Revista de Psicologia e Psicoterapia
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Examining Emotional Engagement during Prolonged Exposure Therapy with Mobile Psychophysiological Technology: A Prospective Study

Alexandra H. Cowden Hindash1,2,3*, Anna H. Staudenmeyer1,4*, Allison Diamond Altman5, Callan Lujan6, Anna Kim1, Martha Schmitz1,2, Sabra S. Inslicht1,2

This case study provides an example of the potential benefit of augmenting Prolonged Exposure therapy with sensory
cues while integrating psychophysiological measurement into clinic-based PTSD psychotherapy. With reference to
the emotion processing theory of PTSD, we highlight the potential of integrating psychophysiological measures
during treatment to shed light on a person’s emotional engagement with their trauma memory. Further, we explore
potential differences when processing is focused on a discrete traumatic event during adulthood compared with
processing a prototypical event from repeated childhood abuse within the same individual. Objective data from
both skin conductance and heart rate, measured by photoplethysmography, were analyzed and compared with
subjective measures of distress throughout 23-sessions of psychotherapy. Bivariate correlations between physiological
and self-reported distress suggest changes in concordance between objective and subjective distress measurements
observed throughout treatment, particularly within sessions identified via clinical judgment as pivotal change
sessions. Exemplar sessions are presented to illustrate the utility of integrating psychophysiological reactivity
measures into a standard clinic-based PTSD treatment. We conclude with a clinical perspective on the potential
benefit of protocol augmentation, the limitations of symptom measures that may not adequately portray therapeutic
processes in complex trauma cases, and provide future directions related to the fruitful integration of sensory cues
and psychophysiological measurement into therapeutic procedures.