A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims.

Abstract

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 ...

Posttraumatic Growth in Treatment-seeking Female Assault Victims

“…Demographic information-This is a brief measure developed for previous studies [42] that covers demographic information (i.e., age, race, education, marital status), as well as type of assault experienced and months since the assault.…”

“…The testretest reliability over a 2-month period for the global score was 0.71. In the present study, Cronbach's alpha for the PTGI total score was 0.94 and ranged from 0.78 to 0.85 for subscale scores.Demographic information-This is a brief measure developed for previous studies [42] that covers demographic information (i.e., age, race, education, marital status), as well as type of assault experienced and months since the assault. …”

Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

“…Understanding these symptom meanings is crucial for the cognitive-behavior therapist in her or his role of treating PTSD and panic when using any of the many component interventions, such as prolonged imaginal exposure (e.g., Foa et al, 1999;Foa & Rothbaum, 1998), interoceptive exposure (e.g., Barlow, 2002;Craske, Meadows, & Barlow, 1994;Falsetti & Resnick, 2000;Otto, Penava, Pollack, & Smoller, 1996), cognitive restructuring (e.g., Clark, 1996;Resick, Nishith, Weaver, Astin, & Feuer, 2002;Resick & Schnicke, 1996), emotional acceptance training (Cloitre, Koenen, Cohen, & Han, 2002), or symptom management skills (e.g., Foa et al, 1999). Regardless of whether the task is reducing catastrophic interpretations of symptoms in the context of panic disorder or helping patients reduce emotional and avoidance responses to trauma cues, the cognitive-behavior therapist needs to understand the range of associations to somatic symptoms that are common in Cambodian refugees.…”

Prediction of numbing and effortful avoidance in female rape survivors with chronic PTSD

“…A relatively small portion of the sample did not meet criteria for PTSD, primarily because this study was part of a larger treatment study that drew a sample of treatment-seeking rape survivors. For a detailed description of the sample and the exclusionary criteria, please refer to Resick, Nishith, Weaver, Astin, and Feuer (2002).…”