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Author Notes:

Jessica L. Maples-Keller, Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA 30329. jessmaples@gmail.com

The present study was supported by NARSAD 19798 (BOR), R01 MH094757 (KJR), R01 MH096764 (KJR), R01 MH071537 (KJR), Howard Hughes Medical Institute, and National Center for Advancing Translational Sciences of the National Institutes of Health under Award number UL1TR002378 and UL1 TR000424. Rothbaum received funding from Wounded Warrior Project, Department of Defense Clinical Trial (Grant No. W81XWH-10-1-1045) and McCormick Foundation.

Rothbaum received royalties from Oxford University Press, Guilford, APPI, and Emory University and received advisory board payments from Genentech, Jazz Pharmaceuticals, Nobilis Therapeutics, Neuronetics, and Aptinyx. Other authors declare that there are no conflict of interests.


Research Funding:

Howard Hughes Medical Institute; National Alliance for Research on Schizophrenia and Depression, Grant/Award Number: 19798; National Institute of Mental Health, Grant/Award Numbers: 071537, 094757, 096764; National Center for Advancing Translational Sciences of the National Institutes of Health, Grant/Award Numbers: TR000424, UL1TR002378


  • Social Sciences
  • Science & Technology
  • Life Sciences & Biomedicine
  • Psychology, Clinical
  • Psychiatry
  • Psychology
  • early intervention
  • prolonged exposure
  • PTSD
  • secondary prevention

Investigation of optimal dose of early intervention to prevent posttraumatic stress disorder: A multiarm randomized trial of one and three sessions of modified prolonged exposure

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Journal Title:



Volume 37, Number 5


, Pages 429-437

Type of Work:

Article | Post-print: After Peer Review


Background: Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. Methods: Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. Results: Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1–12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). Conclusions: This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.
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