Prolonged exposure therapy for the bereaved with subthreshold post‐traumatic stress disorder related to suicide loss: A case report

Abstract Background Subthreshold post‐traumatic stress disorder (PTSD) is associated with nearly the same impairment level as full PTSD. However, the standard treatment for subthreshold PTSD remains unclear. Furthermore, no consensus has been reached on the best way to address grief following the improvement of PTSD symptoms. Case Presentation A single Japanese woman in her 50s experienced sudden fear and insomnia after her only son committed suicide. She visited our hospital 6 months after the death and was diagnosed with depression and subthreshold PTSD. Pharmacotherapy slightly improved her depression and insomnia, but no improvement was observed in her PTSD symptoms, therefore she underwent 13 prolonged exposure (PE) sessions, including grief care in the final two sessions. Through imaginal exposure, she was able to feel her anger toward her deceased son and the feelings he had at the time of the suicide for the first time. Furthermore, as she processed her feelings about her son's suicide, her perception changed, which substantially alleviated her depressive and PTSD symptoms. After her PTSD symptoms improved, she felt sadness for his loss. Consequently, the grieving process was facilitated. Conclusion PE incorporating brief grief care may be effective for the bereaved with suicide‐related PTSD symptoms.