Posted April 14, 2023

Edna Foa, Ph.D., University of Pennsylvania

This project is managed by the CDMRP under the Psychological Health and Traumatic Brain Injury Research Program on behalf of the Military Operational Medicine Research Program.

Posttraumatic stress disorder (PTSD) is a mental health condition that develops after a traumatic event and can cause a range of debilitating symptoms, including anxiety and panic, depression, emotional withdrawal, and sleep problems. PTSD has a high prevalence in military personnel, highlighting the critical need for treatments to improve mission readiness and the quality of life for these Service Members.¹ Prolonged exposure (PE) is an evidence-based treatment that is designed to help patients address their anxiety and depression, and is recommended by the Institute of Medicine, Department of Veterans Affairs, and Department of Defense as a first line treatment for PTSD. Standard PE sessions last 90 minutes; however, this causes a barrier to implementation in a Military Health System that operates within a 60-minute appointment framework.

With a fiscal year 2014 Traumatic Brain Injury/Post-Traumatic Stress Disorder Clinical Trial Award, Dr. Edna Foa sought to determine whether PE can be adapted to 60-minute sessions without compromising the effectiveness of the treatment. To investigate this, Dr. Foa and her team conducted a two-group, randomized control trial investigating whether the 60-minute PE is “not acceptably worse” (non-inferior) to the standard 90-minute PE in a sample of exclusively active-duty personnel. In this trial, 160 active-duty service men and women with PTSD were randomly assigned to either the 60-minute PE or 90-minute PE. The 60-minute sessions were identical to the 90-minute sessions except for a shortened imaginal exposure period where patients re-experience the traumatic memory in vivid detail (shortened from 40 minutes to 20 minutes). Participants were assessed using the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual for Mental Disorders, 5th edition [DSM-5] (CAPS-5), a standardized clinical interview, to determine PTSD severity at baseline, post-treatment, and at 3- and 6-months post-treatment. They were also assessed weekly using the PTSD Checklist for DSM-5 (PCL-5), a self-reported survey of PTSD symptom severity.

As described in 2022 in the Journal of Consulting and Clinical Psychology, scores from the CAPS-5 and PCL-5 were analyzed using a variety of statistical tests. The CAPS-5 and PCL-5 scores for the 60-minute sessions and 90-minute sessions did not surpass the pre-set inferiority margin, meaning one treatment was not better than the other. This, along with a secondary analysis, suggests the 60-minute PE treatment was as effective as the 90-minute PE.2

Shortening PE sessions to 60 minutes could address a significant barrier to adoption of this treatment in Military Health Systems that cannot accommodate 90-minute sessions, thereby increasing access to an efficacious, first line PTSD treatment. The results of this study show that shortening the PE sessions to 60 minutes does not compromise the efficacy of the treatment and provides support for adopting this abridged version in Military Health Systems. This has the potential to improve quality of life as well as mission readiness among Service Members with PTSD.

References:

¹2018. How Common Is PTSD in Veterans? National Center for PTSD, U.S. Department of Veteran Affairs

Publications:

²Foa E, Bredmeier K, Acierno R, et al. 2022. The efficacy of 90-min versus 60-min sessions of prolonged exposure for PTSD: A randomized controlled trial in active-duty military personnel. Journal of Consulting and Clinical Psychology 90:6-503–512.

Links:

Public and Technical Abstracts: The Efficacy of 90-Minute vs 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Control Trial in Active Duty Military Personnel

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