Staff Psychologist SFVAMC/UCSF San Francisco, California
Prolonged Exposure Therapy for Post Traumatic Stress Disorder (PTSD) is based on Emotional Processing Theory that posits that expression of emotion and accompanying cognitive shifts lead to successful trauma processing. Clinicians make treatment decisions based on Subjective Units of Distress (SUDS) ratings during imaginal exposure which rely entirely on a patient’s self-report. However, the accuracy of SUDS ratings depends on a patient’s ability to experience, identify, and name their emotional state, which is particularly difficult for patients with early attachment trauma and complex PTSD. In this pilot case study, we used a mobile wristband to measure electrodermal (EDA) reactivity during the course of treatment in a Veteran with complex PTSD from childhood physical abuse, emotional neglect, and military trauma, undergoing Prolonged Exposure treatment. We examined SUDs ratings in relation to EDA during imaginal exposure sessions as a proxy of emotional awareness during treatment. We predicted that concordance between subjective and objective self-report measures of distress during imaginal exposure would be associated with treatment gains. The pairing of a physiological measure of distress and self-report may yield helpful information for clinicians to better treat patients with complex PTSD.