Posttraumatic stress disorder (PTSD) is a pervasive and often debilitating condition that affects
many individuals in the general population and military service members. Effective treatments for
PTSD are greatly needed for both veterans returning from Iraq and Afghanistan and veterans of other
eras. Prolonged exposure (PE) therapy has been shown to be highly efficacious in clinical trials
involving women with noncombat trauma, but there are limited data on its effectiveness in real-world
clinical practice settings and with veterans.
To evaluate the effectiveness of PE as implemented with veterans with PTSD in a large health care
Design, Setting, and Participants
This evaluation included 1931 veterans treated by 804 clinicians participating in the Department
of Veterans Affairs (VA) PE Training Program. After completing a 4-day experiential PE training
workshop, clinicians implemented PE (while receiving consultation) with a minimum of 2 veteran
patients who had a primary diagnosis of PTSD.
Main Outcomes and Measures
Changes in PTSD and depression symptoms were assessed with the PTSD Checklist and the Beck
Depression Inventory II, measured at baseline and at the final treatment session. Multiple and
single imputation were used to estimate the posttest scores of patients who left treatment before
completing 8 sessions. Demographic predictors of treatment dropout were also examined.
Intent-to-treat analyses indicate that PE is effective in reducing symptoms of both PTSD
(pre-post d = 0.87) and depression (pre-post
d = 0.66), with effect sizes comparable to those reported in previous
efficacy trials. The proportion of patients screening positive for PTSD on the PTSD Checklist
decreased from 87.6% to 46.2%.
Clinically significant reductions in PTSD symptoms were achieved among male and female veterans
of all war eras and veterans with combat-related and non–combat-related PTSD. Results also
indicate that PE is effective in reducing depression symptoms, even though depression is not a
direct target of the treatment.