Implementing PE with Comorbid Disorders

Among individuals with post-traumatic stress disorder (PTSD), 80–90% endorse one or more comorbid psychiatric disorders (Kessler et al., 1995). Comorbidity is associated with a more severe clinical and functional profile relative to a single disorder diagnosis (e.g., Norman et al., 2018; Bedard‐Gilligan et al., 2015). Fortunately, multiple clinical trials (e.g., Schnurr et al., 2022) and meta-analytic reviews (e.g., Powers et al., 2010) highlight the effectiveness of first-line interventions, such as prolonged exposure (PE), for treating PTSD in the presence of comorbid disorders. Current clinical practice guidelines recommend that, in general, when PTSD is the primary presenting concern, it should be treated with first-line psychotherapies such as PE, regardless of whether a co-occurring disorder is present (U.S. Departments of Veterans Affairs and Defense [VA/DoD], 2023). In some instances, which are described in detail throughout the chapter, it is recommended that comorbid disorders are addressed or stabilized before initiating PE.