 Mental Health Changes and Characteristics

 Changes and Beliefs About Mental Health

 Effects of Mental Health Problems
 Obsessive-Compulsive Disorder
 Post Traumatic Stress Disorder

Mental Health Changes and Characteristics

Mental health is not just the absence of a mental health problem but
involves a person's overall emotional and psychological well-being. The
characteristics of good mental health include:
1. Resilience to Difficult Feelings: A mentally healthy person is not
overwhelmed by negative emotions and can effectively manage stress.
2. Coping with Disappointments and Problems: They are able to
navigate through life’s challenges and setbacks without being crushed
by them.
3. Stress Management: Managing everyday stresses and demands
effectively is a key characteristic.
4. Decision-Making Ability: Mentally healthy individuals are capable of
making decisions that guide them in life.
5. Social Engagement: Engaging with others and functioning positively
in society is an important aspect of mental health. This includes
maintaining relationships and contributing to social life.
Importantly, not having all these characteristics doesn't necessarily
mean a person has a mental health problem. Mental health is a
spectrum, and everyone may experience periods of difficulty without it
leading to a mental health diagnosis.
Building skills: To foster these characteristics, it's beneficial to reflect on
how one can positively engage with society (e.g., helping others, participating
in community activities) and cope effectively with challenges (e.g., using
relaxation techniques, seeking support when needed).

Changes and Beliefs About Mental Health

Cultural Variations in Beliefs About Mental Health Problems
 Historical Views: Throughout history, mental health problems were
often believed to have supernatural or spiritual causes, such as being
possessed by evil spirits or cursed. During the 14th to 17th centuries in
Europe and North America, accusations of witchcraft were sometimes
linked to behaviors seen as signs of mental health issues, particularly
among women.
 Cultural Stigma: In many cultures, mental health problems are seen
as shameful, leading to social stigma. This stigma can result in people
being socially, economically, and legally discriminated against. In some
cultures, the behavior of an individual with a mental health issue
reflects poorly on their entire family, which may lead to isolation or
 confinement within the family.
 Treatment Approaches: The treatment for mental health problems is
deeply influenced by cultural beliefs:
o In biologically oriented cultures, medication is often the
treatment of choice.
o In spiritually oriented cultures, treatments can include
prayer, rituals, or exorcism.
o In cultures where emotional expression is valued, self-help
groups and therapy are common.
o In cultures with high levels of shame, people may suffer in
silence, unable to seek help.
Are Mental Health Problems Becoming More Common?
While there is an increase in the number of mental health diagnoses globally,
this doesn’t necessarily mean that mental health problems are becoming
more prevalent. Some factors contributing to this trend include:
 Changes in Classification: Some conditions, like depression, have
seen an increase in diagnoses due to changes in classification systems,
making it easier for more individuals to meet diagnostic criteria.
 Increased Awareness: As more people openly discuss mental health,
there is a greater willingness to seek professional help.
 Loneliness and Isolation: Data shows loneliness is a growing issue
worldwide, especially among young people. This can be linked to
mental health conditions like depression and anxiety, and may be
exacerbated by modern living conditions, such as living alone or the
increasing reliance on digital communication over face-to-face
interactions.
Challenges of Modern Living and Their Effects on Mental Health
 Urban Living: People living in crowded urban environments may
experience increased stress. Studies have shown that city dwellers
tend to have a more active amygdala, the brain region responsible for
responding to threats, compared to those living in rural areas.
 Social Media: Technology and social networking sites have changed
how we interact. While these platforms allow for connection across
great distances, they may also increase feelings of isolation, as virtual
interactions often replace in-person conversations.
Reducing Social Stigma
Despite the progress in understanding mental health, the stigma surrounding
it persists. The World Health Organization (WHO) has set global goals to
improve attitudes toward mental health through its Mental Health Action
Plan (2013-2030). The WHO views stigma and discrimination as major
global health issues and stresses that more efforts are needed to make people
feel comfortable seeking help when necessary.
In summary, changes in societal attitudes and beliefs about mental health, as
well as an increase in recognition of mental health problems, contribute to
both the growing number of diagnoses and the evolving treatment
approaches. The challenge moving forward will be to reduce stigma, improve
accessibility to treatment, and foster a more supportive environment for those
struggling with mental health issues.

Outline of Significant Mental Health Problems and Their Impact on

Individuals and Society
1. Effects on Individuals:
o Difficulty coping with everyday life, including trouble sleeping,
low energy, and poor concentration.
o Challenges in education or work, with a higher likelihood of
unemployment.
o Negative impact on physical health, including poor adherence to
treatment, changes in appetite, and higher rates of substance
abuse.
o Damaged relationships, increased caregiving responsibilities,
and higher stress levels.
o Social isolation and stigma, leading to withdrawal from social
interactions.
2. Effects on Society:
o Economic costs due to decreased work productivity, with mental
health problems contributing to a significant portion of health-
related costs.
o Increased social care costs, including health and housing
support.
o Higher rates of mental health problems in incarcerated
populations, with possible links to crime and imprisonment.
o Impact on family dynamics, with caregivers experiencing stress
and children potentially becoming caregivers themselves.

It highlights that individuals with mental health problems often experience

difficulties in work and education, which leads to higher unemployment rates.
This creates financial instability and increases stress, further worsening
mental health conditions. For example, people with mental health issues
might struggle to maintain a job or education, which compounds the sense of
isolation and anxiety. Additionally, mental health issues are linked to poor
physical health outcomes due to poor medication adherence and decreased
activity levels, as stated in the material.

From a societal perspective, the economic burden of mental health problems

is substantial. The article notes that mental health problems account for 15%
of the economic costs of health issues in developed countries, with
productivity losses costing the global economy over $1 trillion annually. Social
care costs also rise as individuals with mental health conditions require more
extensive health and housing support, further straining public systems.
The impact of social media also exacerbates isolation, as more people,
particularly younger generations, report feeling disconnected despite online
interactions. This increasing sense of isolation negatively affects mental
health, leading to a higher demand for social care services.
Summary
In summary, significant mental health problems have far-reaching effects on
both individuals and society. For individuals, these problems affect daily
functioning, physical health, and relationships, leading to isolation and
unemployment. For society, the economic burden is immense, with increased
healthcare costs and reduced productivity, alongside rising demands for social
services. The negative effects of social media further contribute to feelings of
isolation, highlighting the interconnected nature of mental health and social
well-being.

OCD
Obsessive-Compulsive Disorder (OCD) is a mental health condition
characterized by two main components:
 Obsessions: Repeated, intrusive, and unwanted thoughts, images, or
impulses that cause anxiety. These thoughts are distressing, and the
individual is unable to ignore them or push them out of their mind.
 Compulsions: Repetitive behaviors or mental acts that an individual
feels compelled to perform in response to an obsession. These actions
are performed to reduce anxiety caused by the obsessive thoughts.
OCD Characteristics:
 OCD typically begins between the ages of 15 and 25, though it can
develop later in life or even in childhood.
 It causes significant distress and impacts daily functioning.
 A person may have both obsessions and compulsions, but about 20%
of cases involve only obsessive thoughts without compulsive behaviors.
 Common obsessions include concerns about dirt, germs, or fear of
accidents or death.
 Compulsions can include behaviors like hand washing, checking locks,
or arranging objects in a specific way to relieve anxiety.
Diagnosis:
 OCD is diagnosed based on criteria outlined in the ICD-11.
 Essential symptoms include persistent obsessions and/or compulsions,
time consumption (more than 1 hour per day), and significant distress
or functional impairment.
 Non-essential symptoms may include temporary relief after performing
compulsions or avoidance of triggering situations.
Characteristics of Obsessions and Compulsions in OCD
Obsessions:
 Unwanted thoughts: Intrusive and distressing thoughts or mental
images that repeatedly enter the mind.
 Anxiety-inducing: These thoughts cause high levels of anxiety, which
the individual cannot control.
 Common themes: Obsessions often involve fears of contamination
(dirt or germs), harm (accidents or death), or the need for perfection
(things being "just right").
Compulsions:
 Repetitive behaviors: Actions or mental rituals that the individual
feels compelled to perform to reduce the anxiety caused by the
obsessions.
 Relief from anxiety: Performing the compulsion offers temporary
relief from the distress caused by obsessive thoughts.
 Strict rules: Compulsions often follow a set of rigid rules, such as
needing to wash hands a specific number of times, or checking locks
repeatedly.
 Avoidance: Individuals may avoid people, places, or situations that
trigger obsessive thoughts or compulsive behaviors.

What causes OCD？

Biological (Nature) Factors:
 Brain Structure: Damage to the basal ganglia, an area deep in the
brain, can lead to OCD symptoms, especially those related to
cleanliness or symmetry. This area can be affected by infection, stroke,
or head trauma.
 Genetics: There is evidence for a genetic component to OCD. Genes
like COMT and SERT have been linked to OCD, suggesting a genetic
 vulnerability. Heritability studies show that about 27-47% of OCD cases
can be attributed to genetic factors, though this is not 100%, implying
environmental factors (nurture) also play a role.
Cognitive (Nurture) Factors:
 Cognitive explanations suggest that faulty thinking patterns, such as
catastrophic thinking, hypervigilance, and thought-action fusion
(TAF), contribute to OCD. These biases cause individuals with OCD to
perceive threats where there may be none, leading to excessive
checking behaviors and mental rituals.
 Hypervigilance refers to an increased awareness of potential threats,
causing constant scanning of the environment.
 Thought-action fusion (TAF) is the belief that thinking about a
harmful event is as bad as causing it.
Treatment: Cognitive Behavioral Therapy (CBT) is often used to help
individuals challenge irrational thinking patterns and manage compulsive
behaviors.

Evaluation
Biological Explanations (Nature):
 Strengths:
o Neuroimaging and genetic studies provide evidence that
biological factors, such as damage to the basal ganglia and
specific genetic predispositions (e.g., COMT and SERT genes),
play a role in the development of OCD.
o The heritability estimate of 27-47% supports the idea that
genetics contribute to OCD, highlighting the importance of
biological factors in the disorder.
 Weaknesses:
o Not everyone with basal ganglia damage develops OCD,
suggesting that other factors, such as environmental influences,
are important.
o The heritability estimate of around 50% suggests that genes
alone do not account for OCD, and this highlights the need to
consider environmental factors in the development of OCD.
Cognitive Explanations (Nurture):
 Strengths:
o Cognitive explanations, such as hypervigilance and thought-
action fusion (TAF), provide insights into the specific thought
patterns that maintain OCD symptoms. Research, including
Rachman’s (2004) case study, supports these cognitive biases
as important factors in OCD.
o CBT, which is based on these cognitive principles, has been
shown to be an effective treatment for OCD by helping
individuals challenge irrational thoughts and reduce compulsive
 behaviors.
 Weaknesses:
o Much of the research on cognitive explanations is based on case
studies, which limits the ability to generalize findings to the
broader population.
o Cognitive explanations focus primarily on internal thought
processes and do not account for the social and biological
factors that also contribute to OCD. For example, parental
behavior (such as a parent with contamination fears) might
influence a child's development of OCD, but this is not
emphasized in cognitive models.
Overall Conclusion:
 Both biological and cognitive explanations provide valuable insights
into OCD. However, they are not mutually exclusive and should be
considered together. While biological factors (e.g., brain damage and
genetics) can predispose individuals to OCD, cognitive processes (e.g.,
faulty thinking patterns and biases) play a significant role in the
development and maintenance of the disorder. Further research is
needed to explore the interaction between biological and cognitive
factors and to develop more comprehensive treatments that address
both aspects.

Cognitive Behaviour Therapy (CBT)

Definition: Cognitive Behaviour Therapy (CBT) is a widely used treatment for
mental health conditions like anxiety, depression, and obsessive-compulsive
disorder (OCD). It operates on the principle that thoughts, feelings, and
behaviours are interconnected. The therapy aims to identify and change
negative or inaccurate thinking patterns, which in turn can help to improve
emotions and behaviours.
Key Concepts:
 Thoughts, Feelings, and Behaviours: CBT posits that individuals’
thoughts influence their emotions and actions. Therefore, changing
negative thought patterns can lead to improvements in both emotions
and behaviours.
 Focus on Cognitive Restructuring: In CBT, patients work to identify
and challenge irrational or unhelpful thoughts, replacing them with
more realistic and balanced alternatives.
Exposure and Response Prevention (ERP)
One specific type of CBT used to treat obsessive-compulsive behaviours is
Exposure and Response Prevention (ERP). This therapy involves
exposing individuals to situations that provoke their anxiety (their “worst
fears”) in a controlled, gradual manner. The key principle is to prevent them
from performing the compulsive behaviours that they typically use to
reduce anxiety. Over time, this helps to break the cycle of compulsions and
reduce anxiety.
ERP Example:
 A person with contact contamination anxiety might be exposed to
objects they fear are dirty (like touching a doorknob), and prevented
from immediately washing their hands afterward. Over time, this
reduces the need for compulsive cleaning behaviours.
Cognitive Bias Training Modification
In addition to changing behaviours, CBT also targets irrational thinking
patterns. One approach used is Cognitive Bias Training Modification. The
steps involved include:
1. Identify the Obsession: The client is trained to recognize when an
obsessive thought enters their mind.
2. Cognitive Restructuring: The therapist helps the client assess
whether the obsessive thought is rational or irrational.
o If the thought is identified as irrational (e.g., a highly unlikely
event), it can be challenged with a counterstatement or
alternative, more rational thought.

Evaluation of CBT and ERP:

 Study by Ferrando and Selai (2021):
o Ferrando and Selai conducted a review of 24 studies on ERP
therapy in the treatment of OCD.
o Conclusion: ERP was found to be the superior treatment for
OCD compared to other therapies.
 Group Therapy Effectiveness (Kearns' Study):
o CBT is not only effective in individual therapy sessions but also
works in a group setting. This allows more people to access
treatment compared to individual therapy sessions.
 Challenges and Limitations:
o Time-Consuming: CBT can be a lengthy process and may
require a significant time investment from clients.
o Homework Assignments: Clients are often asked to keep daily
diaries or perform tasks outside of therapy sessions. When
clients don’t complete these assignments, the effectiveness of
CBT decreases.
o Dropout Rate: Due to the time commitment and homework,
some clients may drop out of CBT, reducing its overall success.

Systematic Sampling
 Definition: Systematic sampling is a method of selecting a sample
from a larger population by choosing every 'nth' individual from the
population.
o For example, in a population of 1,000 people, one might select
every 10th person, resulting in a sample of 100 individuals.
Summary Table for CBT and Evaluation

Keams' Study on the Effectiveness of Group-based CBT for OCD

(2010)
Aim:
The aim of the study was to investigate the effectiveness of Cognitive
Behavioral Therapy (CBT), specifically using Exposure and Response
Prevention (ERP), in treating individuals with Obsessive-Compulsive Disorder
(OCD).
Method:
 Sample: 24 individuals (10 males and 14 females) with OCD were
chosen using systematic sampling from a waiting list.
 Procedure: Participants were assessed at the beginning of group
therapy sessions and again after 10 weeks using rating scales to
measure obsessive-compulsive behaviors and anxiety levels.
 The participants were divided into four groups, and each group
underwent ten 90-minute sessions led by a registered cognitive
behavioral therapist.
 Each session focused on a different CBT technique, such as changing
the misinterpretation of thoughts or addressing compulsive behaviors.
Results:
 Significant Reduction: The study showed a significant reduction in OCD
severity across all four groups on all the rating scales used to assess
OCD.
 The data provides the mean scores and the range of scores on two
rating scales before and after CBT. These tables likely highlight a
 decrease in obsessive-compulsive behaviors and anxiety levels, with
participants showing improved mental health after 10 weeks of
therapy.
Conclusion:
 The study concluded that treating individuals with OCD using CBT is
effective in reducing OCD symptoms.
 It also found that group therapy is a viable option to increase access to
treatment, as more clients can be treated in a group setting compared
to individual one-on-one sessions.

Evaluation
Importance of the Study:
 The study demonstrated that CBT (including ERP) is effective in
treating OCD, even within group settings, significantly reducing
symptoms in individuals with OCD.
 One of the key takeaways is that group therapy can make CBT more
accessible, enabling more patients to receive treatment. Group settings
could be a practical alternative, especially when individual therapy
might not be feasible due to time, cost, or availability.
Limitations of the Study:
1. Sample Size: The study had a small sample size, which limits the
generalizability of the results.
2. Selection Bias: The participants were not randomly selected, which
could introduce selection bias. The findings may not apply to a broader,
more diverse population.
3. Lack of Control Group: There was no comparison or control group,
which means it is difficult to determine whether the improvements
were specifically due to the therapy or other factors.
4. No Long-term Follow-up: The study did not measure the long-term
effectiveness of the treatment. Without long-term data, it is unclear
whether the benefits of group therapy are maintained after the therapy
ends.

PTSD
PTSD is a mental health disorder that can develop after an individual has
been exposed to a traumatic event. Unlike temporary negative emotions, the
effects of PTSD can be long-lasting, often interfering with daily life,
relationships, and work. The traumatic event could be either long or short but
must be deeply distressing and frightening in nature.
Three Core Elements of PTSD:
1. Re-experiencing:
This is the re-living of the traumatic event through intrusive memories,
nightmares, and flashbacks. It feels as though the traumatic event is
happening again in the present moment, not just remembering it.
 These memories can be mild or so severe that the person loses
awareness of reality. During re-experiencing episodes, the individual
may have intense emotional and physical reactions, feeling exactly
how they did during the event itself.
2. Avoidance:
People with PTSD may intentionally avoid reminders of the traumatic
event. This can include avoiding places, situations, or even people that
are associated with the trauma. It is a way of trying to protect
themselves from the painful process of re-living the traumatic
experience.
3. Hypervigilance:
Hypervigilance refers to a state of constant anxiety, where the person
is on high alert and reacts excessively to everyday stimuli (e.g.,
jumping at a bird’s noise). This extreme anxiety may cause the
individual to adopt behaviors aimed at feeling safer, like checking the
weather repeatedly for signs of disaster or avoiding headphones when
walking alone, as a way to stay alert to their surroundings.
Biological and Cognitive Influences on PTSD:
Biological Factors:
1. Cortisol Imbalance:
o Cortisol is a hormone released by the adrenal glands during
stress as part of the "fight or flight" response. It helps the body
prepare to respond to threats.
o Research has shown that individuals with PTSD can experience
imbalances in cortisol levels:
 High cortisol levels: These may be a result of prolonged
activation of the stress response, which can exacerbate
PTSD symptoms.
 Low cortisol levels: Low cortisol is also linked to PTSD,
with studies showing that lower levels of this hormone
increase the risk of developing PTSD.
o Evaluation: Testing for cortisol imbalances can help identify
individuals at risk of PTSD, allowing for earlier intervention.
However, it is important to note that cortisol imbalance alone
does not fully explain PTSD, and other factors, including genetics
and life experiences, play a role.
2. Genetics and PTSD:
o A study by Nievergelt et al. (2019) explored the role of genetics
in PTSD by analyzing genetic data from 200,000 individuals
globally. The study found that genetics account for 5-20% of the
risk for PTSD.
o The study suggests that certain gene variants inherited from
parents may predispose individuals to PTSD.
o Evaluation: This research supports the notion of a genetic
 vulnerability to PTSD. However, the genetic link may be
influenced by personality traits and environmental factors, as
seen in twin studies where identical twins may not both develop
PTSD despite having the same genes. This highlights the
complex interaction of nature (genetics) and nurture
(environment).
Cognitive Influence: Dual Representation Theory:
 Dual Representation Theory (Brewin et al., 1996) explains
PTSD symptoms in terms of two memory systems:
1. Verbally Accessible Memory System (VAM): This system
processes information consciously and can be deliberately
recalled.
2. Situationally Accessible Memory System (SAM): This system
processes information unconsciously and is difficult to recall
intentionally or in an organized manner.
 During a traumatic event, the VAM is impaired, while the SAM
continues to process the event. This leads to symptoms such
as flashbacks, where the individual re-lives the trauma
unconsciously.
 Emotional Processing Endpoints (Post-Trauma):
1. Completion: Successful recovery where traumatic memories are
processed and integrated.
2. Chronic Emotional Processing: Incomplete integration, leading to
persistent symptoms and potentially secondary conditions (e.g.,
OCD).
3. Premature Inhibition of Processing: Avoidance of trauma
memories, leading to reactivation of symptoms later on.
 Evaluation: The Dual Representation Theory is valuable for
understanding PTSD from a cognitive perspective, particularly in the
way memories of trauma are processed. It aligns well with biological
explanations, such as the role of cortisol. However, one criticism is the
unclear interaction between the VAM and SAM systems, and how they
work together during traumatic memory processing. The theory lacks
clarity on how these memory systems communicate.
Prolonged Exposure Treatment for PTSD:
 Prolonged Exposure (PE) is a leading therapeutic approach for treating
PTSD, developed by Dr. Edna Foa. The treatment involves confronting
traumatic memories and emotions that individuals with PTSD have
been avoiding.
 Four Key Elements of PE:
1. Psychoeducation: Educating clients about the psychological
responses to trauma and how these responses contribute to
PTSD.
2. Breathing Techniques for Relaxation: Teaching clients to control
 their breathing to manage emotional distress during therapy.
3. In Vivo Exposure: Gradual exposure to real-life trauma-related
situations (e.g., entering an airport after a plane crash) in a safe
and controlled manner. Over time, clients learn to tolerate the
emotional and physical responses associated with these
triggers.
4. Imaginal Exposure: Clients repeatedly recall and verbalize the
traumatic memories with a therapist, helping to process and
integrate these memories into a non-traumatic framework.
 Evaluation:
o Strengths:
 Gradual process: The hierarchy-based exposure allows for
personalization, making the treatment flexible and
adaptable for various types of trauma.
 It can be combined with other therapies (e.g.,
medication) to enhance effectiveness.
 It is now considered one of the most effective treatments
for PTSD.
o Limitations:
 If the client is still in a traumatic environment or lacks a
support system, PE can be too risky and may exacerbate
symptoms.
 Clients may find recording and listening to sessions
uncomfortable, raising concerns about privacy and
emotional distress.
 Willingness: The client must be willing and able to
participate in exposure therapy, which can be challenging
if the trauma is still fresh or overwhelming.

Summary and Evaluation:

1. Biological Factors:
o Cortisol imbalances (either high or low) are associated with
PTSD and may provide a biological marker for identifying those
at risk.
o Genetic predisposition accounts for a significant portion (5-20%)
of PTSD risk, though personality and environmental factors are
also crucial.
2. Cognitive Factors:
o The Dual Representation Theory provides valuable insight into
PTSD symptoms, focusing on how traumatic memories are
stored and processed differently. While it integrates well with
biological explanations, the interaction between memory
systems is not fully understood.
3. Treatment (Prolonged Exposure):
 o Strength: Effectiveness in Reducing PTSD Symptoms Prolonged
Exposure Therapy (PE) has been shown to be highly effective in
reducing PTSD symptoms by confronting trauma-related
memories and avoidance behaviors. It works by helping
individuals face their fears in a controlled and gradual manner,
allowing them to process and integrate traumatic memories.
o Study Support: One study supporting the effectiveness of PE is
by Foa et al. (2005), which examined the efficacy of PE for
individuals with PTSD resulting from sexual assault. The study
found that PE significantly reduced PTSD symptoms and
avoidance behaviors, with participants showing improvements in
emotional responses and intrusive memories. The study
concluded that PE is a leading treatment for PTSD and is more
effective than other therapeutic approaches like supportive
counseling.
o Limitation: Potential for Emotional Overwhelm and Attrition
One limitation of Prolonged Exposure Therapy is that some
individuals may experience emotional overwhelm during
exposure to traumatic memories. This can be particularly
challenging for those who are in an unstable environment or
who have inadequate support systems. The risk of emotional
distress during therapy can sometimes lead to attrition or drop-
out from treatment, as some clients may find it difficult to cope
with the intensity of the exposure process.
o Study Support: In a study by Cahill et al. (2006), it was found
that although PE is effective, about 30% of participants
discontinued treatment due to emotional distress or
dissatisfaction with the process. The study highlighted that for
individuals still in a traumatic environment or lacking sufficient
emotional resources, the intensity of PE could be too
overwhelming and result in treatment discontinuation.
o Prolonged Exposure Therapy is a well-supported,
effective treatment for PTSD, but its intensity and
emotional demands can be challenging for certain
individuals, particularly those with less emotional
support or ongoing trauma.

Eftekhari's Study of Prolonged Exposure for the Treatment of Chronic

PTSD (2006)
Aim:
The aim of this study was to review the effectiveness of prolonged exposure
(PE) therapy in treating chronic PTSD by evaluating previous studies
conducted between 1991 and 2005.
Method:
This study was a meta-analysis or review that assessed six studies of PE,
all focusing on severe trauma (specifically following serious assaults). Each of
the six studies used the core components of Prolonged Exposure therapy:
1. Psychoeducation: Teaching the patient about PTSD and the treatment
process.
2. Breathing and relaxation techniques: Helping the patient control
anxiety.
3. In vivo exposure: Gradual exposure to trauma-related situations to
stop avoidance behavior.
4. Imaginal exposure: Repeated recounting of traumatic memories.
Each study involved 9–12 individual sessions, with each session lasting
around 2 hours. After completing treatment, patients also had follow-up
sessions 3 to 12 weeks later to assess the long-term effects of the therapy.
Results:
All six studies showed large and sustained improvements in PTSD
symptoms following PE treatment. Patients demonstrated significant
reductions in the severity of their PTSD symptoms, and the improvements
were maintained over time.
Conclusion:
The study concluded that prolonged exposure is highly effective for
treating PTSD. By confronting and recounting traumatic memories, as well as
re-approaching trauma-related situations, patients can reduce fear and
separate past traumatic experiences from their present reality, which
is central to overcoming PTSD.

Evaluation of the Study

Why the Study is Important:
1. Large Sample Size:
The study was a review of six studies, meaning the sample size was
considerably larger than any single study. This allows the results to be
more generalizable to a wider population.
2. Longitudinal Evidence:
Since the studies spanned over a 14-year period, the findings
demonstrate the effectiveness of PE over time. This longitudinal
approach strengthens the claim that PE is a reliable and sustained
treatment for PTSD.
3. Guidelines for Therapists:
The research offers practical evidence and guidelines for clinicians,
helping them understand the benefits of PE in real-world applications
and providing support for implementing it as a treatment option for
PTSD.
Limitations of the Study:
1. Unclear Most Beneficial Components:
The review does not specify which part of the Prolonged Exposure
 treatment is most beneficial. For example, it is unclear whether
imaginal exposure, in vivo exposure, or another component has
the most significant effect on improving PTSD symptoms. More
research is needed to isolate which techniques are most effective.
2. Cultural Considerations:
There is limited research on the effectiveness of PE with different
cultural groups. This is important, as trauma experiences and coping
mechanisms may differ across cultures, and treatment approaches may
need to be adapted accordingly.
3. Therapist Reluctance:
Some therapists are reluctant to engage in PE because it requires
patients to recount their trauma, which some believe might increase
symptoms or cause dropout rates. This reluctance can affect the
implementation of PE in clinical settings.
4. Potential Dropout Rates:
Despite the effectiveness of PE, the emotional intensity of
recounting traumatic experiences can be overwhelming for some
individuals. As a result, there is a risk of dropout, and therapists may
hesitate to proceed with this type of treatment.

Summary
Eftekhari's study provides strong evidence supporting the effectiveness of
Prolonged Exposure Therapy for chronic PTSD. By reviewing multiple
studies, the research demonstrates that PE can significantly reduce PTSD
symptoms and help individuals regain control over their emotional responses
to trauma. However, the study also highlights gaps in understanding, such as
which aspects of PE are most effective and how to best adapt the treatment
for diverse cultural groups. Despite these limitations, the study offers valuable
insights for both clinicians and researchers seeking to improve PTSD
treatments.