: These findings suggest that PE can be safely and effectively implemented with Veterans with PTSD, a history of mild to moderate TBI, and current cognitive impairment.

The present study used archival clinical data to analyze the delivery and effectiveness of prolonged exposure (PE) and ancillary services for posttraumatic stress disorder (PTSD) among Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (N = 69) with histories of mild to severe traumatic brain injury (TBI). Data from standard clinical assessments of veterans and active duty personnel treated in both inpatient and outpatient programs at 2 Department of Veteran Affairs medical centers were examined. Symptoms were assessed with self-report measures of PTSD (PTSD Checklist) and depression (Beck Depression Inventory-II) before and throughout therapy. Mixed linear models were utilized to determine the slope of reported symptoms throughout treatment, and the effects associated with fixed factors such as site, treatment setting (residential vs. outpatient), and TBI severity were examined. Results demonstrated significant decreases in PTSD, B = -3.00, 95% CI [-3.22, -2.78]; t(210) = -13.5; p < .001, and in depressive symptoms, B = -1.46, 95% CI [-1.64, -1.28]; t(192) = -8.32; p < .001. The effects of PE treatment did not differ by clinical setting and participants with moderate to severe injuries reported more rapid gains than those with a history of mild TBI. The results provide evidence that PE may well be effective for veterans with PTSD and TBI.

This study integrated psychological and neuroscience research regarding the effects of childhood trauma in order to advance assessment with this population. Recently, researchers proposed new criteria for complex posttraumatic stress disorder (PTSD) on the basis of years of interdisciplinary research, identifying symptoms that have an empirical association with survivors of childhood trauma. The criteria reflect alterations in regulating affect, dissociation, executive functioning, somatization, and chronic characterological changes. These content areas are compatible with recent neuroscience research with this population and illustrate the interplay between mind-brain interactions, chronic stress, and neurodevelopment. Prior research suggested that Scale 8 of the Minnesota Multiphasic Personality Inventory (MMPI) was most sensitive to neurological dysfunction. Therefore, can complex PTSD be detected by the MMPI? Item analyses were performed comparing abused and nonabused participants. Stage 1 of the analysis identified 11 items that differentiated groups. In Stage 2, the study attempted to construct a preliminary scale that correctly classified 81% of participants and 89% of those with a history of abuse. The content of identified items reflects problems with impulsivity, affect regulation, and disrupted cognitive processes. A theoretical explanation is provided in the Discussion section.

PE treatment-related improvements for participants with comorbid PTSD and TBI generalize from PTSD outcomes to PCS and other TBI-related outcomes. Positive outcomes were independent of TBI severity, treatment setting, or Veteran status, but dependent upon PE treatment completion and lower levels of VA service-connected disability.