, Volume 7, Issue 2, pp 127–133

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

  • Jo M. Weis
  • Brad K. Grunert
  • Heidi Fowell Christianson
Therapy Articles

DOI: 10.1007/s11552-012-9408-2

Cite this article as:
Weis, J.M., Grunert, B.K. & Christianson, H.F. HAND (2012) 7: 127. doi:10.1007/s11552-012-9408-2



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.


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.


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.


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


Posttraumatic stress disorderUpper extremity injuriesPsychologyImaginal exposureTime of intervention

Copyright information

© American Association for Hand Surgery 2012

Authors and Affiliations

  • Jo M. Weis
    • 1
  • Brad K. Grunert
    • 2
  • Heidi Fowell Christianson
    • 1
  1. 1.Department of Psychiatry and Behavioral MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of Plastic and Reconstructive SurgeryMedical College of WisconsinMilwaukeeUSA