The 7 October 2023, terrorist attack at the Nova Festival in southern Israel caused deaths, injuries, hostage-taking and prolonged life-threatening exposure, creating an urgent need for early interventions to reduce post-traumatic morbidity. Although prolonged exposure is an established post-traumatic stress disorder (PTSD) treatment, its feasibility and benefit during ongoing threat remain unclear.

This preliminary study evaluated a war-adapted brief prolonged exposure protocol (WBPE) delivered shortly after trauma in Nova Festival survivors with acute stress disorder.

Forty survivors completed the WBPE and were assessed at baseline and immediately post treatment. A subsample of 27 WBPE completers and 18 untreated wait-list controls was reassessed after 5 months. Outcomes were PTSD (PDS-5), depression (PHQ-9) and anxiety (GAD-7) symptom severity.

WBPE was associated with significant reductions in PTSD, depression and anxiety immediately after treatment. At 5 months, WBPE participants showed greater reductions in PTSD and depressive symptom severity and lower PTSD and depression symptom scores than controls, with large effect sizes. Anxiety symptoms improved in both groups, consistent with possible natural recovery. Clinically significant depressive symptoms (48.15 v. 77.78%) and anxiety symptoms (37.04 v. 72.22%) were less frequent in WBPE participants than controls, whereas probable PTSD rates did not differ significantly. Substance use during the study period was associated with poorer outcomes and smaller symptom reductions.

WBPE appears feasible and potentially beneficial under wartime conditions, with meaningful improvements in PTSD and depression despite persistent threat. Substance use was linked to poorer recovery and should be systematically assessed in post-trauma care.