Patient, Therapist, and System Factors Influencing the Effectiveness of Prolonged Exposure for Veterans With Comorbid Posttraumatic Stress Disorder and Traumatic Brain Injury.

Journal Article (Journal Article)

In contrast to concerns that cognitive limitations and neurobehavioral symptoms (NBS) associated with traumatic brain injury (TBI) may inhibit treatment effectiveness, a recent study found prolonged exposure (PE) led to large reductions in posttraumatic stress disorder (PTSD) symptoms among Iraq-Afghanistan veterans with a range of TBI severity (article by Wolf, Kretzmer, Crawford, Thors, Wagner, Strom, Eftekhari, Klenk, Hayward, and Vanderploeg [J Trauma Stress 28:339-347, 2015]). We further examined this sample of 69 veterans to determine whether system, veteran, and therapist factors predicted clinically significant responses. Results of hierarchical, logistic regressions revealed that therapist training in PE and lower service connection were associated with increased odds of large decreases in PTSD symptoms after adjusting for the robust effect of PE sessions completed. Other patient-level factors including age, time since injury, and baseline NBS were unrelated to significant improvements. Findings emphasized the impact of PE dosage, indicated greater mastery of the protocol was beneficial, and showed that service connection could impede self-reported, clinically significant change during PE in this important cohort.

Full Text

Duke Authors

Cited Authors

  • Crawford, EF; Wolf, GK; Kretzmer, T; Dillon, KH; Thors, C; Vanderploeg, RD

Published Date

  • February 2017

Published In

Volume / Issue

  • 205 / 2

Start / End Page

  • 140 - 146

PubMed ID

  • 27668355

Electronic International Standard Serial Number (EISSN)

  • 1539-736X

Digital Object Identifier (DOI)

  • 10.1097/NMD.0000000000000594


  • eng

Conference Location

  • United States