Studies of Exposure Therapy

A number of programs based on exposure therapy has been used to treat PTSD. Among the variations of exposure therapy, the PE protocol has been the most extensively studied and has been found to be highly effective. Like PE, some other exposure therapy programs include both imaginal confrontation with the traumatic memories and in vivo exposure to trauma reminders (e.g., Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998), however, some programs rely exclusively on imaginal exposure to the trauma memory (Bryant et al., 2003a; Cloitre, Koenen, Cohen, & Han, 2002; Tarrier et al., 1999). Even among programs that include both imaginal and in vivo exposure, there are differences in the specific application of the techniques. For example, PE utilizes both components from the beginning of treatment; in contrast, Marks et al. (1998) introduced imaginal exposure in the first half of the program and in vivo exposure in later sessions. Finally, exposure therapy programs differ in the extent to which they include other treatment components. For example, Foa et al. (1999) limited PE to exposure plus psychoedu-cation, training in controlled breathing, and discussion of the exposure experience (called "processing"). In comparison, Blanchard et al. (2003) combined exposure with psychoeducation, progressive muscle relaxation, monitoring of thoughts and CT, and behavioral activation strategies.

Variants of exposure therapy, either alone or in combination with other CBT approaches, have been found effective in samples of female survivors of rape (e.g., Foa et al., 1991, 1999, 2002a; Resick, Nishith, Weaver, Astin, & Feuer, 2002; Rothbaum, 2002) and physical assault (Foa et al., 1999, 2002a); domestic violence (Kubany, Hill, & Owens, 2003; Kubany et al., 2004); physical and sexual abuse in childhood (Cloitre et al., 2002; Echeburua, Corral, Zubizarreta, & Sarasua 1997; Foa et al., 2002a); male and female survivors of motor vehicle accidents (Blanchard et al., 2003; Fecteau & Nicki, 1999); refugees (Otto et al., 2003; Paunovik & Ost, 2001); and mixed trauma samples (Bryant et al., 2003a; Marks et al., 1998; Power et al., 2002; Tarrier et al., 1999; Taylor et al., 2003) comprised primarily of physical and sexual assault victims and survivors of motor vehicle accidents. Below we outline the empirical support for PE and other forms of exposure therapy.

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