The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred seventy-one female rape victims were randomized into 1 of the 3 conditions, and 121 completed treatment. Participants were assessed with the ClinicianAdministered 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 pretreatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highly efficacious and superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales.Cognitive-processing therapy (CPT) was introduced as a possible treatment for posttraumatic stress disorder (PTSD) nearly a decade ago. CPT, specifically designed for the treatment of PTSD resulting from sexual assault, consists of two integrated components: cognitive therapy and exposure in the form of writing and reading about the traumatic event Resick & Schnicke, 1992. The therapy focuses initially on assimilated-distorted beliefs such as denial and self-blame. Then the focus shifts to overgeneralized beliefs about oneself and the world. Beliefs and assumptions held before the trauma are also considered. Clients are taught to challenge their beliefs and assumptions through Socratic questioning and the use of daily worksheets. Once dysfunctional beliefs are deconstructed, more balanced self-statements are generated and practiced. The exposure component consists of having clients write detailed accounts of the most traumatic incident(s) that they read to themselves and to the therapists. Clients are encouraged to experience their emotions while writing and reading, and the accounts are then used to determine "stuck points": areas of conflicting beliefs, leaps of logic, or blind assumptions.In addition to a series of case study reports that indicated the therapy to be promising (Calhoun & Resick, 1993;Resick & Markway, 1991), Resick and Schnicke (1992) reported on CPT presented in a group-therapy format as compared with a naturally occurring wait-list condition. This 12-session therapy appeared to be effective for both PTSD and depressive symptoms in a first report in which 19 women treated with CPT were compared with 20 wait-list women. At 3-and 6-month follow-ups, none of the treated women met the NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript criteria for PTSD (Resick & Schnicke, 1992). Although there was no specific bias in assignment to condition, there was not, unfortunately, random assignment to groups, nor was there independent assessment. Subsequently, the treatment manual was published with data reported on 36 women who were treated in a group format and 9 who completed individual treatment. The therapy package continued to be quite promising.Clearly, the ...

This study evaluated (a) whether chronic, medicated schizophrenia patients show deficits in emotion recognition compared to nonpatients, and (b) whether deficits in emotion recognition are related to poorer social competence. Two emotion recognition tests developed by S. L. Kerr and J. M. Neale (1993) and Benton's Test of Facial Recognition (A. Benton, M. VanAllen, K. Hamsher, & H. Levin, 1978) were given to patients with chronic schizophrenia and nonpatient controls. Patients' social skills, social adjustment, and symptomatology were assessed. Like Kerr and Neale's unmedicated patients, these patients performed worse than controls on both emotion recognition tests and the control test. For patients, facial perception was related to the chronicity of illness and social competence. Chronicity of illness may contribute to face perception deficits in schizophrenia, which may affect social competence. Recent research has evaluated whether schizophrenia patients have impairments in emotion recognition. The findings have been inconsistent: some studies reported differences (Kerr & Neale, 1993), but others did not (Novic, Luchins, & Perline, 1984). Discrepant findings may be partly due to the variety of methods used to study emotion recognition, which has made it impossible to compare the results across different studies. Also, many measures have been developed for a single study, with little attention given to their psychometric properties and cross-validation. An exception to this problem is a set of instruments recently developed by Kerr and Neale (1993) for the assessment of emotion recognition in schizophrenia patients:

The purpose of the current study was to disentangle the relationship of childhood sexual abuse and childhood physical abuse from prior adult sexual and physical victimization in predicting current posttraumatic stress disorder (PTSD) symptoms in recent rape victims. The participants were a community sample of 117 adult rape victims assessed within 1 month of a recent index rape for a history of child sexual abuse, child physical abuse, other adult sexual and physical victimization, and current PTSD symptoms. Results from path analyses showed that a history of child sexual abuse seems to increase vulnerability for adult sexual and physical victimization and appears to contribute to current PTSD symptoms within the cumulative context of other adult trauma.

Background and methods-Factors contributing to posttraumatic stress disorder (PTSD) and comorbid major depression (MDD) were investigated among female victims of intimate partner violence (IPV).Results-High levels of PTSD (75% of the sample) and MDD (54% of the sample) were observed. Individuals with both PTSD and MDD reported significantly greater levels of PTSD and depression symptoms than individuals with either PTSD alone or without major psychopathology. Individuals with comorbid PTSD and MDD had more maladaptive depressogenic cognitive styles than individuals without PTSD. The three groups were comparable in terms of pre-abuse mental health, childhood trauma history, and relationship violence variables and injuries. Maladaptive schemas did not contribute to the identification of comorbidity caseness, whereas PTSD severity and prior trauma did. Psychological aggression by an abuser and PTSD severity accounted for 52% of the variance in depressive symptoms.Limitations-Cross-sectional design and lack of trauma-specific cognitive measures.Conclusions-The findings confirm that comorbid PTSD and MDD is common among IPV victims. The mechanisms that contribute to comorbid depression, however, are unclear, and prospective studies are necessary to delineate the roles that psychological abuse, PTSD severity and prior trauma experiences may have in the development of depression following IPV.

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 linear function was more parsimonious in explaining the CPT avoidance variance. Implications of the findings are discussed.The purpose of controlled therapy outcome research is to identify specific cause-and-effect relationships that increase knowledge of mechanisms of change for affecting psychopathology and, consequently, allow for the development of increasingly effective psychotherapies (Borkovec & Miranda, 1999). Although comparisons of treatment with no-treatment conditions allow one to rule out the role of history, maturation, repeated testing, and statistical regression as explanatory factors for differences in treatment outcome, comparisons of treatment with placebo or a minimal-attention group allow one to conclude that something specific to the treatment condition, above and beyond the general therapeutic relationship, is responsible for therapeutic change (Borkovec & Castonguay, 1998).Once the efficacy of a new therapy is established in the initial stages through controlled trials, comparative designs are generally used to determine whether the therapy is superior to another treatment or matches the outcome of an already established treatment with adequate statistical power. Although comparative designs are useful for demonstrating empirical support for a new therapy, these designs are confounded by the fact that the two compared therapies are inherently different in a large number of ways. However, the results of comparative studies are useful in that they can help both of the treatments in question evolve and change on the basis of new clinical and empirical knowledge that is obtained over the course of the clinical trial (Devilly & Foa, 2001;Tarrier, 2001).Treatment-outcome research with female rape victims has largely involved the use of controlled and comparative trials. Two of the more researched treatments used with this population are prolonged exposure therapy (PE;Foa et al., 1999; Murdock, 1991) and cognitive-processing therapy (CPT; Resick & Schnicke, 1992. Clinical trials conducted with these therapies established the initial efficacy for both these treatments (Foa et al., 1991Resick & Schnicke, 1992. More recently, Resick, Nishith, Weaver, Astin, and Feuer (2002) conducted a clinical trial comparing PE and CPT with a minimal-attention (MA) control group. Although both therapies proved to b...

Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling for education, sleep difficulties were significantly related to drinking motives for coping with negative affect, but not pleasure enhancement or socialization. The findings suggest that sleep difficulties may be an important factor contributing to alcohol use in rape victims with PTSD.

The purpose of the study was to assess the relationship between trauma-related sleep disturbance and physical health symptoms in treatment-seeking female rape victims. A total of 167 participants were assessed for PTSD symptoms, depression, sleep disturbance, and frequency of self-reported health symptoms. Results demonstrated that trauma-related sleep disturbance predicted unique variance in physical health symptoms after other PTSD and depression symptoms were controlled. The findings suggest that trauma-related sleep disturbance is one potential factor contributing to physical health symptoms in rape victims with PTSD.Violence against women yields a variety of deleterious effects, both direct and indirect, on objective and subjective indices of physical health (Resnick et al., 1997). In addition to psychological reactions to trauma such as posttraumatic stress disorder (PTSD) and depression, women who have experienced criminal victimization report a variety of physical symptoms that range across bodily systems, including cardiovascular, gynecological, respiratory, musculoskeletal, and dermatological systems (Kimerling and Calhoun, 1994;Koss et al., 1991).Several studies have demonstrated that PTSD is a mediating factor in the relationship between trauma exposure and reports of elevated health symptoms in women Wolfe et al., 1994). Researchers have proposed multiple biological mechanisms to explain the impact of PTSD on health (Friedman and Schnurr, 1995). Among these proposed mechanisms is the chronic autonomic hyperarousal (Koss and Heslet, 1992;McFarlane et al., 1994) and sleep disturbance associated with PTSD (Friedman and Schnurr, 1995). The hypothesized link between autonomic arousal and physical health was bolstered by the recent finding that the hyperarousal symptom cluster of PTSD was the strongest of the PTSD symptom subclusters in predicting both total health symptoms and global health perception in a sample of women veterans .Given the observed relationships between PTSD, particularly hyperarousal symptoms, and health outcomes, and the potential impact of biological alterations associated with a PTSD diagnosis, we hypothesized that sleep disturbance associated with psychological reactions to trauma may be an important predictor of health symptoms. Sleep disturbance has been associated with a variety of negative health outcomes, including immune system alterations, cardiovascular incidents, and general health symptoms (Kales et al., 1984;Newman et al., 1997). Further, in a study investigating the aftermath of Hurricane Andrew, self-reported sleep disturbance mediated between PTSD symptoms and an index of immune functioning (NKCC levels;Ironson et al., 1997 Recent research suggests that, in addition to PTSD symptoms, depressive symptoms are important in the prediction of self-reported health symptoms after trauma Wolfe et al., 1999). A diagnosis of depression independent of trauma exposure has been linked to poorer reported health and immune system alterations (Miller et al., 1999;Schulberg ...