Does imaginal exposure exacerbate PTSD symptoms?

Foa, Edna B.; Zoellner, Lori A.; Feeny, Norah C.; Hembree, Elizabeth A.; Alvarez-Conrad, Jennifer

doi:10.1037/0022-006x.70.4.1022

Cited by 309 publications

(279 citation statements)

References 31 publications

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“…According to the final multilevel model, it appears that patients in both treatments experience rapid initial declines in self-reported PTSD symptoms, which then level off over time. It should be noted that prior studies have shown that approximately 10 percent of patients may experience an exacerbation following the first imaginal exposure in PE, when patients are asked to describe in detail what happened during their traumatic events (Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2007). This exacerbation in symptoms was not observed in the present study.…”

Section: Discussioncontrasting

confidence: 69%

“…Patients who have ignored or avoided their PTSD symptoms as a form a symptom management may experience an initial increase in PTSD symptoms, especially when they first begin confronting trauma reminders. Encouragingly, Foa et al (2007) found that patients who experienced an exacerbation in their PTSD symptoms experienced similar benefits from PE when compared to patients who did not report an exacerbation in symptoms. Their findings have not been confirmed for CPT patients.…”

Section: Discussionmentioning

confidence: 95%

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Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

et al. 2017

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Multiple randomized clinical trials have shown that cognitive processing therapy (CPT) and prolonged exposure (PE) are evidence-based treatments for posttraumatic stress disorder (PTSD). However, additional research should verify the effectiveness of CPT and PE in conditions more reflective of clinical practice. The present study evaluated the effectiveness of CPT and PE at reducing veterans' self-reported PTSD symptoms as measured by total scores on the PTSD Checklist (PCL). This study involved a retrospective review of 2,030 charts. 750 veterans from 10 U.S. states who received CPT or PE in individual psychotherapy from the Veterans Health Administration were included in the study (N participants in CPT = 376; N participants in PE = 374). The study used multilevel modeling to evaluate the absolute and relative effectiveness of both treatments and to determine the relationship between patient-level factors and total PCL scores during treatment. Results showed that both CPT and PE were equally effective at reducing total PCL scores, but that the effectiveness of both therapies was reduced when compared to results obtained in randomized clinical trials. Patients who completed therapy reported significantly larger reductions on the PCL than patients who did not complete therapy. On average, patients who did not complete a full course of therapy reported little to no improvement on the PCL. Encouragingly, as a group these patients did not report an increase in the severity of their total PCL scores prior to dropping out from therapy. Patients who reported more severe total PCL scores at baseline experienced significantly larger reductions in PCL scores during therapy, but veterans at all levels of initial PTSD symptom severity benefited from treatment. Older veterans and Hispanic veterans had higher total PCL scores at baseline.However, veterans across all ages and three racial/ethnic groups (Caucasian, African American, Hispanic) experienced equivalent rates of symptom reduction. Therapist effects were small, but -ivstatistically significant. The study discusses the significance of these findings in light of prior research on trauma-focused therapy, future directions for research, and implications for practice.-v- Acknowledgements

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Section: Discussioncontrasting

confidence: 69%

Section: Discussionmentioning

confidence: 95%

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

et al. 2017

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“…Few studies have focused on this topic. However, across PTSD treatment studies the following developments have been found in some degree: worsening of psychiatric symptoms among some individuals that is not generally indicative of poorer long-term outcomes (Foa et al, 2002;Tarrier et al, 1999 ); and individual differences leading to variations in treatment response (Hembree et al, 2004;Morrisey et.al., 2005 ;Speckens et al, 2006 ;Tarrier et al, 1999 ). These developments make clear that further investigation is needed.…”

Section: Introductionmentioning

confidence: 99%

“…For example, Foa and her colleagues (Foa, et al, 2002) found that greater numbers of women in a prolonged exposure condition experienced increased symptoms of anxiety and depression following imaginal exposure than did women in an imaginal exposure plus cognitive restructuring condition. However, short term increases in symptoms did not lead to worse PTSD symptoms at the conclusion of treatment.…”

Section: Introductionmentioning

confidence: 99%

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment

Killeen

Hien

Campbell

et al. 2008

Journal of Substance Abuse Treatment

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A substantial number of women who enter substance abuse treatment have a history of trauma and meet criteria for Post Traumatic Stress Disorder (PTSD). Fear regarding the extent to which PTSD treatment can evoke negative consequences remains a research question. This study explored adverse events related to the implementation of an integrated treatment for women with trauma and substance use disorder (Seeking Safety) compared with a non-trauma focused intervention (Women's Health Education). Three hundred fifty-three women enrolled in community substance abuse treatment were randomized to one of the two study groups and monitored weekly for adverse events. There were no differences between the two intervention groups in the number of women reporting study-related adverse events (28 [9.6%] for the Seeking Safety group, 21 [7.2%] for the Women's Health Education group). Implementing PTSD treatment in substance abuse treatment programs appears to be safe, with minimal impact on intervention-related adverse HHS Public Access

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“…While the Emotional Experiencing Scale may be measuring an important factor contributing to psychotherapeutic change, it measures a distinct change process (Greenberg, Warwar, & Malcolm, 2008), therefore a more complete understanding of emotion processing could be provided by examining other related constructs. Affect experiencing has been found to be a significant predictor of psychotherapeutic change for processing trauma (Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002), resolving unfinished business (Greenberg & Malcolm, 2002) and discriminating successful psychotherapy outcomes according to reduced healthcare costs and improved functional status (Town, Abbass, & Bernier, 2013). Affect experiencing and depth of emotional experience are overlapping constructs (Warwar, 2003) but the latter focuses on verbal expression and does not include arousal of bodily affects in its conceptualization.…”

mentioning

confidence: 99%

Is affect experiencing therapeutic in major depressive disorder? Examining associations between affect experiencing and changes to the alliance and outcome in intensive short-term dynamic psychotherapy.

et al. 2017

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Affect experiencing (AE), defined as the facilitation of client in-session bodily arousal and visceral experiencing of affect, is a distinct theoretical process presumed to contribute to therapeutic improvement. This study examined the role of AE in the treatment of major depressive disorder by exploring its association to client distress and therapeutic alliance on a session-by-session basis. A case series design was used to conduct an intensive analysis of the treatment process of 4 clients who received time-limited intensive short-term dynamic psychotherapy, 2 of whom were considered “recovered” and 2 who showed “no change” based upon posttreatment outcomes. Consistent with our hypothesis, we found that cross-correlations between AE and client distress discriminated between “recovered” and “no change” clients. In “recovered” clients, there was evidence that higher in-session peak affect experience was associated with reduced distress 7 days later. The results did not provide consistent evidence for a reverse effect, showing that lower distress during the preceding week predicted higher AE in that session. Finally, there was evidence that AE is an in-session activity that can promote the strengthening of the therapeutic alliance. These collective findings suggest that AE is an important treatment process that contributes to alliance formation and psychotherapeutic improvement. Clinical implications include further evidence that psychodynamic therapists can utilize AE as an active change ingredient for depression.

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Does imaginal exposure exacerbate PTSD symptoms?

Cited by 309 publications

References 31 publications

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

Adverse events in an integrated trauma-focused intervention for women in community substance abuse treatment

Is affect experiencing therapeutic in major depressive disorder? Examining associations between affect experiencing and changes to the alliance and outcome in intensive short-term dynamic psychotherapy.

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