In the presented case, “Daryl” experienced 12 hr of uncertainty regarding the safety of a friend before learning the friend was killed during the April 16th shootings at Virginia Tech. Treatment began 4 years following the shootings. Daryl has two previous premature terminations, was treatment resistant, and at high risk for dropping out. Prolonged exposure (PE) was postponed for nine sessions while comprehensive assessment and psychoeducation occurred. PE took place over 15 sessions, with follow-ups occurring at 3, 6, and 12 months following treatment. During PE, a second shooting and accompanying deteriorating sleep led to brief pauses and modification of treatment. Daryl showed marked reduction of posttraumatic stress disorder (PTSD) symptoms throughout the course of treatment, resulting in complete remission of PTSD at the end of formal treatment as he maintained gains during follow-ups. The case study demonstrates the usefulness of symptom monitoring, specific modifications used within treatment, and the importance of assessing for preparedness for treatment.
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