PE for Older Adults

The prevalence of PTSD appears to be lower in older adulthood compared to childhood and the general adult population. Many samples, however, do not include older adults, and most studies do not report analyses focused on age differences. Little is known about the intersectionality between age and cultural influences, partial PTSD in older adults, differences in symptom presentation between older and younger individuals, the cumulative impact of multiple traumatic events on PTSD in older adulthood, and the impact of the timing of traumatic events. Prolonged exposure therapy (PE) appears to work well in older adults, as it does in the general population, though apparent poor maintenance of gains at follow-up assessment points for some participants may be due to a variety of factors. Despite the strong efficacy of PE for older adults, relatively few providers offer the treatment. Moreover, stigma and misconceptions about mental health among older adults may serve as a barrier to treatment. Additional barriers could include cost, transportation and mobility issues, medication effects, and technophobia about videoconferencing and smartphone apps. Some issues to consider prior to commencing PE with older adults include advertising and language about the treatment, integrating PE with primary care, optimizing the office environment and the assessment process, and using motivational interviewing and technology to enhance treatment. Considerations during PE include the setting and format, the pace of treatment, the therapeutic alliance and treatment expectancy, psychoeducation, social support, and methods for enhancing the consolidation of learning. At the end of PE, therapists can enlist strategies for ensuring retention, recall, and relapse prevention, including offering “booster” sessions of PE as needed. A case example illustrates these issues.