Addressing Dropout From Prolonged Exposure: Feasibility of Involving Peers During Exposure Trials

Posttraumatic stress disorder (PTSD) is a significant problem for combat veterans. Fortunately, effective treatments, such as Prolonged Exposure (PE), are available and widely disseminated in the Veterans Affairs (VA) health-care system. Nonetheless, despite well-documented effectiveness, attrition remains high at approximately 30% across evidence-based interventions. Early studies indicated that dropout was largely related to stigma and logistical barriers (e.g., travel time and cost). However, research demonstrates that eliminating these logistical and stigma-based barriers (e.g., through home-based telemedicine) has little effect on dropout. We surveyed 82 veterans who dropped out of PE treatment regarding reasons for leaving treatment. Approximately half indicated that in vivo homework assignments caused significant problems, and when asked to consider the possibility of peer support during in vivo exposure assignments, 52% indicated that they would consider returning to treatment with such assistance. In response to this feedback, we constructed an in vivo therapy peer support program wherein peers are directly involved with in vivo exposure exercises. The following brief report presents the rationale for, outline of, and initial feasibility data supporting this program to enhance both return to, and completion of, exposure therapy treatment for PTSD.