A Data-Driven Perspective: Response to Commentaries by Maguen and Burkman (2013) and Steenkamp et al. (2013)

We respond to commentary from and on our presentation of how to use PE to treat PTSD resulting from perceived perpetration (). We focus our response on the distinction between moral injury, which can result in many potential mental health outcomes, with various treatment plans coming out of the patientʹs presentation, and treatment of PTSD resulting from trauma that may or may not include moral injury. We then focus on the strong evidence base that supports the use of PE for PTSD across trauma types and across many complicated patient presentations, including evidence within veteran populations. We respond to common misunderstandings of PE and Emotional Processing Theory that underlie this treatment model. Specifically, we discuss the flexibility that is inherent in the PE model, reassert that PE focuses on whatever emotion/s are present and provoked by direct confrontation of traumatic material (e.g., reminders, memories), and discuss that habituation is not the only process at work in PE. As such, shame and guilt related to moral injury can be effectively addressed, as noted in Smith et al. Finally, rather than developing a new and unproven model of treatment as the commentaries propose, we assert that given the strong evidence base for efficacy and effectiveness of PE for PTSD and the significant and ongoing investment in dissemination of PE, continued support for providers on how to effectively use PE with difficult patients is warranted.