Comparing treatment outcomes of prolonged exposure therapy across trauma type and veteran status

This retrospective cohort study evaluated the effectiveness of prolonged exposure therapy (PE) across trauma types (combat, terror, civilian) and veteran status (military veterans vs. civilians) in a real-world clinical setting. We hypothesized that individuals who experienced combat- and terror-related trauma would have higher baseline posttraumatic stress disorder (PTSD) symptom scores than those who experienced civilian trauma but that PE would result in comparable symptom reductions across all groups. Participants were 98 patients with chronic PTSD who were treated at two community mental health centers in Israel by clinicians trained and supervised in PE. Participants were categorized by trauma type combat: n = 34, terror: n = 25, civilian: n = 39) and veteran status (military veteran: n = 43, civilian: n = 55). PTSD symptoms were assessed using the PTSD Symptom Scale–Interview Version (PSS-I). Participants showed significant symptom reductions across all trauma types and veteran statuses. No interaction effects were detected for trauma type or veteran status. Effect sizes were large across all groups, ds = 2.20–2.28. The findings support the hypothesis that PE is effective in reducing PTSD symptoms regardless of trauma type or veteran status. These results are particularly significant given that modern conflicts often occur in civilian-populated areas rather than traditional battlefields, making the findings relevant to various regions worldwide, including Israel, Ukraine, and Gaza.