Prolonged exposure (PE) is recognized in many guidelines as an effective, evidence based treatment for post-traumatic stress disorder (PTSD), with the active ingredients being in vivo and imaginal exposure. Despite this, patients and clinicians are often reluctant to engage in this form of treatment. Imaginal exposure can be perceived as too anxiety proving, leading to discomfort among both patient and clinician. In vivo exposure alone, however, has also been established as an effective treatment for anxiety disorders that can provide significant results in a rapid manner.

A 31-year-old female with no prior psychiatric history presented to treatment in an acute depressive episode following a motor vehicle accident two years prior. She also met criteria for PTSD. Her Beck Depression Inventory (BDI) and PTSD Checklist for DSM-5 (PCL–5) scores were 42 (severe depression) and 64, respectively. Due to constraints, a modified form of PE was initiated, with five in vivo exposure sessions conducted.

After five sessions of in vivo exposure, the patient's PCL–5 score decreased from 64 to 36 and her BDI score decreased from 42 to 13 (minimal depression).

This case report underscores the effectiveness of a modified form of PE, using in vivo exposure alone as a treatment for PTSD. This has significant implications in particular for patients or clinicians who are unable to initiate imaginal exposure (e.g., patient finding it too difficult to tolerate/refusing to engage, language barriers, etc.). In such situations, in vivo exposure appears to be an alternate, effective, short-term treatment option.

The authors have not supplied their declaration of competing interest.