(PS13-85) Confirming Peer Support in PE Is Effective for Betrayal Traumas

Prolonged Exposure (PE) is a highly effective treatment for posttraumatic stress disorder (PTSD). Yet, with an unfortunately high dropout rate, efforts to retain patients are being developed. The PE+Peers program, integrating social support directly during in-vivo exposure, helped military veterans who previously dropped out of PE return to and succeed in treatment (Hernandez-Tejada et al., 2017; Hernandez-Tejada et al., under review). While social support does improve psychotherapy outcomes, survivors of betrayal trauma, such as sexual violence by peers who are supposedly part of one’s protective team, may “poison” social support, causing unique difficulty trusting others who join them in therapy. The present study uses data from a randomized trial integrating peer support into PE to reverse attrition (Hernandez-Tejada et al., 2020). We focus on comparing engagement with, and efficacy of, this program for combat veterans vs. survivors of a more salient interpersonal betrayal: military sexual trauma (MST).

In the trial, participants were randomly assigned to receive PE with a peer offering general support vs. peer support during in-vivo exposure for 2-4 weeks. This study focused on combat veterans (n = 13) and MST survivors (n = 23) receiving instrumental support during in-vivo exposures. Baseline and posttreatment measures of PTSD were collected.

The total number of sessions completed did not differ between groups (M_MST = 10 sessions, M_combat = 10.46 sessions, p = .641). A repeated measures ANOVA showed a statistically significant decrease in symptoms over time, F(1, 34) = 50.22, p < .001, with no significant effect of trauma group, F(1, 34) =0.31, p = .582. Both groups showed, on average, clinically significant improvement defined by a ten point decrease on the PTSD measure (M_MST = 23.82; M_combat = 26.12).

Instrumental peer support during PE is effective in treating PTSD for those with several negative prognostic factors, such as previous dropout and an index trauma representing a violent betrayal of trust. Replication of this program for those seeking treatment for the first time, as well as populations outside the military, are needed and likely promising.

Hernandez-Tejada, M.A, Bruce, M.J., Muzzy, W., Birks, A., Macedo, G., Hart, S., Hamski, S., & Acierno, R. (under review).Peer support during in vivo exposure homework increases likelihood of prolonged exposure therapy completion.
 

Hernandez-Tejada, M. A., Hamski, S., & Sánchez-Carracedo, D. (2017). Incorporating peer support during in vivo exposure to reverse dropout from prolonged exposure therapy for posttraumatic stress disorder: Clinical outcomes. The International Journal of Psychiatry in Medicine, 52(4-6), 366-380. https://doi.org/10.1177/0091217417738938

Hernandez-Tejada, M. A., Muzzy, W., Price, M., Hamski, S., Hart, S., Foa, E., & Acierno, R. (2020). Peer support during in vivo exposure homework to reverse attrition from prolonged exposure therapy for posttraumatic stress disorder (PTSD): Description of a randomized controlled trial. Trials, 21(1), 366. https://doi.org/10.1186/s13063-020-04302-5