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This study tested a family-based skills-building intervention in veterans with chronic combat-related posttraumatic stress disorder (PTSD). Veterans and a family member were randomly assigned to 1 of 3 conditions: (a) waiting list, (b) 18 sessions of twice-weekly exposure therapy, or (c) 18 sessions of twice-weekly exposure therapy followed by 16 sessions of behavioral family therapy (BFT). Participation in exposure therapy reduced PTSD positive symptoms (e.g., reexperiencing and hyperarousal) but not PTSD negative symptoms. Positive symptom gains were maintained at 6-month follow-up. However, participation in BFT had no additional impact on PTSD symptoms.

This article analyzes the literature on the treatment of posttraumatic stress disorder (PTSD). It briefly exposes the theoretical basis for each treatment modality and extensively examines pharmacological, behavioral, cognitive, and psychodynamic therapies, as well as group and family therapies, hypnosis, inpatient treatment, and rehabilitation. Articles were identified by scanning Medline and PsychLit for all papers in English reporting treatment of PTSD. Anecdotal case reports were, then, excluded. Eighty one articles were identified and categorized as either biological or psychological, with the latter category further divided into behavioral, cognitive, psychodynamic, and other treatment modalities. Information regarding the type of trauma, the sample studied, the treatment method, and the results of the treatment has been extracted from each article and is presented briefly. A synthesis of findings in each area is provided. Most studies explored a single treatment modality (e.g., pharmacological, behavioral). The cumulated evidence from these studies suggests that several treatment protocols reduce PTSD symptoms and improve the patient's quality of life. The magnitude of the results, however, is often limited, and remission is rarely achieved. Given the shortcoming of unidimensional treatment of PTSD, it is suggested that combining biological, psychological, and psychosocial treatment may yield better results. It is further argued that rehabilitative goals should replace curative techniques in those patients with chronic PTSD. A framework for identifying targets for each treatment modality is presented.

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This paper describes the experiences of children who have witnessed the homicide ( d a parent and are then legally compelled "to tell what (they] have seen." The witnessing of a human killing constitutes psychic trauma, and the child may exhibit symptoms of a posttraumatic stress clisorcler. There may also be N wide range of gricf responses. Our focus is on the interplay of the child's grief and traumatic reactions, and the demands of the legal system. The horrrbing loss of impulse control in the assailant, the mutilation of the victim, and the helple.ssness of the victim and witness continue to haunt the child. W e review the issues arising from police quesfioning, qualification procedures, testimony in open court, and ikfendmt sentencing. The child's efforts at mastering the trciuma can be either enhanced or impeded by involvement in judicial proceedings. With more complete mastety of traumatic anxiety, the child cun become a more effective witness. W e argue f o r the usefulness of having (in expert in psychic trauma to assist these young witnesses and outline legal recommendations to provide lidequate mental-health consultation.During the past three years we have investigated the consequences to children who have witnessed a parent's homicide (Eth & Pynoos, 1983). Obviously, this is an unforgettable personal tragedy. Juxtaposed with the child's efforts to master the trauma and mourn successfully are the possible societal demands to participate in subsequent criminal proceedings.

Continuous terror created similar distress in proximal and remote communities. Exposure to discrete events was not a necessary mediator of terror threat. A subgroup of those exposed developed serious symptoms, whereas others were surprisingly resilient. Disruption of daily routines was a major secondary stressor.

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