Current Treatment Options in Psychiatry

, Volume 6, Issue 2, pp 107–118 | Cite as

Adjusting the Timeframe of Evidence-Based Therapies for PTSD-Massed Treatments

  • Jennifer Schuster WachenEmail author
  • Katherine A. Dondanville
  • Wyatt R. Evans
  • Kris Morris
  • Allison Cole
PTSD (S Creech and L Sippel, Section Editors)
Part of the following topical collections:
  1. Topical Collection on PTSD



Current clinical practice guidelines for the treatment of post-traumatic stress disorder (PTSD) strongly recommend individual manualized trauma-focused therapy. However, it can be challenging for patients to complete a full course of treatment. There has been recent interest in modifying the format of evidence-based psychotherapies for PTSD to be delivered within a shorter time frame to reduce the likelihood of dropout and optimize the potential for a positive treatment outcome. This article will review the existing literature on massed psychotherapies for PTSD, including only the treatments highly recommended by the current PTSD treatment guidelines that have been modified to an intensive format.

Recent Findings

The literature supporting massed treatment formats for PTSD is limited to date. Two randomized clinical trials (RCTs) provide the strongest evidence for efficacy for prolonged exposure and cognitive therapy for PTSD, and preliminary studies of cognitive processing therapy and eye movement desensitization and reprocessing are promising.


Current results suggest that massed formats of existing evidence-based psychotherapies for PTSD are promising efficient and effective methods to expedite recovery from PTSD symptoms. Additional RCTs are needed to demonstrate the efficacy of these treatments in a range of patient populations.


Post-traumatic stress disorder PTSD Massed treatment Intensive treatment Cognitive therapy Exposure therapy 


Compliance with Ethics Guidelines

Conflict of Interest

Katherine A. Dondanville, Wyatt R. Evans, Kris Morris, and Allison Cole declare no conflict of interest.

Jennifer Schuster Wachen currently receives Department of Defense funding to conduct a trial of massed Cognitive Processing Therapy.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, et al. Trauma and PTSD in the WHO world mental health surveys. Eur J Psychotraumatol. 2017;8:sup5. Scholar
  2. 2.
    Rothbaum BO, Foa EB, Riggs DS, Murdock T, Walsh W. A prospective examination of post-traumatic stress disorder in rape victims. J Trauma Stress. 1992;5(3):455–75. Scholar
  3. 3.
    Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol. 2016;51(8):1137–48.CrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5: fifth edition. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  5. 5.
    American Psychological Association. Clinical practice guideline for the treatment of PTSD. 2017.
  6. 6.
    International Society for Traumatic Stress Studies. New ISTSS Prevention and Treatment Guidelines. 2018.
  7. 7.
    Veterans Health Administration & Department of Defense. VA/DoD clinical practice guideline for the management of post-traumatic stress. 2017.
  8. 8.
    Imel ZE, Laska K, Jakupcak M, Simpson TL. Meta-analysis of dropout in treatments for posttraumatic stress disorder. J Consult Clin Psychol. 2013;81(3):394–404. Scholar
  9. 9.
    •• Foa EB, McLean CP, Zang Y, Rosenfield D, Yadin E, Yarvis JS, et al. Effect of prolonged exposure therapy delivered over 2 weeks vs 8 weeks vs present-centered therapy on PTSD symptom severity in military personnel: a randomized clinical trial. J Am Med Assoc. 2018;319(4):354–64. This study is the first published RCT of massed prolonged exposure.
  10. 10.
    Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA. 2015;314(5):489–500. Scholar
  11. 11.
    Gutner CA, Suvak MK, Sloan DM, Resick PA. Does timing matter? Examining the impact of session timing on outcome. J Consult Clin Psychol. 2016;84(12):1108–15. Scholar
  12. 12.
    Foa EB, Hembree EA, Rothbaum BO. Prolonged exposure therapy for PTSD. New York: Oxford University; 2007.Google Scholar
  13. 13.
    Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99(1):20–35.CrossRefGoogle Scholar
  14. 14.
    Peterson AL, Foa EB, Blount TH, McLean CP, Shah DV, Young-McCaughan S, et al. Intensive prolonged exposure therapy for combat-related posttraumatic stress disorder: design and methodology of a randomized clinical trial. Contemp Clin Trials. 2018;72:126–36.CrossRefGoogle Scholar
  15. 15.
    Hendriks L, de Kleine RA, Broekman TG, Hendriks GJ, van Minnen A. Intensive prolonged exposure therapy for chronic PTSD patients following multiple trauma and multiple treatment attempts. Eur J Psychotraumatol. 2018;9:1. Scholar
  16. 16.
    Foa EB, Riggs DS, Dancu CV, Rothbaum BO. Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. 1993;6(4):459–473.
  17. 17.
    Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther. 2000;38:319–45. Scholar
  18. 18.
    •• Ehlers A, Hackmann A, Grey N, Wild J, Liness S, Albert I, et al. A randomized controlled trial of 7-day intensive and standard weekly cognitive therapy for PTSD and emotion-focused supportive therapy. Am J Psychiatry. 2014;171(3):294–304. This study is the first and only RCT of intensive cognitive therapy for PTSD.
  19. 19.
    Ehlers A, Clark DM, Hackmann A, Grey N, Liness S, Wild J, et al. Intensive cognitive therapy for PTSD: a feasibility study. Behav Cogn Psychother. 2010;38(4):383–98. Scholar
  20. 20.
    Bryant RA, Moulds ML, Guthrie RM, Dang ST, Nixon RDV. Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. J Consult Clin Psychol. 2003;71:706–12.CrossRefGoogle Scholar
  21. 21.
    Schnurr PP, Friedman MJ, Engel CC, Foa EB, Shea MT, Chow BK, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. J Am Med Assoc. 2007;297:820–30.CrossRefGoogle Scholar
  22. 22.
    Murray H, El-Leithy S, Billings J. Intensive cognitive therapy for post-traumatic stress disorder in routine clinical practice: a matched comparison audit. Br J Clin Psychol. 2017;56(4):474–8. Scholar
  23. 23.
    Foa EB. Posttraumatic stress diagnostic scale manual. Minneapolis: National Computer Systems Inc; 1995.Google Scholar
  24. 24.
    Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ. Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. J Clin Psychiatry. 2013;74(6):541–50. Scholar
  25. 25. Massed cognitive processing therapy for combat-related PTSD identifier: NCT03808727. 2019. 08727&rank=1.
  26. 26.
    Bryan CJ, Leifker FR, Rozek DC, Bryan AO, Reynolds ML, Oakey DN, et al. Examining the effectiveness of an intensive, 2-week treatment program for military personnel and veterans with PTSD: results of a pilot, open-label, prospective cohort trial. J Clin Psychiatry. 2018;74:2070–81. Scholar
  27. 27.
    Shapiro F. Eye movement desensitization and reprocessing: basic principles, protocols, and procedures (2nd ed.). 2001.Google Scholar
  28. 28.
    Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. J Trauma Stress. 1989;2(2):199–223. Scholar
  29. 29.
    World Health Organization.
  30. 30.
    Bongaerts H, Minnen AV, Jongh AD. Intensive EMDR to treat patients with complex posttraumatic stress disorder: a case series. J EMDR Pract Res. 2017;11(2):84–95. Scholar
  31. 31.
    Hurley EC. Effective treatment of veterans with PTSD: comparison between intensive daily and weekly EMDR approaches. Front Psychol. 2018;9.
  32. 32.
    • Van Woudenberg C, Voorendonk EM, Bongaerts H, Zoet HA, Verhagen M, Lee CW, et al. Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. Eur J Psychotraumatol. 2018;9:1. This study is a large open trial of EMDR + PE.Google Scholar
  33. 33.
    • Harvey MM, Rauch SAM, Zalta AK, Sornborger J, Pollack MH, Bothbaum BO, et al. Intensive treatment models to address posttraumatic stress among post-9/11 warriors: the warrior care network. Focus. 2017;15:378–83. This article describes four different intensive outpatient program models for service members and veterans.
  34. 34.
    Yasinski C, Sherrill AM, Maples-Keller JL, Rauch SA. Intensive outpatient prolonged exposure for PTSD in post-9/11 veterans and service-members: program structure and preliminary outcomes of the Emory Healthcare Veterans Program. Trauma Psychol News. 2017;12(3):14–7.Google Scholar
  35. 35.
    Zalta AK, Held P, Smith DL, Klassen BJ, Lofgreen AM, Normand PS, et al. Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD. BMC Psychiatry. 2018;18(1):242. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jennifer Schuster Wachen
    • 1
    Email author
  • Katherine A. Dondanville
    • 2
  • Wyatt R. Evans
    • 2
  • Kris Morris
    • 3
  • Allison Cole
    • 4
  1. 1.Women’s Health Sciences Division, National Center for PTSDVA Boston Healthcare System and Boston University School of MedicineBostonUSA
  2. 2.Division of Behavioral Medicine, Department of Psychiatry, School of MedicineUniversity of Texas Health Science Center at San AntonioSan AntonioUSA
  3. 3.Fort Belvoir Community HospitalFort BelvoirUSA
  4. 4.Women’s Health Sciences Division, National Center for PTSDVA Boston Healthcare SystemBostonUSA

Personalised recommendations