(PS11-C55) Effective and Enduring: Prolonged Exposure Therapy for PTSD in Bipolar Populations

Introduction: Bipolar disorder and post-traumatic stress disorder (PTSD) frequently co-occur. However, no treatment guidelines currently exist for this population. While prolonged exposure therapy (PE) is a well-established and efficacious treatment for PTSD, its outcomes in patients with co-occurring bipolar disorder are unexplored. The current study evaluates the preliminary efficacy of PE for patients with comorbid bipolar disorder and PTSD.

Methods: Eligible participants were enrolled in a course of PE and completed assessments of PTSD symptoms (PCL-5), suicidal thoughts and behaviors (i.e., implicit associations between self/death and a measure of suicidal thinking) (SIAT and CHRT), state and trait anxiety (STAI-S and STAI-T), depression (QIDS-SR 16) and mania (ASMR) at baseline, throughout treatment, and at 6-month post-treatment follow-up. 32 patients enrolled in this study, with 75% (24/32) completing all ten sessions of PE and 50% (16/32) completing assessments at 6-month follow-up.

Results: PTSD symptoms (PCL-5) decreased over the treatment from (M = 48.97, SD = 11.03) to (M = 24.12, SD = 14.06) and continued to decrease through the 6-month post-treatment follow-up visit (M = 19.50, SD = 17.23). Suicide Implicit Association Task (SIAT) scores decreased from baseline (M= -.47, SD = .36) to 6-month follow-up (M= -.72, SD =.29). Self-reported suicidal thinking (CHRT) and depressive symptoms (QIDS-SR 16) both decreased from (M= 19.61, SD= 7.09; M = 12.56, SD =5.83) at baseline to (M= 14.71, SD= 5.11, M = 7.70, SD=4.40) at session 10 and rebounded up from sessions 10 to 6 months post-treatment. State and trait anxiety (STAI-S & STAI-T) scores increased from (M=44.94, SD=5.13; M=48.38, SD=5.27) at baseline to (M= 46.64, SD=5.88; M=49.57, SD=6.53) at session 5, decreased below the baseline levels from session 5 to session 10 (M=43.65, SD= 5.88; M= 45.33, SD=5.48), then stayed stable from session 10 to 6 months. Low levels of manic symptoms (ASRM) did not change significantly for the entire study period.

Discussion: Overall, we found preliminary evidence for efficacy of PE co-occurring with bipolar disorder. PTSD symptoms decreased significantly after 10 sessions of PE with sustained decreases through 6-month follow-up. Depressive symptoms, suicidal thoughts, and anxiety also decreased. While current literature has evidenced PE’s effectiveness in PTSD symptom reduction, this form of treatment had not been explored in our target population before. Our results suggest PE could be effective in reducing PTSD symptoms in individuals with comorbid bipolar disorder and PTSD. Future controlled trials are warranted.