Sheba Research Examines Prolonged Exposure Therapy for PTSD 

The study analyzed treatment records from 98 patients with chronic PTSD, who completed prolonged exposure therapy (PE) between 2008 and 2017 at two institutions in Israel: Sheba Medical Center and the Ramat-Chen Brüll Mental Health Center. Among the researchers behind the study was Dr. Nitsa Nacasch Axelrod, Director of the Dror Clinic for Cognitive-Behavioral Therapy at Sheba.

Patient Segmentation and Study Approach

Patients were grouped in two ways. First, by trauma type: combat-related, terror-related, or civilian trauma, with civilian trauma referring to non-combat, non-terror incidents such as motor vehicle accidents or sexual assault. Second, by veteran status: whether a patient was a military veteran or a civilian. These classifications overlap, but they are not identical. Civilians could fall into the terror-related or civilian trauma categories, while veterans were limited to the combat- and terror-related categories.

PTSD symptoms were measured before and after treatment using the PTSD Symptom Scale–Interview Version (PSS-I), a semistructured clinical interview. Researchers then compared symptom change across the trauma-type groups and separately across the veteran-status groups.

Different Starting Points, Similar Outcomes 

Patients with combat- and terror-related trauma, as well as military veterans generally, began treatment with notably higher symptom severity than civilians or those with civilian-type trauma. Despite this gap, all groups showed large, statistically similar improvements by the end of therapy and significant decreases in PTSD symptom severity from pre- to post-treatment.

This finding stands apart from some earlier meta-analyses, which suggested prolonged exposure therapy produces smaller effect sizes for combat-related PTSD compared with civilian trauma. The study’s authors point to several possible factors, including that in this sample, all patients, regardless of background, were treated at the same community clinics under the same clinical supervision model.

The Unique Israeli Context

The authors note that their findings should be read within Israel’s specific circumstances. Military service in Israel is mandatory, meaning many civilians in the sample also had a history of service, even if not in combat roles. This creates a veteran population that is demographically closer to the general civilian population than in countries with voluntary military enlistment, which the authors say may help explain why no significant difference in treatment response emerged between the groups.

Israel has also faced recurring periods of conflict and terrorism in recent years, exposing both civilians and military personnel to trauma that might otherwise be considered distinct categories. The authors suggest this overlapping exposure is one reason a treatment shown effective across trauma types and patient backgrounds carries particular relevance in this setting, though they caution that the same demographic overlap that shaped their findings may limit how directly the results apply to countries with voluntary military service.

Clinical and Real-World Implications

This study demonstrates the applicability of prolonged exposure therapy across different trauma types and patient backgrounds. Its findings suggest that civilians exposed to terrorism, as well as military personnel who have endured combat under extreme conditions, may benefit from this treatment if they develop PTSD, offering hope to those facing the psychological aftermath of trauma in conflict-affected settings.

That commitment to evidence-based care and meaningful outcomes reflects the same standard of excellence that has helped earn Sheba its Newsweek recognition as one of the World’s Best Hospitals.

Related Publication: Comparing treatment outcomes of prolonged exposure therapy across trauma type and veteran status