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INFLUENTIAL PUBLICATIONS   |    
A Meta-Analytic Review of Prolonged Exposure for Posttraumatic Stress Disorder
Mark B. Powers; Jacqueline M. Halpern; Michael P. Ferenschak; Seth J. Gillihan; Edna B. Foa
FOCUS 2013;11:428-436. doi:10.1176/appi.focus.11.3.428
Abstract

Two decades of research demonstrate the efficacy of exposure therapy for posttraumatic stress disorder (PTSD). The efficacy of prolonged exposure (PE), a specific exposure therapy program for PTSD that has been disseminated throughout the world, has been established in many controlled studies using different trauma populations. However, a meta-analysis of the effectiveness of PE for PTSD has not been conducted to date. The purpose of the current paper is to estimate the overall efficacy of PE for PTSD relative to adequate controls. We included all published randomized controlled trials of PE vs. control (wait-list or psychological placebo) for the treatment of PTSD in adolescents or adults. Treatments were classified as PE if they included multiple sessions of imaginal and in vivo exposure and were based on the manualized treatment developed by Foa, Rothbaum, Riggs, and Murdock (1991). Thirteen studies with a total sample size of 675 participants met the final inclusion criteria. The primary analyses showed a large effect for PE versus control on both primary (Hedges’s g = 1.08) and secondary (Hedges’s g = 0.77) outcome measures. Analyses also revealed medium to large effect sizes for PE at follow-up, both for primary (Hedges’s g = 0.68) and secondary (Hedges’s g = 0.41) outcome measures. There was no significant difference between PE and other active treatments (CPT, EMDR, CT, and SIT). Effect sizes were not moderated by time since trauma, publication year, dose, study quality, or type of trauma. The average PE-treated patient fared better than 86% of patients in control conditions at post-treatment on PTSD measures. PE is a highly effective treatment for PTSD, resulting in substantial treatment gains that are maintained over time.

(Reprinted with permission from Clinical Psychology Review 2010; 30:635–641) 

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Figure 1. Forest Plot of Prolonged Exposure vs. Control Effect Sizes (Hedges’s g) at Posttreatment on Primary Outcome Measures

Figure 2. Forest Plot of Prolonged Exposure vs. Control Effect Sizes (Hedges’s g) at Follow-Up on Primary Outcome Measures
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Table 1.Measures for Coding Analyses
Table Footer Note

Note. BDI = Beck Depression Inventory; CAPS = Clinician Administered PTSD Scale; HADS = Hospital Anxiety and Depression Scale; IES = Impact of Events Scale; MPSS-SR = Modified PTSD Symptom Scale-Self Report; PCL = PTSD Checklist; PSS-I = PTSD Symptom Scale-Interview; PSS-SR = PTSD Symptom Scale-Self Report; QOLI = Quality of Life Inventory; SAS (G,S,W) = Social Adjustment Scale (Global, Social, Work); SIP = Structured Interview for PTSD; SI-PTSD = Davidson’s Structured Interview for PTSD; STAI = State Trait Anxiety Inventory; STAI-S = State subscale of State Trait Anxiety Inventory; STAI-T = Trait subscale of the State Trait Anxiety Inventory.

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Table 2.Studies Included in the Meta-Analysis
Table Footer Note

Note. BDI = Beck Depression Inventory; CAPS = Clinician Administered PTSD Scale; HADS = Hospital Anxiety and Depression Scale; IES = Impact of Events Scale; MPSS-SR = Modified PTSD Symptom Scale-Self Report; PCL = PTSD Checklist; PSS-I = PTSD Symptom Scale-Interview; PSS-SR = PTSD Symptom Scale-Self Report; QOLI = Quality of Life Inventory; SAS (G,S,W) = Social Adjustment Scale (Global, Social, Work); SIP = Structured Interview for PTSD; SI-PTSD = Davidson’s Structured Interview for PTSD; STAI = State Trait Anxiety Inventory; STAI-S = State subscale of State Trait Anxiety Inventory; STAI-T = Trait subscale of the State Trait Anxiety Inventory.

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