A Systematic Review of the Efficacy of Adding Nonexposure Components to Exposure Therapy for Posttraumatic Stress Disorder

Exposure therapies are the treatment of choice for posttraumatic stress disorder (PTSD). However, a substantial number of individuals drop out of treatment or have residual symptoms. One strategy explored to improve outcomes is adding nonexposure components (e.g., cognitive restructuring, stress inoculation training) to exposure therapies. The primary goal of this review was to determine the efficacy of adding nonexposure components ("exposure plus" condition) to exposure therapies ("exposure only" condition). Eight articles met inclusion criteria. Results indicated that exposure plus yielded superior outcomes for intent-to-treat clinician-rated PTSD symptoms at posttreatment and 6-month follow-up. However, the effect size was small and not clinically significant. There were no differences between conditions on any other outcome measures. Implications and future research needs are discussed.