieved from http://search.ebscohost.com.visn1kis.idm.oclc.org/login.aspx?direct=true&AuthType=ip,athens&db=psyh&AN=1998-06729-014&site=ehost-live

26.

Lisak

(1994). The psychological impact of sexual abuse: Content analysis of interviews with male survivors. Journal of Traumatic Stress, 7, 525-548. doi:10.1002/jts.2490070403

27.

Maniglio

(2009). The impact of child sexual abuse on health: A systematic review of reviews. Clinical Psychology Review, 29, 647-657.

28.

Molnar

B. E.

Buka

S. L.

Kessler

R. C.

(2001). Child sexual abuse and subsequent psychopathology: Results from the National Comorbidity Survey. American Journal of Public Health, 91, 753-760.doi:10.2105/AJPH.91.5.753

29.

National Center for PTSD. (2018). PTSD Checklist for DSM-5 (PCL-5). Retrieved from https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

30.

O’Leary

P. J.

Barber

(2008). Gender differences in silencing following childhood sexual abuse. Journal of Child Sexual Abuse, 17, 133-143. doi:10.1080/10538710801916416

31.

Paolucci

E. O.

Genuis

M. L.

Violato

(2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135, 17-36.

32.

Pereda

Guilera

Forns

Gómez-Benito

(2009). The prevalence of child sexual abuse in community and student samples: A meta-analysis. Clinical Psychology Review, 29, 328-338. doi:10.1016/j.cpr.2009.02.007

33.

Resick

P. A.

Monson

M. C.

Chard

C. M.

(2016). Cognitive processing therapy for PTSD: A comprehensive manual. New York, NY: Guilford Press.

34.

Skevington

S. M.

Lotfy

O’Connell

K. A.

(2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 13, 299-310.

35.

Smarr

K. L.

Keefer

A. L.

(2011). Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care & Research, 63 Suppl 11, S454-S466. https://doi-org.visn1kis.idm.oclc.org/10.1002/acr.20556

36.

Stein

M. B.

Barrett-Connor

(2003). Sexual assault and physical health: Findings from a population based study of older adults. Psychosomatic Medicine, 62, 838-843.

37.

Talbot

Chapman

Conwell

McCollumn

Franus

Cotescu

Duberstein

(2009). Childhood sexual abuse is associated with physical illness burden and functioning in psychiatric patients 50 years of age and older. Psychosomatic Medicine, 71, 417-422.

38.

Taylor

J. E.

Harvey

S. T.

(2010). A meta-analysis of the effects of psychotherapy with adults sexually abused in childhood. Clinical Psychology Review, 30, 749-767.

39.

Turchik

J. A.

Edwards

K. M.

(2012). Myths about male rape: A literature review. Psychology of Men & Masculinity, 13, 211-226.

40.

Ullman

S. E.

(2007). Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. Journal of Child Sexual Abuse, 16, 19-36.

41.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

Schnurr

P. P.

(2013). The PTSD Checklist for DSM-5 (PCL-5). Retrieved from www.ptsd.va.gov

42.

World Health Organization. (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment. Geneva, Switzerland: Author.

43.

Yoder

M. S.

Tuerk

P. W.

Acierno

(2010). Prolonged exposure with a World War II veteran: 60 years of guilt and feelings of inadequacy. Clinical Case Studies, 9, 457-467. doi:10.1177/1534650110386107