Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Apr;30(2):166-172.
doi: 10.1002/jts.22175. Epub 2017 Mar 22.

Integrated Treatment of PTSD and Substance Use Disorders: Examination of Imaginal Exposure Length

Adam C Mills  1   2 , Christal L Badour  3 , Kristina J Korte  1 , Therese K Killeen  1 , Aisling V Henschel  1   2 , Sudie E Back  1   2
Affiliations
Randomized Controlled Trial

Integrated Treatment of PTSD and Substance Use Disorders: Examination of Imaginal Exposure Length

Adam C Mills et al. J Trauma Stress. 2017 Apr.

Abstract

Efforts to improve the efficiency of prolonged exposure (PE) therapy for posttraumatic stress disorder (PTSD) have demonstrated that reducing the length of imaginal exposures does not negatively affect treatment outcome. A recent adaptation of PE, called Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure [COPE], integrates substance use disorder treatment with PE in the same timeframe (twelve 90-minute sessions, 8 of which include imaginal exposure). The current study, which represents a subanalysis of a larger randomized controlled trial, examined how the length of imaginal exposures (nonrandomized and measured continually) related to PTSD, substance use, and depression in a sample of military veterans (N = 31) who completed the COPE treatment. Participants completed an average of 11.5 of the 12 therapy sessions and 7.2 of the 8 imaginal exposures during treatment. Results of 3 linear mixed models indicate that PTSD, substance use, and depressive symptoms all improved over the course of treatment (ps < .001; η2 ranged between .17 and .40), and that the length of imaginal exposures did not significantly interact with any outcome. Although preliminary, the findings suggest that it may be feasible to shorten imaginal exposures without mitigating treatment gains. Implications for treatment are discussed.

PubMed Disclaimer

References

    1. Abramowitz JS. Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy. 1996;27:583–600.
    1. Adams ZW, McCauley JL, Back SE, Flanagan JC, Hanson RF, Killeen TK, Danielson CK. Clinician perspectives on treating adolescents with co-occurring post-traumatic stress disorder, substance use, and other problems. Journal of Child & Adolescent Substance Abuse. 2016;25:1–9. - PMC - PubMed
    1. Arntz A, Tiesema M, Kindt M. Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. Journal of Behavior Therapy and Experimental Psychiatry. 2007;38:345–370. - PubMed
    1. Back SE, Brady KT, Sonne SC, Verduin ML. Symptom improvement in co-occurring PTSD and alcohol dependence. The Journal of Nervous and Mental Disease. 2006;194:690–696. - PubMed
    1. Back SE, Foa EB, Killeen TK, Teesson M, Mills KL, Cotton BD, Brady KT. Concurrent treatment of PTSD and substance use disorders using prolonged exposure (COPE): Therapist guide. New York, NY: Oxford University Press; 2014.

Publication types