The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition.

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The present study examines a recently proposed model of suicide behavior in a group of college-aged suicide ideators. The model focuses on the relationship between negative life stress, cognitive rigidity and/or poor problem-solving skills, hopelessness, and suicide ideation and attempting. In short, this model proposes that individuals deficient in the capacity for divergent thinking are cognitively unprepared to cope with the high levels of life stress observed in populations of suicide attempters, and, as a result, are likely to become hopeless under such circumstances. This ensuing state of hopelessness resulting from the individual's inability to engage in effective problem-solving places the individual at risk for suicidal behavior. Results indicate that college-student suicide ideators are under higher levels of negative life stress, are more hopeless, and have higher levels of depression than their nonideating peers. Although no relationship was observed between suicide ideation and cognitive rigidity or suicide intent and cognitive rigidity, poor problem-solvers under high stress were found to be significantly higher on suicide intent than any other group. The results are interpreted as offering support for a stress-problem-solving model of suicidal behavior in which poor problem-solvers under high life stress are considered to be at risk for depression, hopelessness, and suicidal behavior.

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Fifty-two women who served during the Vietnam era were assessed for war-zone exposure, traumatic life events, post-traumatic stress disorder (PTSD), and self-reported health status. Symptoms of PTSD were examined as mediators in the relationship between traumatic exposure and subsequent reports of health problems. Results showed that PTSD symptoms accounted significantly for variance in health problems reported by women with prior traumatic stressor exposure. When the cardinal symptom domains of PTSD (re-experiencing, numbing, avoidance, hyper-arousal) were analyzed separately, the symptom cluster representing hyper-arousal accounted uniquely for the variance associated with health complaints, beyond that contributed by other symptom clusters. Discussion of the results focuses on mechanisms underlying the relationship between specific symptoms of PTSD and self-reported health. Implications for intervention within the medical system are also considered.

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The purpose of the current study was to examine the relationship between childhood abuse, social support, and problem-solving appraisal within a juvenile delinquent sample. Hierarchical regression analyses were used to assess whether childhood abuse, social support, and problem-solving appraisal were independently predictive of suicidality, and further, whetherproblem-solving appraisal and social support moderated the childhood abuse-suicidality relationship. Childhood sexual abuse was found to be an independent predictor of suicidal ideation and behavior. In addition, both problem-solving confidence and social support moderated the relationship between childhood abuse and suicidal ideation. The results of this study underscore the importance of both problem-solving appraisal and social support to suicidality in adolescents with a history of abuse.