A Mindfulness-Integrated Therapeutic Approach to Enhance Client Engagement with Prolonged Exposure and Habit Reversal Therapy and Bolster Therapist Trainee Self-Efficacy and Distress Tolerance.

This article focuses on the integration of mindfulness practices into prolonged exposure (PE) therapy and habit reversal therapy (HRT) to treat a complex case of post-traumatic stress disorder (PTSD) with comorbid depression and body-focused repetitive behaviors (BFRBs). The case involved a 30-year-old woman with PTSD stemming from childhood sexual abuse and coercive sex, alongside trichotillomania, excoriation disorder, and severe depression. Mindfulness was employed both as a foundational practice for the therapist—a trainee with no prior trauma treatment experience—to enhance distress tolerance and self-efficacy, and as an embedded component within therapy to improve the client’s engagement and ability to tolerate distress during exposure and habit reversal exercises. Following 21 sessions of mindfulness-integrated PE and 17 sessions of mindfulness-integrated HRT, the client showed complete remission of PTSD and depression symptoms, cessation of BFRBs, and maintained these gains at one-year follow-up. The case underscores mindfulness as a promising adjunct to exposure-based treatments, particularly in enhancing therapist confidence, client adherence, and the integration of multiple therapeutic modalities for complex trauma presentations.