Effect of Prolonged Exposure Therapy Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD Symptom Severity in Military Personnel
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Overview
Randomized noninferiority trial shows massed exposure therapy reduces PTSD symptoms similarly to spaced therapy in military personnel, indicating compressed treatment schedules are viable.
Key Points
- To evaluate the efficacy and noninferiority of massed prolonged exposure therapy (2 weeks) compared with spaced prolonged exposure therapy (8 weeks), present-centered therapy, and minimal-contact control in military personnel with PTSD.
- Randomized clinical trial (NCT01049516) conducted at Fort Hood, Texas, enrolling 370 active duty military personnel with combat-related PTSD returning from Iraq, Afghanistan, or both (analyzed n=366).
- Participants were randomized to massed prolonged exposure (n=110; 10 sessions over 2 weeks), spaced prolonged exposure (n=109; 10 sessions over 8 weeks), present-centered therapy (n=107; 10 sessions over 8 weeks), or minimal-contact control (n=40; weekly phone calls for 4 weeks).
- Primary outcome was PTSD symptom severity measured by the PTSD Symptom Scale-Interview (PSS-I, range 0-51; noninferiority margin 2.3 points with 1-sided α = .05) assessed through 6-month follow-up.
- At 2 weeks posttreatment, massed therapy reduced PSS-I scores significantly more than minimal-contact control (mean score 17.62 vs 21.41; decrease difference, 3.70 [95% CI, 0.72 to 6.68]; P = .02).
- Massed therapy was noninferior to spaced therapy at 2 weeks posttreatment (mean score 17.62 vs 18.03; difference, 0.79 [1-sided 95% CI, -∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment (mean score 18.88 vs 18.34; difference, 0.55 [1-sided 95% CI, -∞ to 2.05; P = .03 for noninferiority]).
- Spaced therapy showed no significant difference compared to present-centered therapy at posttreatment (mean PSS-I score 18.03 vs 18.65; difference in decrease, 0.10 [95% CI, -2.48 to 2.27]; P = .93).
Cite This Study
Foa et al. (2018) studied this question.