A trial of prolonged exposure therapy for outpatients with comorbid bipolar disorder and posttraumatic stress disorder (PTSD).

Background: Bipolar disorder and posttraumatic stress disorder (PTSD) commonly co-occur, but no treatment guidelines exist for this population. Prolonged exposure (PE) is a well-established and efficacious treatment for PTSD, untested in patients with comorbid bipolar disorder. The current study evaluates the feasibility and preliminary efficacy of PE for patients with bipolar disorder and PTSD.
Methods: Participants were enrolled in PE and completed assessments of PTSD symptoms, suicidality, state and trait anxiety, depression, and mania at baseline, Sessions 5 and 10, and at 6-months post-treatment.
Results: 32 patients enrolled in this study, with 75 % (24/32) completing all ten PE sessions and 50 % completing 6-month follow-up assessments. PTSD symptoms decreased from baseline to Session 10 and continued to decrease throughout the follow-up period. Suicidality, measured by implicit associations between self and death, showed a similar pattern of decrease over treatment and follow-up periods. Suicidal thinking and depressive symptoms decreased from baseline through Session 10 and rebounded slightly, remaining below baseline at 6-months follow-up. State and trait anxiety increased initially through Session 5 but then decreased and remained stable. Mania scores remained stable at all assessment periods.
Limitations: The study is limited by a small sample size and absence of a control condition. Criterion A trauma was not required, limiting generalizability, and there was significant attrition at follow-up.
Conclusions: These findings suggest that PE is a feasible and preliminarily efficacious treatment for patients with bipolar disorder and comorbid PTSD, and support the conduct of a fully powered efficacy of PE for this comorbidity.
Competing Interests: Declaration of competing interest Andrew A. Nierenberg: Dr. Nierenberg is in the scientific advisory board of Altimate, Flow, Milken Center for Strategic Philanthropy, Myriad, and 4M Therapeutics. He is also a consultant at Alkermes, Clexio, Ginger/Headspace Health, Janssen, Merck, Neuronetic, NeuroRX, Otsuka, Protagenics, SAGE, Sunovion, and Unravel Bioscience. He receives honoraria from Belvior, Psychiatric Annals Slack Publication, and Wiley Depression and Anxiety. He also receives royalties from Guilford Publications, and unravel Bioscience. Finally, he is in the adjudication committee for Novartis. He has received grant funding from PCORI. Louisa G. Sylvia: Dr. Sylvia has received grant funding from PCORI, NIH, HRSA Tiny Blue Dot Foundation and AFSP. She has also received funding as a member of the Milken Institute's Scientific Advisory Board as well as royalties form New Harbinger for her two published books on bipolar disorder.
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