As the number of veterans in the U.S. with post-traumatic stress disorder (PTSD) has grown, scientists and doctors have struggled to find a treatment that could reduce the symptoms. But a new study has found that a treatment, called prolonged exposure therapy, was able to reduce the number of veterans who could be diagnosed with PTSD by almost 50 percent, while also reducing symptoms of depression.

Prolonged exposure therapy has been around for quite some time now, however, before veterans hospitals began using the therapy in 2007, it was originally created for women who had experienced rape or sexual assault, and subsequently developed PTSD symptoms.

"One of the important factors in chronic PTSD is avoidance — avoiding thinking about the trauma and avoiding going places that remind you of the trauma or are similar," Edna Foa, head of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania, told Reuters. Foa, who wasn't part of the study, added that the whole point of therapy is in "helping the patient confront the memories and confront the situations they avoid."

For a group of veterans that are in dire need of treatment, the therapy could provide relief. PTSD affects an estimated six percent of the U.S. population and almost 13 percent of Iraq and Afghanistan veterans, MedPage Today reported. One Veterans Affairs report found that out of about 830,000 veterans who were treated at VA hospitals over the past ten years, 29 percent had PTSD, and 22 percent had depression.

To combat this, the Department of Veteran's Affairs (VA) started requiring all Veterans Health Administration (VHA) centers to provide access to evidence based psychotherapies, including prolonged exposure therapy. In 2007, psychologists and social workers began training for these therapies.

How Well Did The Therapy Work?

Dr. Afsoon Eftekhari, of the Veterans Affairs Palo Alto Health Care System in Menlo Park, Calif., conducted the study from the time the program began. The team of researchers assessed the effects of prolonged exposure on 1,931 veterans who had a primary diagnosis of PTSD — a total of 804 clinicians performed the therapy. The patients included veterans from the Iraq and Afghanistan conflicts, the Vietnam War, and the Persian Gulf War.

The researchers scored the patient's self-reported PTSD symptoms on a scale from 17 to 85, with a score of 50 or above indicating PTSD. They also reported depression on a scale from zero to 63. Before prolonged exposure began, the veterans' average score for PTSD symptoms was 63, with 88 percent of them meeting a diagnosis for PTSD.

After nine sessions, and accounting for about 25 percent of people who dropped out before completion, the average score for PTSD symptoms dropped to 48, and only 46 percent of veterans still scored high enough to be diagnosed with PTSD.

Their depression scores dropped as well. When they began, the average score was 30, which meant moderate to severe depression, however, at the end of the study, their average scores were 21.

"One of the real strengths of this study was that it involved PTSD from a variety of causes," Dr. Bruce Capehart, of Duke University, told MedPage Today. "The results showed a fairly consistent response whether the problem was caused by combat trauma, non-combat trauma, or even sexual assault. I think that is a real strength for extrapolating these results to the civilian setting."

PTSD Must Be Treated

Sheila Rauch, who studies veterans' mental health at the University of Michigan Medical School and the VA Ann Arbor Healthcare System, praised the study for showing the effect prolonged exposure had on veterans.

"The unique piece of information it provides is really a very large sample of veterans," Rauch told Reuters. "The more we can get the word out to people with post-traumatic stress disorder that there are treatments that work ... the happier I am."

It certainly may be a lot more reasonable to look into prolonged exposure now, and not just for veterans. A study from April found that as many as 50 percent of people with PTSD haven't attempted to seek treatment.

"Not counting traumatic events that are experienced by individuals as opposed to entire populations, the number of people who need help for their PTSD and related symptoms is mind boggling," the researchers wrote in the study.

At the time of the study, researchers noted that a large number of clinicians were largely under-trained or skeptical, and concerned about the costs of using evidence based treatments, but this new research could set the stage for more to come.

"PTSD treatment researchers are acutely aware of the tremendous need to disseminate effective treatments widely such that patients have access to them, and are also aware of the challenges to successfully meet this need."


Eftekhari A, Ruzek J, Crowley J, et al. Effectiveness of National Implementation of Prolonged Exposure Therapy in Veterans Affairs Care. JAMA Psychiatry. 2013.

Foa E, Gillihan S, Bryant R. Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD. Psychological Science in the Public Interest. 2013.