Complications
Many patients experience high levels of initial distress in the very beginning stages of exposure therapy. This may produce some discomfort among practitioners who do not have significant experience implementing exposure therapy, and practitioners may discontinue treatment out of fear that distress levels and symptoms may increase over time. However, these assumptions are often inaccurate, and several rigorous studies do not support the notion.[120][121][122][123]
Moreover, initial increase in distress during early sessions of exposure therapy is associated with superior post-treatment outcomes.[123] Studies have found that patients do not tend to prematurely discontinue treatment when receiving exposure therapy versus other interventions.[124][125] However, for those unable to tolerate trauma-focused intervention, the provision of non-trauma-focused cognitive behavioral therapy should be considered.[73]
Educating the patient about the treatment and potential initial increases in distress may decrease the distress.
Although underlying mechanisms remain unclear, there is a clear association between clinically confirmed stress related disorders and a higher subsequent risk of cardiovascular disease.[126] Clinicians should take this into consideration during assessment and monitoring.
PTSD has been identified as a risk factor for developing dementia. Clinicians should take this into consideration during the assessment and monitoring of patients with chronic PTSD.[127]
Psychiatric reactions to life stressors may result in immune dysfunction. These findings are of etiological importance, but as yet do not provide direct evidence for altered clinical management.[128]
May occur secondary to the trauma exposure and resulting symptoms. Treatment is with appropriate psychotherapies and medication.
May occur secondary to the trauma exposure and resulting symptoms. Treatment is with appropriate psychotherapies and medication.
May occur secondary to the trauma exposure and resulting symptoms. Treatment is with appropriate psychotherapies and medication.
Anger and irritability are prevalent and may impede treatment success. Successful treatment often coincides with a reduction of these symptoms.[129] However, anger, if too extreme, can interfere with a patient's ability to process anxiety and fear.
Severe dissociative symptoms also may interfere with the efficacy of exposure-based treatment. One strategy is to postpone discussion of anger issues until exposure-based components of the intervention are completed.[130]
Patients who are unable to postpone addressing anger may benefit from learning anger management techniques before beginning exposure therapy.
Grounding techniques aimed at reducing avoidance may be helpful for patients with severe dissociative symptoms.[130] Examples of grounding techniques may include squeezing an object, counting items in a room, or any other activity that heightens patient's awareness of the immediate environment.[36]
In attempting to cope with their symptoms, many patients use alcohol, drugs, caffeine, or nicotine.
If PTSD is primary to any substance use, effective treatment of the PTSD will often help reduce these problems.
If the person has developed dependence, this needs to be treated before the person is offered trauma-focused psychological interventions.
In severe cases, it may be necessary to work collaboratively with specialist substance use services.
As with every psychiatric condition, suicide is a rare but important potential complication. Initial and ongoing assessment should routinely include questions to gauge the presence of suicide risk and, if present, the severity of the risk.
Patients with PTSD have an increased risk of developing various health conditions. Individuals with such a diagnosis are at increased risk of life-threatening infections.[131] Clinicians should take this into consideration during the assessment and monitoring of patients with chronic PTSD.
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