Prolonged Exposure Therapy for Treatment of PTSD in Veterans

Prolonged Exposure Therapy (PE) has been identified as one of the most effective forms of therapy for veterans with PTSD resulting from combat. Veterans from Vietnam, Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND), along with Gulf War Veterans, struggle with PTSD as a result of trauma experienced during their service. However, although these veterans may realize some relief of their PTSD symptoms with PE, the effectiveness of the therapy is directly related to the type of trauma the veterans experienced. “The purpose of the current study is to compare PTSD and related outcomes in veterans from various combat theaters, OEF/OIF/OND, Gulf War, Vietnam, receiving a manualized Prolonged Exposure (PE) intervention for PTSD in a southeastern VA Medical Center,” said Matthew Yoder of the Ralph H. Johnson VA Medical Center and Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston, and lead author of the study.

Yoder and his colleagues evaluated over 100 veterans with PTSD while they underwent PE. The therapy consisted of weekly sessions lasting 90 minutes, and included imaginal exposure, in vivo exposure, psycho-education and anxiety measures. The team found that PE was a highly effective method of treatment for the combat veterans, with slight differences in the outcome based on the type of trauma the veterans experienced. “A surprising finding, however, was that Gulf War veterans responded differently to PE than did veterans from other theaters,” said Yoder. “That is, while their symptoms did not differ significantly at the initial assessment, Gulf War veterans had higher symptoms at the final session than both OEF/OIF/OND and Vietnam era veterans and the slope of their symptom improvement over the course of treatment was not as steep as that of the other two cohorts” Yoder believes that the fear of biological attack, versus physical combat attack, in the Gulf War veterans, was directly responsible for this variance in treatment outcome. He said, “These patients reported fearing for their lives and a of sense helplessness, perceptions which qualify the events as traumatic according to the DSM–IV, but are qualitatively different than traumatic events typically reported by combat veterans.” He added, “Overall, the present study found further support for the effectiveness of PE with combat veterans, as treatment effect sizes were large across cohorts, with veterans of the Gulf War benefiting but responding at a slower rate than veterans from other wars.”

Yoder, M., Tuerk, P. W., Price, M., Grubaugh, A. L., Strachan, M., Myrick, H., & Acierno, R. (2011, November 14). Prolonged Exposure Therapy for Combat-Related Posttraumatic Stress Disorder: Comparing Outcomes for Veterans of Different Wars. Psychological Services. Advance online publication. doi: 10.1037/a0026279

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • johanna


    November 18th, 2011 at 7:02 PM

    Odd because the Gulf War vets have kinda become our forgotten generation of soldiers and it sounds like they are carrying a pretty heavy burden of experiences from their time in warfare but that many people rarely talk about.

  • N.P


    November 18th, 2011 at 9:34 PM

    While better methods of therapy are a gr8 thing,I’d say the earlier therapy is given the better it is-thats hw it works with any treatment isnt it?
    A lot of people suffer from things they could have easily preventd had they sought help earlier and the time factor does seem to be a very important one especially in things like trauma that many veterans could face.

  • jess


    November 19th, 2011 at 4:46 PM

    Prolonged exposure therapy- like, is this like having them relive what they went thru in war? That would seem to be real hard on them, and hard for me to think of how this could help them move on

  • nicholas p

    nicholas p

    November 21st, 2011 at 10:25 AM

    “although these veterans may realize some relief of their PTSD symptoms with PE, the effectiveness of the therapy is directly related to the type of trauma the veterans experienced.”

    these words sum it all.there is no one-size-fits-all when it comes to therapy and although one may be more effective than others,it really comes down to the individual case and a good therapist is one who identifies what is best for a particular case and then proceeds with that therapy.

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