Clinicians of Varying Backgrounds Can Successfully Deliver Prolonged Exposure Therapy
While professional experience has some impact on the course of prolonged exposure therapy for PTSD, all well-trained practitioners can effectively administer this form of treatment, according to recent findings from a team of American researchers.
A form of change-oriented psychotherapy called prolonged exposure therapy (PE therapy) has verified usefulness as a treatment for people affected by post-traumatic stress disorder (PTSD). In a study published in February 2015 in the Journal of Traumatic Stress, researchers from five U.S. institutions sought to determine if the experience level and the attitude of the professional conducting prolonged exposure therapy alters the successful use of the treatment in PTSD cases. These researchers concluded that experience level of the clinician has some effect, but not enough to change the likelihood of positive PE therapy outcomes.
Doctors diagnose post-traumatic stress disorder in people who continue to experience (or start experiencing) damaging and dysfunctional reactions to highly traumatic circumstances at least 30 days after exposure to such circumstances has occurred. These dysfunctional reactions broadly fall into four categories: a compelling urge to stay away from situations, events or people that act as reminders of prior trauma exposure; an inability to avoid reliving prior trauma exposure while sleeping or awake; an inability to reliably deactivate the body’s natural “fight-or-flight” response; and a general increase in negative or “down” thought patterns or states of mind. The specific mixture of symptoms can vary considerably from individual to individual.
Only a minority of people exposed to a potentially traumatizing event or situation will eventually meet the criteria used to diagnose PTSD. Groups particularly likely to qualify for a diagnosis include women (who develop PTSD more than twice as often as men), people physically injured during a traumatic experience, people subjected to extended or ongoing trauma exposure, people who have a significantly negative short-term reaction to a traumatic experience, people with a history of mental illness, people who lack a well-developed social support network and people already subjected to high stress levels at the time of trauma exposure.
Prolonged Exposure Therapy
Prolonged exposure therapy is a psychotherapeutic approach that belongs to a larger school of therapy called cognitive behavioral therapy. All cognitive behavioral practitioners seek to help their clients/patients understand and recognize thoughts and reactions that contribute to dysfunctional responses to high-stress situations or events. These practitioners also help their clients/patients replace their harmful thoughts and reactions with alternatives that contribute to well-being and emotional stability. During PE therapy, a therapist or doctor asks his or her patient/client to purposefully discuss or directly experience circumstances that have triggered damaging stress responses in the past. As a rule, the circumstances in question do not actually pose a threat to the individual. Eventually, a course of prolonged exposure therapy helps participants master their stress reactions and avoid contributing to downturns in their mental health and well-being.
Do Practitioners Alter Treatment Success?
In the study published in the Journal of Traumatic Stress, researchers from the National Center for PTSD, Palo Alto University, the Stanford University School of Medicine, the U.S. Department of Veterans Affairs and Johns Hopkins University used data gathered from 1,105 practitioners to help determine if practitioner experience and attitude significantly alter the effectiveness of prolonged exposure therapy as a PTSD treatment. All of the participating professionals had weekly access to PE therapy experts through a federally supported program. In addition, all of the participants spent at least half of their working hours helping patients/clients diagnosed with PTSD. Most of the practitioners (57 percent) had professional status as psychologists; the vast majority of the remaining participants were social workers. All of the participants submitted detailed information on their levels of experience administering PE therapy to clients/patients, as well as on the positive or negative attitudes they held on the effectiveness or usefulness of the therapy.
The professionals enrolled in the study administered prolonged exposure therapy to 3,133 veterans of military service whose PTSD symptoms were associated with a range of underlying causes. When the researchers examined the outcomes of treatment, they found that, among well-trained practitioners, the profession of the person administering the therapy is the only source of a measurable difference in treatment outcomes. Specifically, they concluded that practitioners trained as social workers achieve results slightly superior to the results achieved by other professionals. However, the researchers also found that the difference in outcomes for other professionals is not great enough to degrade the general treatment effectiveness of PE therapy for PTSD.