The efficacy of PE has been investigated in six separate studies. In the first of these, Foa et al. (1991) compared rape survivors treated with PE to a waiting-list control group, a group receiving supportive counseling, and another treated with SIT (Meichenbaum, 1977; Veronen & Kilpatrick, 1983). SIT is a CBT package that teaches clients several anxiety management strategies and encourages them to apply these strategies in their daily life. At the end of nine treatment sessions, women in the PE and SIT groups showed significant improvement, whereas those who received supportive counseling or were placed on the waiting list did not. The SIT group showed the most improvement on PTSD symptoms immediately after treatment. However, the PE group continued to improve over the follow-up period, such that at follow-up, the PE group tended to be superior to the other groups on symptoms of PTSD, depression, and anxiety.
Foa et al. (1999) extended this research by examining the effects of PE alone, SIT alone, the combination of PE and SIT, and a waiting-list condition. All three active treatments produced significant improvement compared to the waiting-list condition. Contrary to expectations, though, there was no evidence that combining PE and SIT improved outcome. Also, this study did not replicate the superiority of SIT at posttreatment found in the earlier study. Instead, at both posttreatment and follow-up assessments, PE was found superior to SIT on some measures, whereas on other measures the two treatments did not differ.
In a third study examining the efficacy of PE, Foa and her colleagues (2002a) compared PE presented alone to a program that combined PE and cognitive restructuring (CR) and to a waiting-list condition. The researchers hypothesized that cognitive restructuring represented the most important ingredient of SIT and that focusing on this skill and reducing the complexity of the combined treatment might prove more effective in treating PTSD. Results indicated that PE and PE/CR were highly and equally effective at reducing PTSD, depression, and anxiety compared to the waiting list. As in the earlier study, combined treatment was not superior to PE alone. The treatment gains of both groups were maintained during follow-up. Similar results were reported by Paunovic and Ost (2001), who also compared PE with PE plus CR and found that both treatments produced significant improvement, but PE/CR was not superior to PE alone.
Resick et al. (2002) compared PE with cognitive processing therapy (CPT), a form of cognitive therapy specifically developed for rape survivors (Resick & Schnicke, 1992), and a waiting-list condition. In addition to the cognitive therapy techniques that form the core of CPT, this program includes an exposure component of repeatedly writing and reading the trau ma narrative. Resick et al. (2002) found that, compared to the waiting-list condition, both PE and CPT produced large improvement in PTSD symptoms and depression, and the gains were maintained through 9 months of follow-up. There were no significant differences between groups on these measures, but CPT appeared to have a slight advantage over PE on measures of guilt.
Rothbaum (2002) compared a group of survivors treated with PE to a waiting-list group and a group treated with EMDR (Shapiro, 1989, 1995). EMDR combines elements of brief, repeated imaginal exposure, a form of CR, and therapist-induced rapid eye movements or other laterally alternating stimuli (e.g., finger tapping) that occurs during exposure to the trauma-related imagery. Results indicated that, compared to the waiting-list condition, both treatments produced significant improvement in PTSD, depression, and anxiety, and the two active treatments did not differ at the posttreatment assessment. However, the PE group was superior to the EMDR group on several measures taken at a 6-month follow-up assessment.
In sum, studies of PE have consistently been found it to be a highly effective treatment for PTSD and associated anxiety and depression. When directly compared, PE has been found to be as or more effective than relaxation, SIT, CT, and EMDR. Moreover, treatments that have combined PE with SIT or CR, although very effective, have not yielded better results than PE alone.
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