Inhibitory Retrieval-Based Exposure Therapy for Patients With Posttraumatic Stress Disorder: Results From a Single-Case Experimental Design Study

Cognitive and Behavioral Practice, vol. 33, pp. 392–408

Abstract

• Inhibitory Retrieval (IR) principles can be effectively applied to PTSD exposure treatment. • IR-based exposure reduced PTSD symptoms and negative expectancies. • Emotional Processing Theory (EPT)-based exposure showed similar reductions. • No specific advantages of IR-based exposure were observed over EPT-based exposure. Exposure therapy is an effective treatment for posttraumatic stress disorder (PTSD). The inhibitory retrieval (IR) approach to exposure utilizes strategies to optimize inhibitory learning and retrieval, but has yet to be systematically applied to PTSD. This randomized replicated single-case AB with follow-up design evaluated the applicability and effects of IR-based exposure therapy (12 sessions over 4 weeks) in patients ( n = 9) with DSM-5 defined PTSD. Daily measures of PTSD symptoms, negative expectancies and distress tolerance were collected during baseline, treatment and follow-up phases and analyzed using multilevel models for Single Case Experimental Designs (SCED). Results showed that PTSD symptoms significantly decreased over treatment compared to baseline ( b = −0.22, p < .001). Clinically meaningful symptom reductions were observed for most patients at posttreatment (56%) and follow-up (67%), as assessed with clinical interview. Negative expectancies significantly decreased over treatment in comparison to baseline ( b = −0.60, p = .001), while distress tolerance did not change significantly ( b = −0.02, p = .223). To explore specificity, a simultaneous study with a similar design ( n = 10) using Emotional Processing Therapy principles was conducted, yielding similar findings. This study provides initial evidence that IR-based principles can be effectively applied to exposure therapy for PTSD but does not indicate enhanced efficacy or unique effects on theorized change mechanisms. Future research should further examine change mechanisms to refine treatment approaches for PTSD.

Authors 5

1. Marike J. Kooistra corresponding Aachen

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University and Parnassia Groep, PsyQ, The Hague

2. Danielle A. C. Oprel Aachen

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University and Parnassia Groep, PsyQ, The Hague

3. Maartje Schoorl Aachen

   Leiden University

   Affiliation as printed

   Leiden University and Leiden University Treatment Center (LUBEC)

4. Willem A. J. van der Does Aachen

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University Treatment Center (LUBEC)

   Leiden University, Parnassia Groep, PsyQ, The Hague

5. Rianne A. de Kleine Aachen

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University and Parnassia Groep, PsyQ, The Hague