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A Randomized Controlled Trial

Paula P. Schnurr, PhD; Matthew J. Friedman, MD, PhD; Charles C. Engel, MD, MPH; Edna B. Foa, PhD; M. Tracie Shea, PhD; Bruce K. Chow, MS; Patricia A. Resick, PhD; Veronica Thurston, MBA; Susan M. Orsillo, PhD; Rodney Haug, PhD; Carole Turner, MN; Nancy Bernardy, PhD

JAMA. 2007;297:820-830.

Context  The prevalence of posttraumatic stress disorder (PTSD) is elevated among women who have served in the military, but no prior study has evaluated treatment for PTSD in this population. Prior research suggests that cognitive behavioral therapy is a particularly effective treatment for PTSD.

Objective  To compare prolonged exposure, a type of cognitive behavioral therapy, with present-centered therapy, a supportive intervention, for the treatment of PTSD.

Design, Setting, and Participants  A randomized controlled trial of female veterans (n=277) and active-duty personnel (n=7) with PTSD recruited from 9 VA medical centers, 2 VA readjustment counseling centers, and 1 military hospital from August 2002 through October 2005.

Intervention  Participants were randomly assigned to receive prolonged exposure (n = 141) or present-centered therapy (n = 143), delivered according to standard protocols in 10 weekly 90-minute sessions.

Main Outcome Measures  Posttraumatic stress disorder symptom severity was the primary outcome. Comorbid symptoms, functioning, and quality of life were secondary outcomes. Blinded assessors collected data before and after treatment and at 3- and 6-month follow-up.

Results  Women who received prolonged exposure experienced greater reduction of PTSD symptoms relative to women who received present-centered therapy (effect size, 0.27; P = .03). The prolonged exposure group was more likely than the present-centered therapy group to no longer meet PTSD diagnostic criteria (41.0% vs 27.8%; odds ratio, 1.80; 95% confidence interval, 1.10-2.96; P = .01) and achieve total remission (15.2% vs 6.9%; odds ratio, 2.43; 95% confidence interval, 1.10-5.37; P = .01). Effects were consistent over time in longitudinal analyses, although in cross-sectional analyses most differences occurred immediately after treatment.

Conclusions  Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings.

Trial Registration  clinicaltrials.gov Identifier: NCT00032617

Author Affiliations: National Center for PTSD, White River Junction, Vt (Drs Schnurr, Friedman, and Bernardy and Ms Thurston); Dartmouth Medical School, Lebanon, NH (Drs Schnurr, Friedman, and Bernardy); Walter Reed Army Medical Center and Uniformed University of the Health Sciences (Dr Engel) and VA Office of Women Veterans Health (Ms Turner), Washington, DC; Department of Psychiatry, University of Pennsylvania, Philadelphia (Dr Foa); VA Medical Center and Brown University Medical Center, Providence, RI (Dr Shea); VA Cooperative Studies Program, Menlo Park, Calif (Mr Chow); VA National Center for PTSD (Dr Resick), Boston University School of Medicine (Dr Resick) and Suffolk University (Dr Orsillo), Boston, Mass; VA Readjustment Counseling Center, Cheyenne, Wyo (Dr Haug).

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