David Morris (“After PTSD, More Trauma”, Sunday Review, January 19, 2015) courageously shares his struggles in overcoming posttraumatic stress disorder (PTSD) and describes his negative experiences with prolonged exposure (PE) treatment. There is a critical element missing from Mr. Morris’ account, and it could reasonably explain why he withdrew from treatment. An axiomatic principle of PE as commonly delivered is a gradual build-up to the more distressing treatment components. This process allows clients to develop the coping skills needed to progress in therapy. Just as one should build up to the full distance when preparing for a marathon, one must typically build up to the more demanding aspects of treatment when undergoing PE.
The efficacy of exposure therapies for a wide range of problems, ranging from phobias to PTSD, is supported by decades of research. Although treatment may have been delivered improperly in Mr. Morris’ case, it is at least equally plausible that he is in the minority of clients who experience a short-term symptom worsening following PE. Studies have shown that such exacerbation is unrelated to negative treatment outcomes, and that most clients who experience this worsening improve soon afterwards.
We advise people with PTSD to seek out interventions that have been consistently demonstrated to be effective. Should that intervention fail to yield benefits following an adequate dose, it is in clients’ best interest to try another evidence-based approach, as Mr. Morris did when undergoing cognitive processing therapy.
Dean McKay, Ph.D.
Scott O. Lilienfeld, Ph.D.
The authors are, respectively, Professor of Psychology, Fordham University and Samuel Candler Dobbs Professor of Psychology, Emory University. The authors are members of the Science of Clinical Psychology (SSCP). SSCP is Section III of Division 12 of the American Psychological Association (APA), and an organizational affiliate of the Association of Psychological Science (APS), but we are writing on behalf of SSCP, not APA or APS.