Imaginal exposure exacerbation revisited: Deconstructing patient characteristics associated with worse reactions to the initiation of imaginal exposure in PTSD.

Abstract

OBJECTIVE:

This study examines whether imaginal exposure leads to symptom exacerbation, systematically comparing individuals who received prolonged exposure (PE) to those who received pharmacotherapy. The study also examined whether common clinical features increase the likelihood of symptom exacerbation.

METHOD:

In 151 men and women with PTSD, we examined rates of reliable exacerbation of PTSD and depression symptoms after initiation of imaginal exposure and compared it to those receiving sertraline. We also examined relationships between exacerbation, treatment outcome, dropout, imaginal distress, and specific clinical features, including co-occurring MDD, multiple co-occurring disorders, childhood sexual abuse as target trauma, and a history of childhood physical or sexual abuse.

RESULTS:

Symptom exacerbation was not more common in PE compared to sertraline, not associated with higher dropout, or predictive of worse outcome. Those with co-occurring depression or multiple disorders, a target trauma of child sexual abuse, or a history of child abuse reported functionally equivalent peak distress at onset of imaginal as those without these characteristics. These factors did not lead to more exacerbation or worse adherence.

CONCLUSION:

Exacerbation was not specific to PE and patients with and without symptom worsening showed comparable treatment gains, suggesting symptom exacerbation may reflect a common clinical process.

• Authors: Rosemary S W Walker, Elizabeth H Marks, Jeff Jaeger, Jeanne M Duax, Norah C Feeny, Lori A Zoellner
• Journal: Behaviour research and therapy (Behav Res Ther) Vol. 135 Pg. 103747 (12 2020) ISSN: 1873-622X [Electronic] England
• PMID: 33049550 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Published by Elsevier Ltd.

Chemical References

• Serotonin Uptake Inhibitors
• Sertraline

Topics

• Adult
• Adult Survivors of Child Abuse
• Child
• Child Abuse
• Child Abuse, Sexual
• Depressive Disorder, Major (psychology)
• Disease Progression
• Female
• Humans
• Implosive Therapy (methods)
• Male
• Mental Disorders
• Middle Aged
• Patient Dropouts
• Risk Factors
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sertraline (therapeutic use)
• Stress Disorders, Post-Traumatic (psychology, therapy)