The Efficacy of 90-Minute vs. 60-Minute Sessions of Prolonged Exposure for PTSD: A Randomized Controlled Trial in Active Duty Military Personnel

May 26, 2017

With up to 20 percent of post-9/11 combat veterans suffering from posttraumatic stress disorder (PTSD) symptoms, our nation needs to provide effective treatments to the greatest number of people possible.

One form of therapy proven effective, Prolonged Exposure (PE), is recommended by the Institute of Medicine and being rolled out by the Departments of Defense (DoD) and Veterans Affairs (VA) to help service members and veterans recover from PTSD. A major barrier to that rollout, however, is that PE typically is delivered in 90-minute sessions. That makes it difficult for military and VA mental health clinicians to provide PE because, due to large patient loads and federal scheduling policies, they usually must limit therapy sessions to 60 minutes. But if PE could be shown to maintain high success rates with shorter sessions, more military and VA providers could offer this powerful therapy.

Testing shorter exposure sessions

A key element of PE is a procedure known as “imaginal exposure,” during which patients recall and recount their trauma memories. Preliminary evidence has suggested that patients may benefit greatly from PE even when the time spent in imaginal exposure is shortened to fit into a 60-minute session.

In this STRONG STAR-affiliated clinical study, Edna Foa, PhD, of the University of Pennsylvania and her research team will evaluate the delivery of PE in 60-minute sessions. They will enroll 160 San Antonio-area active duty service members, randomly assign them to receive PE treatment with 60- or 90-minute sessions, and compare outcomes of the two groups. All treatment sessions will be conducted at a non-military site. The cause of the PTSD may include various types of trauma (e.g., combat, attacks, sexual or physical assault, childhood trauma, abuse, accidents) and does not have to be service-related.

In addition to measuring progress based on patients’ subjective self-reporting and clinicians’ objective assessments, the investigators seek to gain insight on how PE works – and which components of the therapy are most beneficial – by observing changes in patients’ physical symptoms of stress. Physical symptoms to be monitored include heart rate, which accelerates during stress, and skin electrical conductivity, which increases as a result of stress-induced perspiration. Tracking of physical changes during different parts of the therapy could yield insight on how PE helps patients recover from PTSD and, based on that knowledge, ways of enhancing this and other PTSD treatments to increase their effectiveness.

Potential benefits

Data from this study showing high success rates from shortened PE sessions could lead to increased availability of this powerful therapy for hundreds of thousands of combat veterans. More military and VA clinicians could offer PE, because it would fit within the time constraints of their heavy workload and federal scheduling policies. The military and general public would benefit from enhanced readiness of our Armed Forces and reduced public costs of service members’ lost work time and veterans’ disability benefits. Civilian therapists also may be more likely to use PE therapy if they had available a 60-minute format compatible with insurance reimbursement requirements. Finally, study findings about how and why PE is such an effective treatment could provide insights on how to improve PTSD treatment even further.