Harping on "Talking About It"

I get monthly updates about the latest in trauma research and this abstract has good info that can translate to practice, if you work with young people with PTSD.

"Prolonged exposure" is a therapeutic intervention that uses the repetition of story to habituate to a traumatic memory - in order to digest and archive the memory so it no longer chases you into the night and then day.

Long established as an effective treatment, it tends to be difficult for both clinician and client - at least initially.  What has been long avoided is greatly feared and what is greatly feared is long avoided.  After a few experiences with prolonged exposure and the resultant "sudden gains" observed in young clients - well, you can see how compelling it would be for a clinician.

Here's the abstract of the article for your learning pleasure...

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder
Aderka, Idan M.; Appelbaum-Namdar, Edna; Shafran, Naama; Gilboa-Schechtman, Eva
Journal of Consulting and Clinical Psychology, Vol 79(4), Aug, 2011. pp. 441-446.

Abstract

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumaticstressdisorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up.

Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982).

Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms.  Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p < .001, and depressive symptoms, F(1, 61) = 7.9, p < .01, at treatment termination. Differences in posttraumatic symptoms were maintained during both follow-up periods.

Conclusions: Sudden gains are common in pediatric prolonged exposure for PTSD and are predictive of long-term outcome.  Treatment planning can benefit from consideration of the intra-individual course of improvement, and treatment development may be enriched by understanding the mechanisms responsible for sudden gains.