Direct comparison of reconsolidation of traumatic memories and prolonged exposure therapy: A randomized controlled trial.

New therapies are needed for posttraumatic stress disorder (PTSD), particularly in military service members (SMs). Reconsolidation of traumatic memories (RTM) is a novel treatment with promising results in small clinical trials. We randomized 94 active duty or retired SMs (Mage = 45.80, 31.0% women) with PTSD to receive up to ten 90-min sessions of RTM (n = 48) or prolonged exposure (PE; n = 46) to ascertain whether RTM achieved a greater and/or faster response. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was used to establish eligibility and assess response at 2 weeks and 2, 6, and 12 months postintervention. The PTSD Checklist for DSM-5 was administered before Sessions 2, 4, 6, 8, and 10 to assess response rapidity. We hypothesized that RTM would achieve quicker responses and higher loss of diagnosis rates than PE. From baseline to postintervention, participants in both the RTM (39.13 vs. 22.38), d = 1.42, p < .001, and PE groups (39.26 vs. 22.45), d = 1.50, p < .001, showed improvement on the CAPS-5, with no between-group difference, p = .959. Response (RTM: 74.2%, PE: 72.4%), loss of diagnosis (RTM: 58.1%, PE: 51.7%), and withdrawal (RTM: 18.8%, PE: 32.6%) rates showed no significant differences. Gains were largely sustained through 12 months. RTM had more early responders (72.2%) than PE (27.8%), p = .005; 70.0% of participants addressed multiple traumas with RTM versus 30.0% for PE, p = .022. RTM and PE demonstrated comparable large effect sizes, but RTM achieved more early responses.