Skip to main content
SpringerLink
Log in

Early versus delayed imaginal exposure for the treatment of posttraumatic stress disorder following accidental upper extremity injury

  • Therapy Articles
  • Published:
HAND

Abstract

Background

The consequences following work-related injuries are far reaching, which are in part due to unrecognized and untreated posttraumatic stress disorder (PTSD). Imaginal exposure is a frequently used cognitive behavioral approach for the treatment of PTSD. This study examined the impact of early versus delayed treatment with imaginal exposure on amelioration of PTSD symptomatology in individuals who suffered upper extremity injuries.

Methods

Sixty individuals who suffered severe work-related injuries received standard, non-randomly assigned psychological treatment for PTSD (e.g., prolonged imaginal exposure) either early (30–60 days) or delayed (greater than 120 days) following severe work-related upper extremity injury. Nine measures of various components of PTSD symptomatology were administered at onset of treatment, end of treatment, and at 6-month follow-up evaluations.

Results

Patients showed significant treatment outcomes at all three measurement intervals in both the early and delayed groups demonstrating that Prolonged Imaginal Exposure is an appropriate treatment for persons diagnosed with PTSD. In addition, there was no difference in return to work status between the early and the delayed treatment groups. However, the early treatment group required significantly fewer treatment sessions than the delayed treatment group.

Conclusions

Results supported the utility of imaginal exposure and the need for early assessment and referral for those diagnosed with PTSD following upper extremity injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Amir M, Kaplan Z, Kotler M. Type of trauma, severity of posttraumatic stress disorder core symptoms, and associated features. J Gen Psych. 1996;123:341–51.

    Article  CAS  Google Scholar 

  2. Bear-Lehman J. Factors affecting return to work after hand injury. J Occup Therapy. 1983;37(3):189–94.

    Article  CAS  Google Scholar 

  3. Beck AT, Steer, R. Beck Depression Inventory. Chicago: The Psychological Corporation, Harcourt Brace Jovanovoch, Inc., 1987.

  4. Best CL, Ribbe DP. Accidental injury: approaches to assessment and treatment. In: Freedy JR, Hobfoll SE, editors. Traumatic stress: from theory to practice. New York: Plenum Press; 1995. p. 315–37.

    Google Scholar 

  5. Burgess ES, Hibler R, Keegan D, Everly Jr GS. Symptoms of posttraumatic stress disorder in workers’ compensation patients attending a work rehabilitation program. Int J Rehab Health. 1996;2(1):29–39.

    Article  Google Scholar 

  6. Cheng YH. Explaining disablement in modern times: hand-injured workers’ accounts of their injuries in Hong Kong. Soc Sci Med. 1997;45(5):739–50.

    Article  PubMed  CAS  Google Scholar 

  7. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  8. Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psych Bull. 1986;1099(1):20–35.

    Article  Google Scholar 

  9. Foa EB, Meadows EA. Psychosocial treatments for posttraumatic stress disorder: a critical review. Ann Rev Psych. 1997;48:449–80.

    Article  CAS  Google Scholar 

  10. Foa EB, Rothbaum BO, Riggs DS, Murdoc TB. Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. J Consult Clin Psych. 1991;59:715–23.

    Article  CAS  Google Scholar 

  11. Grunert BK, Devine CA, Matloub HS, et al. Flashbacks after traumatic hand injuries: prognostic indicators. J Hand Surg. 1988;13A(1):125–7.

    Google Scholar 

  12. Grunert BK, Devine CA, Matloub HS, et al. Psychological adjustment following work-related hand injury: 18 month follow-up. Ann Plast Surg. 1999;29(6):537–42.

    Article  Google Scholar 

  13. Grunert BK, Devine CA, Smith C, et al. Graded work exposure to promote work return after severe hand trauma: a replicated study. Ann Plast Surg. 1992;29(6):532–6.

    Article  PubMed  CAS  Google Scholar 

  14. Grunert BK, Dzwierzynski WW. Prognostic factors for return to work following severe hand injuries. Techniq Hand Upper Extrem Surg. 1997;1(3):213–8.

    Article  CAS  Google Scholar 

  15. Grunert BK, Hargarten SW, Matloub HS, et al. Predictive value of psychological screening in acute hand injuries. J Hand Surg. 1992;17A(2):196–9.

    Google Scholar 

  16. Grunert BK, Matloub HS, Sanger JR, Yousif NJ. Treatment of posttraumatic stress. J Hand Surg. 1990;5A(3):511–5.

    Google Scholar 

  17. Grunert BK, Smith C, Devine CA, et al. Early psychological aspects of severe hand injuries. J Hand Surg. 1988;13B(2):177–80.

    Google Scholar 

  18. Grunert BK, Smucker MR, Weis JM. When prolonged exposure fails: adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD. Cog Behav Prac. 2003;10(4):333–46.

    Article  Google Scholar 

  19. Grunert BK, Weis JM, Smucker MR, Christianson HF. Imagery rescripting and reprocessing therapy after failed prolonged imaginal exposure for post-traumatic stress disorder following industrial injury. J Behav Ther Exp Psychiat. 2007;38:317–28.

    Article  Google Scholar 

  20. Horowitz MJ, Wilner N, Alvarez W. Impact of event scale: a measure of subjective distress. Psychosomatic Med. 1979;41:209–18.

    CAS  Google Scholar 

  21. Jaycox L, Foa EB, Morral AR. Influence of emotional engagement and habituation of exposure therapy for PTSD. J Consult Clin Psych. 1998;66(1):185–92.

    Article  CAS  Google Scholar 

  22. Kaufman AS. Assessing adolescent and adult intelligence. Boston: Allyn and Bacon, Inc.; 1990.

    Google Scholar 

  23. Keane TM, Fairbank JA, Caddell JM, Zimmering RT. Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behav Ther. 1989;20(2):245–60.

    Article  Google Scholar 

  24. Malt U, Ugland OM. A long-term psychosocial follow-up study of burned adults. Acta Psychiatr Scand. 1989;80(355):94–102.

    Article  Google Scholar 

  25. Pfeffer J. Posttraumatic stress disorder. Brit J Hosp Med. 1988;39:85–6.

    Google Scholar 

  26. Scotti JR, Beach BK, Northrop LM, et al. The psychological impact of accidental injury: a conceptual model for clinicians and researchers. In: Freedy JR, Hobfol SE, editors. Traumatic stress: from theory to practice. New York: Plenum Press; 1995. p. 181–212.

    Google Scholar 

  27. Sherman JJ. Effects of psychotherapeutic treatments of PTSD: a meta-analysis of controlled clinical trials. J Traum Stress. 1998;11(3):413–33.

    Article  CAS  Google Scholar 

  28. Smith GS, Wellman H, Sorock G, et al. Injuries at work in the US adult population: contributions to the total injury burden. Amer J Pub Health. 2005;95(7):1213–9.

    Article  Google Scholar 

  29. Smucker MR, Dancu C, Foa EB, Niederee JL. Imagery rescripting: a new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress. J Cog Psychother Int Qtr. 1995;9(1):3–17.

    Google Scholar 

  30. Smucker MR, Niederee J. Treating incest-related PTSD and pathogenic schemas through imaginal exposure and rescripting. Cog Behav Prac. 1995;2:63–93.

    Article  Google Scholar 

  31. Spielberger CD. Manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychologists Press, Inc.; 1982.

    Google Scholar 

  32. Tabachnick BG, Fidell LS. Using multivariate statistics. 3rd ed. New York: Harper Collins; 1996.

    Google Scholar 

  33. Weis JM, Grunert BK. Posttraumatic stress disorder following traumatic injuries in adults. Wis Med J. 2004;03(6):27–30.

    Google Scholar 

  34. Weiseth L. The stressors and posttraumatic stress syndrome after an industrial disaster. Acta Psychiatr Scand. 1989;80(355):25–37.

    Article  Google Scholar 

  35. Wolpe J, Lazarus AA. Behavior therapy techniques. New York: Pergamon Press; 1966.

    Google Scholar 

Download references

Disclosure

The authors declare that they have no conflicts of interest, commercial associations, or intent of financial gain regarding this research.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8710 W. Watertown Plank Road, Milwaukee, WI, 53226, USA

    Jo M. Weis & Heidi Fowell Christianson

  2. Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Brad K. Grunert

Authors
  1. Jo M. Weis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brad K. Grunert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Heidi Fowell Christianson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jo M. Weis.

About this article

Cite this article

Weis, J.M., Grunert, B.K. & Christianson, H.F. Early versus delayed imaginal exposure for the treatment of posttraumatic stress disorder following accidental upper extremity injury. HAND 7, 127–133 (2012). https://doi.org/10.1007/s11552-012-9408-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11552-012-9408-2

Keywords

Search

Navigation