Modified Prolonged Exposure Therapy for Posttraumatic Stress Disorder with an 85-Year-Old Native American Cajun Man With Late-Onset Deafness: A Case Report

ABSTRACT

Objectives

Few studies of exposure therapy with adults 85 years and older exist. This case report presents results of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) modified for an 85-year-old Native American Cajun man with late-onset deafness, who used a cochlear implant, and reported high Western/non-Native American acculturation. The following modifications were made primarily in response to the client’s individual, disability-related barriers to completing the standard PE protocol: (a) inclusion of the client’s spouse in aspects of treatment planning and homework assignments; (b) variable session length and frequency; (c) homework was limited to the daily practice of breathing retraining and in vivo exposure to triggering images; and (d) therapist reliance on nonverbal indicators of distress during imaginal exposures.

Methods

The PTSD Checklist for DSM-5 (PCL-5) and 15-item Geriatric Depression Scale (GSD-15) were primary progress and outcome measures.

Results

The modified treatment was associated with clinically significant decreases in baseline PTSD (19 points) and depressive (8 points) symptoms.

Conclusions

PE protocol modifications did not compromise treatment outcomes for this client.

Clinical Implications

PE protocols should be modified based on the individual needs of diverse older adults underrepresented in efficacy research.

KEYWORDS:

• Posttraumatic stress disorder
• modified prolonged exposure therapy
• older adults

Disclosure statement

No potential conflict of interest was reported by the author(s).

Clinical implications

• Prolonged Exposure (PE) was modified to accommodate an 85-year-old male’s individual and disability-related needs.

• Modifications included inclusion of a family member, variable session length/frequency, homework limited to breathing retraining and review of a triggering image, and therapist reliance on nonverbal indicators of distress during imaginal exposures.

• The modified treatment was associated with clinically significant reductions in baseline PTSD and depressive symptoms.

• Individually adapted PE for older adults not represented in efficacy research can be effective in extending the reach of available evidence-based treatments for PTSD.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article. This material is the result of work supported with resources and the use of facilities at the Alexandria VA Health Care System. The views expressed in this article are those of the author(s) and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.