Discussion
anger, anxiety, MPE, PTSD, depression
DISORDER, SECONDARY
The current study aimed to assess whether the longevity of treatment gains for MPE therapy was non-inferior to SPE therapy, and to ascertain whether MPE was non-inferior to SPE in the impact on secondary outcome measures. As hypothesised, MPE and SPE maintained a reduction in PTSD severity at 12 months, consistent with outcomes reported at 12 weeks (Dell et al., The emergence of MPE in recent years has been a promising advancement in the field, however until now, the long-term gains of a massed protocol have not been examined in a large-scale high-quality RCT. The effect size for PTSD symptom changes from baseline to 12 months was large and MPE was non-inferior to SPE. Further, the percentage of individuals who lost their diagnosis was sustained from T3 (Dell et al., It is widely acknowledged that patients experiencing PTSD frequently have comorbid mental health issues, particularly military and veteran patients. While significant reductions in depression, anxiety, and anger have been reported following SPE therapy (Aderka et al., Alongside the reductions in PTSD and other comorbid mental health conditions, improvements in quality of life were observed for both groups at 12 weeks and maintained at 12 months. This finding is consistent with recent SPE research (Schnurr et al., The outcomes of this study should be considered with limitations in mind. First, measures of comorbid mental health conditions were all self-reported and may not accurately reflect the rates present in the population. Second, the extent to which these findings can be applied to populations other than military and veterans is yet to be determined, and with the sample being predominantly male, there is the question of applicability of the results to females. Third, the substantial observed loss to follow-up requires us to exert some caution in interpretation of the results. Lastly, while the current findings contribute to increasing evidence for MPE's clinical utility, it is worth acknowledging that prolonged exposure may be suitable for certain clinical presentations, while another evidence-based treatment may be most suitable for others. It is imperative characteristics relevant to optimal treatment response continue to be explored. Similarly, MPE may not be suitable for all therapists given the intensity of treatment delivery and requirement to allow for five sessions with one individual per week.This study demonstrated that MPE was non-inferior to SPE in the reduction and maintenance of PTSD symptomatology and loss of diagnosis up to 12 months following therapy. Comparable reductions in depression, anxiety, and anger symptoms were also evident across the two treatments. The PTSD treatment field is cognisant of the front-line treatments for the disorder, however in a practical clinical setting, these treatments need to be offered in a modality that will suit patients and the demands of their life, particularly given that patients who are provided their preferred treatment are more likely to adhere and report greater reductions in self-reported mental health issues (Zoellner, Roy-Byrne, Mavissakalian, & Feeny, 