4 Studies of CBT with PTSD

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C. & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867-879. ABSTRACT - The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure therapyand a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred and seventy-one female rape victims were randomized into one of three conditions and 121 completed treatment. Participants were assessed with the Clinician-administered PTSD Scale, the PTSD Symptom Scale, the Structured Clinical Interview for DSM-IV, the Beck depression Inventory, and the Trauma-Related Guilt Inventory. Independent assessments were made at pre-treatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highl effecatious and superior to MA. The two therapies had similar effects except that CPT produced better scores on 2 of 4 guilt subscales.

Nishith, P., Resick, P. A., & Griffin, M.G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880-886. ABSTRACT - Curve estimation techniques were used to identify the pattern of therapeutic change in female rape victims with posttraumatic stress disorder (PTSD). Within session data on the Posttraumatic Stress Disorder Symptom Scale were obtained, in alternate therapy sessions, on 171 women. The final sample of treatment completers included 54 prolonged exposure (PE) and 54 cognitive-processing therapy (CPT) completers. For both PE and CPT, a quadratic function provided the best fit for the total PTSD, reexperiencing, and arousal scores. However, a difference in the line of best fit was observed for the avoidance symptoms. Although a quadratic function still provided a better fit for the PE avoidance, a linnear function was more parsimonious in explaining the CPT avoidance variance. Implications of the findings are discussed.

Koss, M. P., Figueredo, A. J. & Prince, R. J. (2002). Cognitive mediation of rape's mental, physical, and social health impact: Tests of four models in cross-sectional data. Journal of Consulting and Clinical Psychology, 70, 926-941. ABSTRACT - Four nested, theoretically specified, increasingly complex models were tested representing cognitive mediation of rape's effects on mental, physical, and social health. Data were cross-sectional (N=253 rape survivors). Outcomes were standardized assessments of social maladjustment, physical, and psychological symptoms, including posttraumatic stress disorder (PTSD). The best-fitting model was not fully cognitively mediated. Personological and rape characteristics influenced the level of self-blame experienced and the intensity of maladaptive beliefs about self and others. Self-belam and maladaptive beliefs predicted psychological distress, which strongly influenced all health outcomes. Self-rating of rape memory characteristics contributed little to predicting postrape distress. The model accounted for 56% of the variance in general distress, including 91% of the psychological symptom severity; 54% of PTSD symptoms; 65% of social maladjustment; and 17% of physical symptoms. Longitudinal replication is planned.

Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A. & Alvarez-Conrad, J. (2002). Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and Clinical Psychology, 70, 1022-1028. ABSTRACT - Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concern that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation nwas examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptom exacerbation. Individuals who reported symptom exacerbation benefitted comparable from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.

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