Perceived Benefits and Drawbacks of Massed Prolonged Exposure: A Qualitative Thematic Analysis of Reactions From Treatment Completers

Clinical Impact Statement Prolonged exposure (PE) for the treatment of posttraumatic stress disorder has substantial empirical support. Conventional delivery of PE is once per week for about 3 months, which may not be desirable or sustainable to many patients. Recent studies support massed delivered PE (e.g., daily sessions for 2 weeks) as an alternative that may support treatment engagement by limiting between-session distraction, avoidance, and demotivation. This qualitative analysis of patient reactions to massed PE found that patients had an overall positive response and identified that the intensive treatment structure limits distractions and avoidance while providing quick gains that enhanced motivation and engagement. Objective: Advocates of massed prolonged exposure (PE) argue an intensive approach may address between-session distraction, avoidance, and demotivation that can result in dropout or interference with treatment engagement. Despite growing empirical support for the efficacy and effectiveness of massed PE, little evidence suggests massed PE matches patient preferences. Further, program evaluation efforts have not assessed unforeseen or underestimated benefits and drawbacks of massed PE. The current study is the first known study to assess patient reactions to massed PE. Method: Participants were 25 military veterans diagnosed with posttraumatic stress disorder who were accepted into a 2-week massed PE program. After the final session, participants completed a written survey using open-ended questions regarding their perceived benefits and drawbacks of massing the full PE protocol into 2 weeks. After demonstrating interrater reliability, coders used a thematic analysis approach to identify themes and subthemes in the qualitative data. Results: Overall, participant reactions were much more positive (51.27%) than negative (17.77%). Participants identified benefits that are largely consistent with the justification for massed PE: (a) The structure limits distractions and avoidance, and (b) quick gains enhance motivation and engagement. With respect to drawbacks, participants identified that massed PE causes short-term discomfort and is demanding in terms of effort and time, which is also consistent with clinical theory of PE and justification for massed delivery. Conclusions: Participant reactions correspond to the rationale for massed PE; that is, participants identified that despite short-term discomfort and demands, they tend to like and benefit from the intensity of massed PE.