Does imaginal exposure exacerbate PTSD symptoms?
Abstract
Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concem that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation was examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptom exacerbation. Individuals who reported symptom exacerbation benefited comparably from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.
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Two studies examined symptom deterioration during exposure therapy for PTSD, experienced by 3-15% of patients.
“Two studies examined symptom deterioration during exposure therapy for PTSD, which is experienced by a minority of patients (3-15%, Cloitre et al., 2010;Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002).”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002
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- Authors
- Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alvarez-Conrad, J.
- Affiliations
- University of Pennsylvania (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2002-08
- Volume
- 70
- Issue
- 4
- Pages
- 1022-1028
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2065936066
- Cited by
- 393
- References
- 28
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 14 · 2023: 9 · 2022: 17 · 2021: 18 · 2020: 33 · 2019: 37 · 2018: 18 · 2017: 16 · 2016: 23 · 2015: 23 · 2014: 24 · 2013: 21 · 2012: 15
- FWCI
- 12.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh042173-03)
- National Institute of Mental Health (R01MH042178, MH42173)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- post-traumatic stress disorder, prolonged exposure therapy, imaginal exposure, symptom exacerbation, treatment side effects, treatment discontinuation, chronic PTSD, women, treatment outcomes
- MeSH terms
- Adult, Chronic Disease, Female, Humans, Imagination, Psychotherapy, Severity of Illness Index, Stress Disorders, Post-Traumatic
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