Posttraumatic Stress Disorder and Chronic Pain Arising from Motor Vehicle Accidents: Efficacy of Interoceptive Exposure Plus Trauma-Related Exposure Therapy

Abstract

Preliminary data are presented on the pattern of treatment response of combining interoceptive exposure (IE) with trauma-related exposure therapy (TRE) in five female patients with posttraumatic stress disorder (PTSD) and comorbid chronic musculoskeletal pain originating from motor vehicle accidents. Treatment consisted of four sessions of IE followed by eight sessions of TRE. Four participants reported a reduction in PTSD symptoms after completing treatment, and three no longer met diagnostic criteria for PTSD. Although both interventions were associated with reductions in PTSD symptoms, TRE was associated with greater reductions in PTSD symptoms than IE and was particularly effective at reducing avoidance. IE was associated with larger reductions in anxiety sensitivity than TRE. Pain symptoms lessened slightly during IE and then worsened following TRE. Anxiety decreased after completing treatment, whereas panic and depressive symptoms responded less so. Three individuals completed a 3-month follow-up assessment. There was no change in their PTSD diagnostic status, and all experienced a slight loss of pre–post gains, particularly involving the return of pain. Clinical and research implications are discussed.

Keywords:

• posttraumatic stress disorder
• chronic pain
• interoceptive exposure
• trauma-related exposure therapy.

Acknowledgments

Jaye Wald was supported by a Career Investigator Award from the Michael Smith Foundation for Health Research. The authors gratefully acknowledge the assistance of Mandy Chen, Rachel Frimer-London, Sonia Handa, Erika Penner, Kelly Watt, Marci Regambal, Natalie Moore, Alison Stewart, and Kiran Kalkat. Preliminary results of this study were presented at the 70th Annual Convention of the Canadian Psychological Association, Montreal, June 11–13, 2009.