A Randomized Controlled Trial on Cognitive Restructuring and Imagery Modification to Reduce the Feeling of Being Contaminated in Adult Survivors of Childhood Sexual Abuse Suffering from Posttraumatic Stress Disorder

Abstract

Background: The feeling of being contaminated (FBC) is a common phenomenon in survivors of childhood sexual abuse (CSA) suffering from posttraumatic stress disorder (PTSD). Thus far, this symptom has been neglected in research and therapy. For this reason, we developed Cognitive Restructuring and Imagery Modification (CRIM), a two-session treatment (lasting 90 and 50 min) that specifically targets the FBC. The present study examined the efficacy of the treatment. Methods: Thirty-four women with CSA-related PTSD (mean age = 37 years) were randomized to either the CRIM group or a waitlist control group. Primary outcomes were intensity, vividness, and uncontrollability of the FBC, associated distress, and PTSD symptoms, which were assessed using the Clinician-Administered PTSD Scale and the Posttraumatic Diagnostic Scale. Outcomes were measured pre- and posttreatment, and at the 4-week follow-up. (M)ANOVAs were used to compare improvements across conditions. Results: All FBC scores yielded a greater reduction in the CRIM group than the waitlist control (WL) group. Between-group effect sizes at follow-up were large and highly significant (intensity: d = 1.52, p < 0.001; vividness: d = 1.28, p < 0.001; uncontrollability: d = 1.77, p < 0.001; distress: d = 1.80, p < 0.001). PTSD symptoms also yielded a greater reduction in the CRIM group than the WL group, with large between-group effect sizes (Clinician-Administered PTSD Scale: d = 0.93, p < 0.001). Conclusions: Our findings support the efficacy of the newly developed CRIM in reducing the FBC and PTSD symptoms in adult survivors of CSA.

Defining the index trauma in post-traumatic stress disorder patients with multiple trauma exposure: impact on severity scores and treatment effects of using worst single incident versus multiple traumatic events

“…The most recent meta-analysis on this topic (Ehring et al, 2014) included 16 randomized controlled trials (RCTs), and we identified one more (Jung & Steil, 2013). Details of these 17 studies are presented in Supplementary Table 1.…”

Cognitive restructuring and imagery modification for posttraumatic stress disorder (CRIM-PTSD): A pilot study

“…The effectiveness of CRIM has been tested in a randomized wait-list controlled trial of 34 victims of CSA with posttraumatic stress disorder (PTSD; Jung & Steil, 2013). The results showed a significantly greater reduction in the feeling of being contaminated among the CRIM group than among the wait-list control group.…”

Imagery Rescripting as stand-alone treatment for posttraumatic stress disorder related to childhood abuse

“…This might indicate that a considerable proportion of patients with childhood abuse-related PTSD are lacking skills to effectively handle the emotions that are triggered by PE sessions. Second, some authors criticize that PE limits itself to the extinction of fear, and does not cover other emotions and cognitions often associated with CA-related PTSD, such as anger, irrational guilt, shame, disgust and self-contempt (Grunert, Weis, Smucker, & Christianson, 2007;Jung & Steil, 2013). Indeed, there is preliminary evidence that PE is less effective in changing trauma-related emotions of anger (Foa, Riggs, Massie, & Yarczower, 1995), guilt and shame (Arntz, Tiesema, & Kindt, 2007;Grunert et al, 2007).…”

“…In their protocol, ImRs was applied as an add-on to standard PE, based on the assumption that it would be ineffective to avoid exposure to the complete trauma memory. Until now, this protocol has not systematically been tested in a population with CA-related PTSD, but ImRs has been shown to improve standard exposure therapy Jung & Steil, 2013;Steil, Jung, & Stangier, 2011), and also to be effective in a sample with previous treatment failures (Grunert, Smucker, Weis, & Rusch, 2003). In addition, ImRs has been found to be effective in targeting intrusive images and memories within other disorders, such as social phobia (Wild, Hackmann, & Clark, 2007;Wild, Hackmann, & Clark, 2008), specific phobia (Hunt & Fenton, 2007), and depression (Brewin et al, 2009;Wheatly et al, 2007).…”