Modified Prolonged Exposure Therapy for Posttraumatic Stress Disorder with an 85-Year-Old Native American Cajun Man With Late-Onset Deafness: A Case Report

Abstract

ABSTRACT Objectives Few studies of exposure therapy with adults 85 years and older exist. This case report presents results of prolonged exposure (PE) for posttraumatic stress disorder (PTSD) modified for an 85-year-old Native American Cajun man with late-onset deafness, who used a cochlear implant, and reported high Western/non-Native American acculturation. The following modifications were made primarily in response to the client’s individual, disability-related barriers to completing the standard PE protocol: (a) inclusion of the client’s spouse in aspects of treatment planning and homework assignments; (b) variable session length and frequency; (c) homework was limited to the daily practice of breathing retraining and in vivo exposure to triggering images; and (d) therapist reliance on nonverbal indicators of distress during imaginal exposures. Methods The PTSD Checklist for DSM-5 (PCL-5) and 15-item Geriatric Depression Scale (GSD-15) were primary progress and outcome measures. Results The modified treatment was associated with clinically significant decreases in baseline PTSD (19 points) and depressive (8 points) symptoms. Conclusions PE protocol modifications did not compromise treatment outcomes for this client. Clinical Implications PE protocols should be modified based on the individual needs of diverse older adults underrepresented in efficacy research.