Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.

The authors report on changes in cognitions related to posttraumatic stress disorder (PTSD) among 54 female survivors of sexual and nonsexual assault with chronic PTSD who completed either prolonged exposure alone or in combination with cognitive restructuring. Treatment included 9-12 weekly sessions, and assessment was conducted at pretreatment, posttreatment, and a modal 12-month follow-up. As hypothesized, treatment that included prolonged exposure resulted in clinically significant, reliable, and lasting reductions in negative cognitions about self, world, and self-blame as measured by the Posttraumatic Cognitions Inventory. The hypothesis that the addition of cognitive restructuring would augment cognitive changes was not supported. Reductions in these negative cognitions were significantly related to reductions in PTSD symptoms. The addition of cognitive restructuring did not significantly augment the cognitive changes. Theoretical implications of the results are discussed.

The aim of this study was to evaluate the psychometric properties of the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5), a self-report measure of posttraumatic stress disorder (PTSD) based on diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Participants were 242 urban community residents, veterans, and college undergraduates recruited from 3 study sites who had experienced a DSM-5 Criterion A traumatic experience. The PDS-5 demonstrated excellent internal consistency (␣ ϭ .95) and test-retest reliability (r ϭ .90) and good convergent validity with the PTSD Checklist-Specific Version (r ϭ .90) and the PTSD Symptom Scale-Interview Version for DSM-5 (PSSI-5; r ϭ .85). The PDS-5 also showed good discriminant validity with the Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Trait scale (all Z H Ͼ 3.05, ps Ͻ .01). There was 78% agreement between the PDS-5 and the PSSI-5. Receiver operating characteristic analysis yielded a cutoff score of 28 for identifying a probable PTSD diagnosis. The PDS-5 is a valid and reliable measure of DSM-5 PTSD symptomatology.

According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.

Background “Mindfulness-based” interventions show promise for stress-reduction in general medical conditions, and initial evidence suggests that they are well accepted in trauma-exposed individuals. Mindfulness-based Cognitive Therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat PTSD. Methods Consecutive patients seeking treatment for chronic PTSD (veterans of Vietnam, Korea, WWII, Desert Storm) at a VA outpatient clinic were enrolled in eight week MBCT groups, modified for PTSD (four groups, n=20) or brief treatment-as-usual (TAU) comparison group interventions (three groups, n=16). MBCT consisted of PTSD psychoeducation, mindfulness of body, breath, and emotions, mindful movement, exercises for managing intrusive thoughts and feelings, and daily home practice though audio recording. Pre- and post-therapy psychological assessments with clinician administered PTSD scale (CAPS) were performed with all patients, and self-report measures (PTSD diagnostic scale, PDS, and Posttraumatic cognitions inventory, PTCI) were administered in the MBCT group. Results Pre- to post-treatment effects analysis demonstrated significant improvement in PTSD symptoms. Intent to treat analyses showed significant improvement in CAPS (t(19)=4.8, p<.001) in the MBCT condition but not the TAU conditions, and a significant Condition*Time interaction (F[1,26]=16.4, p<.005). MBCT completers analysis (n =15, 75%) also showed good compliance with assigned homework exercises, and significant and clinically meaningful improvement in PTSD symptom severity on post-treatment assessment in CAPS and PDS (particularly in avoidance/numbing symptoms), and reduced PTSD-relevant cognitions in PTCI (in particular, self-blame). Conclusions These data suggest group mindfulness-based cognitive therapy as an acceptable brief intervention / adjunct therapy for combat PTSD, with potential for reducing avoidance symptom cluster and PTSD cognitions. Further studies are needed to examine efficacy in a randomized controlled design and to identify factors influencing acceptability and effectiveness.

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This therapist guide of prolonged exposure (PE) treatment is accompanied by the patient workbook, Reclaiming Your Life from a Traumatic Experience. The treatment and manuals are designed for use by a therapist who is familiar with cognitive behavioral therapy (CBT) and who has undergone an intensive training workshop for prolonged exposure by experts in this therapy. The therapist guide instructs therapists to implement this brief CBT program that targets individuals who are diagnosed with posttraumatic stress disorder (PTSD) or who manifest PTSD symptoms that cause distress and/or dysfunction following various types of trauma. The overall aim of the treatment is to help trauma survivors emotionally process their traumatic experiences to diminish or eliminate PTSD and other trauma-related symptoms. The term prolonged exposure (PE) reflects the fact that the treatment program emerged from the long tradition of exposure therapy for anxiety disorders in which patients are helped to confront safe but anxiety-evoking situations to overcome their unrealistic, excessive fear and anxiety. At the same time, PE has emerged from the adaption and extension of Emotional Processing Theory (EPT) to PTSD, which emphasizes the central role of successfully processing the traumatic memory in the amelioration of PTSD symptoms. Throughout this guide, the authors highlight that emotional processing is the mechanism underlying successful reduction of PTSD symptoms.

Abstract-Prolonged exposure (PE) is an effective first-line treatment for posttraumatic stress disorder (PTSD), regardless of the type of trauma, for Veterans and military personnel. Extensive research and clinical practice guidelines from various organizations support this conclusion. PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single-and multiple-incident traumas. The PE protocol includes four main therapeutic components (i.e., psychoeducation, in vivo exposure, imaginal exposure, and emotional processing). In light of PE's efficacy, the Veterans Health Administration designed and supported a PE training program for mental health professionals that has trained over 1,300 providers. Research examining the mechanisms involved in PE and working to improve its acceptability, efficacy, and efficiency is underway with promising results.