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PATTERNS OF CHANGE IN RESPONSE TO PROLONGED EXPOSURE: IMPLICATIONS FOR TREATMENT OUTCOME
Author(s) -
Clapp Joshua D.,
Kemp Joshua J.,
Cox Keith S.,
Tuerk Peter W.
Publication year - 2016
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22534
Subject(s) - medicine , veterans affairs , depression (economics) , checklist , telehealth , physical therapy , emergency medicine , psychology , telemedicine , health care , macroeconomics , economics , cognitive psychology , economic growth
Background Assessment of response to Prolonged Exposure (PE) suggests some patients may experience discontinuous change involving sudden symptom reductions and/or temporary exacerbations. The current study looked to (1) isolate profiles of PE response among treatment‐seeking veterans and (2) identify factors associated with unique patterns of change. Methods Archival records were examined for veterans receiving PE through a specialty Veterans Affairs Medical Center (VAMC) clinic ( N = 109). Latent profile analysis was used to extract response trajectories defined by change in weekly PTSD Checklist (PCL) scores. Associations with provider status (staff vs. intern), setting (in‐person vs. telehealth), initial severity (PTSD; depression), and eventual treatment gains were examined. Results Three profiles were observed. Rapid Responders (18.3%) evidenced sharp reductions at Week 2 and again between Weeks 5 and 6. Linear Responders (40.4%) demonstrated gradual reductions throughout the 10‐week assessment window. Delayed Responder (41.3%) scores were relatively stable over the evaluation period although final session outcomes indicated reliable change (PCLΔ > 10) in 40% of patients. Profiles were similar with respect to provider status, treatment setting, and initial symptom severity. Rapid Responders evidenced lower final session scores relative to Linear ( g = 1.13) and Delayed ( g = 1.85) groups, with Linear Responders reporting lower end scores than Delayed Responders ( g = 1.02). Conclusions Anticipating patterns of recovery and their association with therapeutic outcome is of immense clinical value. Sudden gains emerged as a strong predictor of enhanced response. Data also suggest potential benefits of extending standard intervention for patients who fail to demonstrate an immediate response to PE.