Exposure inhibition therapy as a treatment for chronic posttraumatic stress disorder (PTSD) is evaluated in a randomized treatment outcome pilot study. The exposure inhibition therapy is based on crucial parts of the behavioral-cognitive inhibition theory (Paunovi?, 2010). In this treatment primary incompatible respondent memories are utilized in order to 1) directly counter numbing and depressive symptoms, 2) incorporate the primary trauma memory into primary incompatible memories, and 3) inhibit primary respondent trauma memories. Twenty-nine crime victims with chronic PTSD were randomized to a group that received exposure inhibition therapy immediately (N = 14), or a wait-list control group (N = 15) that waited for 2.5 months and then received the treatment. The group that first received treatment improved significantly on PTSD symptoms, (CAPS, IES-R, PCL) depression (BDI), anxiety (BAI), posttraumatic cognitions of self, others and guilt (PTCI), and coping self-efficacy (CES) compared to the wait-list control group. The treatment efficacy was high for PTSD symptoms, depressive and anxiety symptoms, as well as on most cognitive measures. When the wait-list control group received treatment similar results were observed. Results were maintained at a 3-months follow-up in the treatment group, and on some measures improvement continued. Three empirically derived cut-off criteria (44, 39 27) were used for the CAPS, and one cut-off level for the BDI (10), in order to assess the clinical significance of the results. The majority of clients no longer fulfilled PTSD as a result of the treatment regardless of the level of cut-off criteria, and similar results were observed on the BDI. In conclusion, exposure inhibition therapy was an effective treatment for chronic PTSD in this study. A proposal is made to compare exposure inhibition therapy with the state-of-the-art therapy for chronic PTSD, i.e. exposure therapy. Several hypotheses are presented; e.g. that exposure inhibition therapy may be more effective for some symptoms, and involving less emotional pain in the therapeutic process.
KeywordsExposure Inhibition TherapyPosttraumatic Stress DisorderCrime VictimsRandomized Treatment Outcome Pilot StudyBehavioral-Cognitive Inhibition Theory
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.
Arntz, A., Tiesema, M., & Kindt, M. (2007). Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. Journal of Behavior Therapy and Experimental Psychiatry, 38, 345-370. doi:10.1016/j.jbtep.2007.10.006
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective. New York: Basic Book
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety. Journal of Consulting and Clinical Psychology, 56, 893-897. doi:10.1037/0022-006X.56.6.893
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of eva- luation. Clinical Psychology Review, 8, 77-100. doi:10.1016/0272-7358(88)90050-5
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Benight, C. & Bandura, A. (2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42, 1129-1148. doi:10.1016/j.brat.2003.08.008
Benight, C., Flores, J., & Tashiro, T. (2001). Bereavement coping self-efficacy in cancer widows. Death Studies, 25, 97-125.
Benight, C., Freyaldenhoven, R. W., Hughes, J., Ruiz, J. M., & Zoschke, T. A. (2000). Coping self-efficacy and psychological distress following the Oklahoma city bombing. Journal of Applied Social Psychology, 30, 1331-1344. doi:10.1111/j.1559-1816.2000.tb02523.x
Benight, C. C., Ironson, G., & Durham, R. L. (1999). Psychometric properties of a hurricane coping self-efficacy measure. Journal of Traumatic Stress, 12, 379-386. doi:10.1023/A:1024792913301
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Charney, D. S., & Keane, T. M. (1997). Clinician-Administered PTSD Scale for DSM-IV. Boston: National Center for Posttraumatic Stress Disorder, Behavioral Science Division at Boston VA Medical Center and Neurosciences Division at West Haven VA Medical Center.
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75-90. doi:10.1002/jts.2490080106
Primary Respondent Memories
Blanchard, E. B., Hickling, E. J., Taylor, A. E., Forneris, C. A., Loos, W., & Jaccard, J. (1995). Effects of varying scoring rules of the clinician-administered PTSD scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims. Behaviour Research and Therapy, 33, 471-475. doi:10.1016/0005-7967(94)00064-Q
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34, 669-673. doi:10.1016/0005-7967(96)00033-2
Brewin, C. (2006). Understanding cognitive behaviour therapy: A retrieval competition account. Behaviour Research and Therapy, 44, 765-784. doi:10.1016/j.brat.2006.02.005
Brown, T. A., DiNardo, P. A., & Barlow, D. H. (1994). Anxiety Disorders Interview for DSM-IV. Phobia and Anxiety Disorders Clinic Center for Stress and Anxiety Disorders University at Albany State University of New York.
Cahill, S. P., Rothbaum, B. O., Resick, P., & Follette, V. M. (2009). Cognitive-behavioral therapy for adults. In E. B. Foa, T. M. Keane, M. J. Friedman and J. A. Cohen (Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp. 139-222). New York: Guilford Press.
Cloitre, M., Cohen, L. R. & Koenen, K. C. (2006). Treating survivors of childhood abuse: Psychotherapy for the interrupted life. New York: Guilford Press.
Ehlers, A. & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345. doi:10.1016/S0005-7967(99)00123-0
Ehlers, A., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress, 11, 457-471. doi:10.1023/A:1024448511504
Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67, 194-200. doi:10.1037/0022-006X.67.2.194
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., & Orsillo, S. M. (1999). The posttraumatic cognitions inventory (PTCI): Development and validation. Psychological Assessment, 11, 303-314. doi:10.1037/1040-3590.11.3.303
Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press.
Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for post-traumatic stress disorder: A critical review. In J. Spence, J. M. Darley and D. J. Foss (Eds.), Annual Review of Psychology (Vol. 48, pp. 449-480). Palo Alto, CA: Annual Reviews.
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York: The Guilford Press.
Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155-176. doi:10.1016/S0005-7894(89)80067-X
Jaycox, L. H., Foa, E. B., & Morral, A. R. (1998). Influence of emotional engagement and habituation on exposure therapy for PTSD. Journal of Consulting and Clinical Psychology, 66, 185-192. doi:10.1037/0022-006X.66.1.185
Paunovi?, N. (1999). Exposure counterconditioning (EC) as a treatment for severe PTSD and depression with an illustrative case. Journal of Behavior Therapy and Experimental Psychiatry, 30, 105-117. doi:10.1016/S0005-7916(99)00010-5
Paunovi?, N. (2002). Prolonged exposure counterconditioning (PEC) as a treatment for chronic posttraumatic stress disorder and major depression in an adult survivor of repeated child sexual and physical abuse. Clinical Case Studies, 1, 148-170. doi:10.1177/1534650102001002004
Paunovi?, N. (2003). Prolonged exposure counterconditioning as a treatment for chronic posttraumatic stress disorder. Journal of Anxiety Disorders, 17, 479-499. doi:10.1016/S0887-6185(02)00233-5
Paunovi?, N. (2010). Behavioral-cognitive inhibition theory: Conceptualization of posttraumatic stress disorder and other psychopathology disorders. Psychology, 1, 349-366. doi:10.4236/psych.2010.15044
Paunovi?, N. & ?st, L.-G. (2005). Psychometric properties of a Swedish translation of the clinician-administered PTSD scale-diagnostic version. Journal of Traumatic Stress, 18, 161-164. doi:10.1002/jts.20013
Resick, P. A., & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748-756. doi:10.1037/0022-006X.60.5.748
Terr, L. C. (1991). Childhood traumas: An outline and overview. American Journal of Psychiatry, 148, 10-20.
Van der Kolk, B. A., & Fisler, R. (1995). Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. Journal of Traumatic Stress, 8, 505-525. doi:10.1002/jts.2490080402
Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1992). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. San Antonio, Texas: Paper Presented at the 9th Annual Meeting of the International Society for Traumatic Stress Studies,.
Weathers, F. W., Ruscio, A. M., & Keane, T. M. (1999). Psychometric properties of nine scoring rules for the clinician-administered posttraumatic stress disorder scale. Psychological Assessment, 11, 124- 133. doi:10.1037/1040-3590.11.2.124
Weiss, D. S., & Marmar, C. R. (1997). The Impact of Event Scale-Revised. In J. P. Wilson and T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 399-411). New York: The Guilford Press.
Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional stroop task and psychopathology. Psychological Bulletin, 120, 3-24. doi:10.1037/0033-2909.120.1.3