PE for PTSD: First Steps

Barbara-Rothbaum

Associate Vice-Chair of Clinical Research, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
Director, Emory Healthcare Veterans Program
Director, Emory Trauma and Anxiety Recovery Program
Paul A. Janssen Chair in Neuropsychopharmacology

Key Points

  1. Sarah’s unresolved trauma from the war and domestic abuse significantly impacts her mental health, suggesting PTSD and secondary depression.
  2. The treatment plan focuses on prolonged exposure therapy, emphasizing the importance of confronting avoidance through both imaginal and in vivo exposures.
  3. Continuous support and reinforcement are crucial for Sarah’s therapeutic journey, with a focus on emotional processing and exposure to traumatic memories.
Earn 1 CE Credits

Sarah experienced traumatic events as an 8-year-old girl during a war in Africa. Her family faced immediate danger, including an invasion of soldiers in their home and threats at gunpoint. Amidst the chaos, they fled to safety, eventually relocating to the United States. However, the trauma was never openly discussed or emotionally processed, contributing to ongoing issues for Sarah.

Presenting Problem

Sarah’s unaddressed trauma from the war and witnessing her father’s abuse towards her mother likely contribute to her current psychological state. Initial assessments suggest that Sarah may be suffering from post-traumatic stress disorder (PTSD) and secondary depression, which she may deny.

Treatment Plan

First Meeting

  • Objective: Identify Sarah’s primary complaints, gather her trauma history, and explore possible PTSD and depression.
  • Approach: Explain PTSD’s development due to avoidance and propose prolonged exposure therapy as a treatment.
  • Goal: Gain consent for prolonged exposure (PE) therapy.

Session 1

  • Overview: Present treatment plan and procedures.
  • Key Activities:
    1. Detailed information gathering on traumatic events.
    2. Breathing retraining instruction and practice assignment.
    3. Identification of the index trauma (most haunting event).
  • Homework: Practice breathing exercises and exposure to safe but avoided situations.

Session 2

  • Focus: Educate Sarah about common trauma reactions and the rationale for exposure therapy.
  • Activities:
    1. Hand out information on trauma reactions.
    2. Discussion on sharing information with loved ones.
    3. Construction of an in vivo exposure hierarchy, challenging Sarah’s avoidance behaviors.

Session 3

  • Objective: Begin imaginal exposure to the index trauma.
  • Process:
    1. Record the imaginal exposure session.
    2. Engage in emotional processing post-exposure.
    3. Provide substantial reinforcement and support.
  • Continuation: Prepare for further sessions based on Sarah’s progress.

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PE for PTSD: First Steps