A 12-Year Longitudinal Case Report: Integrating Schema Therapy and Prolonged Exposure in Delayed-Onset PTSD Following the Great East Japan Earthquake

Abstract

Objectives: This case study examined the long-term course and treatment of posttraumatic stress disorder (PTSD) following the 2011 Great East Japan Earthquake (GEJE) and nuclear disaster. Specifically, this study investigated the role of early maladaptive schemas (EMSs) and coping modes in symptom persistence, the interplay between physical health issues and PTSD symptoms, and the efficacy of a staged treatment approach. Methods: We present a 12-year longitudinal case study of a woman with delayed-onset PTSD. The patient underwent a staged treatment comprising supportive therapy, schema therapy, and prolonged exposure (PE) therapy. Treatment progress and symptom manifestations were qualitatively analyzed, focusing on schema modifications, coping mode changes, and trauma processing. Results: The key findings were: (1) EMSs (e.g., enmeshment and subjugation) contributed to PTSD symptom maintenance and influenced postdisaster interpersonal patterns; (2) maladaptive coping modes played a role in symptom persistence and delayed disease onset; (3) the observed cyclical pattern of symptom exacerbation was particularly evident in the anniversary effect; (4) the staged treatment approach effectively addressed complex PTSD, with schema therapy facilitating subsequent trauma-focused interventions. Conclusion: This study highlights the potential of combining schema therapy and PE to treat complex delayed-onset PTSD following compound disasters. This underscores the importance of addressing the underlying cognitive structures and coping mechanisms alongside trauma-focused interventions. These findings have implications for postdisaster long-term mental healthcare planning and suggest directions for future research to optimize treatment approaches for persistent PTSD.