Intensive Delivery of PE

Current psychotherapy practice standards emphasize weekly sessions. This model is not based on what mental health research directs as the optimal session frequency, but out of habit and reimbursement practices from insurance providers (e.g., limits to session frequency, duration, and number of approved sessions for an episode of care) (Schleider et al., 2021). While the first clinical trials of prolonged exposure (PE) for PTSD used a twice-weekly model that showed excellent efficacy (Foa et al., 1999), later trials moved to the standard weekly model of psychotherapy with continued efficacy. Recently, the use of massed protocols, also known as accelerated protocols, has been increasing. These massed protocols deliver a full therapeutic dose through daily or even twice-daily sessions. Based on current evidence, massed PE appears to yield robust outcomes within less than half the time of weekly delivered PE or other evidence-based treatments for PTSD. Clients experience treatment successes more quickly and clinicians can harness early behavioral momentum to accelerate these gains throughout treatment. If able to utilize massed PE within the treatment setting, it is strongly recommended that massed PE be considered as a first-line treatment option for PTSD as it improves engagement, retention, and the likelihood that clients will receive a full dose of PE.