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A Preliminary Examination of Prolonged Exposure Therapy With Iraq and Afghanistan Veterans With a Diagnosis of Posttraumatic Stress Disorder and Mild to Moderate Traumatic Brain Injury

Wolf, Gregory K. PsyD; Strom, Thad Q. PhD; Kehle, Shannon M. PhD; Eftekhari, Afsoon PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

The Journal of Head Trauma Rehabilitation: January/February 2012 - Volume 27 - Issue 1 - p 26–32
doi: 10.1097/HTR.0b013e31823cd01f
TBI in the Military

Objective: Preliminary examination of the effectiveness of prolonged exposure (PE) therapy for the treatment of posttraumatic stress disorder (PTSD) with Operation Enduring Freedom and Operation Iraqi Freedom Veterans who have experienced traumatic brain injury (TBI).

Participants: Ten Veterans with a history of mild to moderate TBI and chronic PTSD.

Setting: Outpatient Mental Health/PTSD clinics and polytrauma centers at 2 VA medical centers.

Measures: Comprehensive evaluation that included clinical interview, neuropsychologic evaluation, and/or neuroimaging; Posttraumatic Stress Disorder Checklist and Beck Depression Inventory–Second Edition.

Procedures: Standard implementation of the PE manual was used in all cases with slight adjustments to account for Veterans' residual cognitive deficits. Veterans completed between 8 and 18 sessions.

Results: Veterans demonstrated significant reductions in total PTSD and depression symptoms from pre- to posttreatment. Within-group effect sizes were large.

Conclusions: These findings suggest that PE can be safely and effectively implemented with Veterans with PTSD, a history of mild to moderate TBI, and current cognitive impairment.

James A. Haley Veterans Affairs Medical Center, Tampa, Florida (Dr Wolf); Department of Veterans Affairs Medical Center and Department of Psychiatry, University of Minnesota (Dr Strom); Department of Veterans Affairs Medical Center (Dr Kehle), Minneapolis, Minneapolis; and National Center for PTSD, Dissemination and Training Division, Menlo Park, California (Dr Eftekhari).

Corresponding Author: Gregory K. Wolf, PsyD, James A. Haley VA Medical Center (MHBS), 13000 Bruce B. Downs, Blvd, Tampa, FL 33612 (

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. Drs Wolf, Strom, Kehle, and Eftekhari report no competing interests.

This material is the results of work supported with resources and the use of facilities at the Minneapolis and James A. Haley VA Medical Centers. The authors also express their gratitude to Drs Edna Foa and Elizabeth Hembree for their ongoing mentorship, consultation, and dissemination of prolonged exposure therapy within the VA Healthcare System.

The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.