Examining potential contraindications for prolonged exposure therapy for PTSD

Abstract

Although prolonged exposure (PE) has received the most empirical support of any treatment for post-traumatic stress disorder (PTSD), clinicians are often hesitant to use PE due to beliefs that it is contraindicated for many patients with PTSD. This is especially true for PTSD patients with comorbid problems. Because PTSD has high rates of comorbidity, it is important to consider whether PE is indeed contraindicated for patients with various comorbid problems. Therefore, in this study, we examine the evidence for or against the use of PE with patients with problems that often co-occur with PTSD, including dissociation, borderline personality disorder, psychosis, suicidal behavior and non-suicidal self-injury, substance use disorders, and major depression. It is concluded that PE can be safely and effectively used with patients with these comorbidities, and is often associated with a decrease in PTSD as well as the comorbid problem. In cases with severe comorbidity, however, it is recommended to treat PTSD with PE while providing integrated or concurrent treatment to monitor and address the comorbid problems.

Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts

“…In standard weekly TFT programmes, patients characteristics are not found to be stable predictors of treatment outcome (Ehlers et al, 2013; Ehring et al, 2014; Powers et al, 2010; van Minnen, Arntz, & Keijsers, 2002; van Minnen, Harned, Zoellner, & Mills, 2012) and findings concerning (early) treatment process variables, such as fear habituation, are inconsistent (Bluett, Zoellner, & Feeny, 2014; Sripada & Rauch, 2015; van Minnen & Hagenaars, 2002). This variability might be explained by the fact that in most studies prediction analyses of associations were performed in entire and thus heterogeneous samples.…”

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

“…In contrast to this line of reasoning, evidence has emerged showing that first-line trauma-focused treatments are effective in treating those with a history of CSA and symptoms of Complex PTSD without prior stabilization or training in emotion regulation (Bongaerts, Van Minnen, & De Jongh, 2017; Van Minnen, Harned, Zoellner, & Mills, 2012). For example, in a study among 110 female veterans with PTSD in a residential treatment setting, no differences in treatment response were found using trauma-focused treatment (i.e.…”

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

“…Lanius (2015) further outlines how the model could guide treatment for trauma-affected patients, as TRASC of different dimensions of consciousness may require different treatments, something that future clinical studies could investigate. Studies on the impact of dissociation on treatment show inconsistent results, with some studies finding dissociation to predict poorer response (Bae, Kim, & Park, 2016; Kleindienst et al, 2016) while others fail to find such an effect (Minnen & Harned, 2012; Zoet, Wagenmans, van Minnen, & de Jongh, 2018). Heterogeneity in how dissociation is measured and conceptualized may influence the results, making it important to investigate whether experiences of TRASC affect treatment outcome; such an evaluation is planned for the present randomized controlled trial.…”