Objectives A previous pilot trial evaluating computer-based cognitive behavioral therapy (CBT4CBT) among 77 heterogeneous substance users (alcohol, marijuana, cocaine, opioids) provided preliminary support for its efficacy in the context of a community-based outpatient clinic. Aims of the present trial were to conduct a more definitive trial in a larger, more homogeneous sample. Methods Randomized clinical trial in which 101 cocaine-dependent methadone maintained individuals were randomized to standard methadone maintenance or methadone maintenance with weekly access to CBT4CBT, with 7 modules delivered within an 8 week trial. Results Treatment retention and data availability were high and comparable across the treatment conditions. Participants assigned to the CBT4CBT condition were significantly more likely to attain three or more consecutive weeks of abstinence from cocaine (36 versus 17%, p<.05, OR=.36). The group assigned to CBT4CBT also had better outcomes on most dimensions, including urine specimens negative for all drugs, but these reached statistical significance only for the completer sample (N=69). Follow-up data collected 6 months after treatment termination were available from 93% of the randomized sample; these indicated continued improvement for those assigned to the CBT4CBTgroup, replicating previous findings regarding its durability. Conclusions This trial replicates earlier findings indicating CBT4CBT is an effective adjunct to addiction treatment with durable effects. CBT4CBT is an easily disseminable strategy for broadening the availability of CBT, even in challenging populations such as cocaine-dependent individuals enrolled in methadone maintenance programs. Clinical trials.gov ID number NCT00350610

A social‐ecological framework for resilience underscores the importance of conceptualizing individuals embedded within their context when evaluating a person's vulnerability and adaptation to stress. Despite a high level of trauma exposure, most veterans exhibit psychological resilience following a traumatic event. Interpersonal trauma is associated with poorer psychological outcomes than noninterpersonal trauma and is experienced more frequently across the lifespan by women as compared to men. In the present study, we examined gender differences in trauma exposure, resilience, and protective factors among veterans. Participants included 665 veterans who completed a baseline survey assessing traumatic events; 544 veterans (81.8%) completed a 1‐year follow‐up survey assessing resilience, combat exposure, deployment social support, deployment preparedness, and military sexual trauma (MST). Principal component analyses revealed the Traumatic Life Events Questionnaire categorized into four meaningful components: sexual abuse, interpersonal violence, stranger violence, and accidents/unexpected trauma. Women reported greater exposure to sexual abuse, d = 0.76; interpersonal violence, d = 0.31; and MST, Cramer's V = 0.54; men reported greater exposure to stranger violence, accidents/unexpected trauma, and combat exposure, ds = 0.24–0.55. Compared to women, men also reported greater social support during deployment, d = 0.46. Hierarchical linear regression indicated that men's resilience scores were higher than women's, β = .10, p = .032, yet this association was no longer significant once we accounted for trauma type, β = .07, p = .197. Results indicate that trauma type is central to resilience and suggest one must consider the social‐ecological context that can promote or inhibit resilient processes.

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Objective: This study explores trauma exposure, posttraumatic stress disorder (PTSD) symptoms and diagnosis, and PTSD symptom associations with key presenting problems in male intimate partner violence (IPV) perpetrators. The goal is to elucidate the implications of trauma and PTSD for understanding the presenting clinical problems of partner violent men. Method: Male IPV perpetrators (n = 293) at a community-based agency completed assessments of their past traumatic event exposures; current PTSD symptoms; depression; alcohol problems; illicit drug use; relationship problems; and perpetration of physical assault, psychological aggression, injury, sexual coercion, and general (nonrelationship) violence. Results: Seventy-seven percent of participants reported past trauma exposure, 62% reported multiple trauma exposures, and 11% screened positive for a probable diagnosis of PTSD. PTSD symptom levels were significantly correlated with depression, alcohol and drug use, general violence, and all indicators of relationship maladjustment and abuse. In multivariate analyses, PTSD symptoms uniquely predicted relationship dysfunction and relationship abuse over and above the influence of alcohol problems, drug use, and depression, and all 3 PTSD symptom clusters had some unique associations with relationship abuse scales. Conclusion: Trauma exposure and PTSD symptoms should be routinely assessed in IPV perpetrator treatment. More research is needed to determine whether PTSD symptoms influence treatment response and to investigate trauma-informed interventions for this population.