The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample.

Posttraumatic stress disorder (PTSD) has been associated with reduced, similar, or increased urinary cortisol levels. The authors identified a factor that might contribute to such variability when they obtained 24-hour urinary neurohormone profiles on 69 women with PTSD due to childhood sexual abuse. Half (n = 35) had subsequently experienced adult sexual abuse (ASA) while the other half (n = 34) had not. The ASA group had significantly elevated urinary cortisol, norepinephrine and dopamine levels in comparison to the non-ASA group. Neither a history of childhood or adult physical abuse nor other variables contributed to this finding. The results suggest that the psychobiological consequences of exposure to the same traumatic event may differ as a result of an interaction between age and the composite history of trauma exposure.

This article describes one hospital’s use of simulation to improve the knowledge, skills, and abilities of an emergency department team regarding the patient experience. Step-by-step instructions are provided on how to conduct the simulations in a way that allows for the practice of new skills in a safe environment—one that promotes reflection, feedback, and learning.