Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder.

Abstract

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...

Treatment of complex posttraumatic self-dysregulation

“…Fewer than 20 clinical trials and fewer than 10 studies examining the process of therapy and change have been reported for "uncomplicated PTSD" (Foa, Keane, & Friedman, 2000;Nishith, Resick, & Griffin, 2002), so it is understandable that the evidence base is just beginning to evolve for posttraumatic self-dysregulation. We hope this overview of the phase-oriented model and of emerging therapies for self-regulatory sequelae of trauma will encourage the development of increasingly integrative and effective trauma treatments.…”

“…Models that view fragmentation of episodic memory as the core of posttraumatic impairment rely upon writing or telling the personal story as a means of gaining or regaining coherent narrative autobiographical memory (Courtois, 1999;Harvey, 1996;Van der Hart et al, 1998). These approaches are not necessarily incompatible; research on process and outcome in PTSD psychotherapy is too nascent to justify definitive evidence-based guidelines for therapeutic trauma memory work (Foa, Rothbaum, & Furr, 2003;Nishith, Resick, & Griffin, 2002). Therapists therefore must gauge and be prepared to flexibly revise their approach to assisting each client with trauma memory work based upon clinical assessment of the client's self-regulation both during and between therapy sessions.…”

Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy

“…One pattern, the "steady decline" is gradual and linear, whereas the "spike" and "habituation curve" capture a brief period of symptom exacerbation that is discontinuous and curvilinear. Nishith, Resick, and Griffin (2002) examined the shape of change over the course of therapy in a sample of women with rape-related PTSD who received two empirically-supported therapies -prolonged exposure or cognitive-processing therapy. These authors used curve estimation techniques to examine whether a linear or curvilinear pattern best described the course of symptom reduction in the therapies.…”

Acceptance and Mindfulness-Based Approaches to the Treatment of Posttraumatic Stress Disorder

“…However, the most well-developed and fully researched combination therapy is Resick and Schnicke's (1992) cognitive processing therapy (CPT) for rape-related PTSD, which combines elements of cognitive therapy, exposure therapy, and AMT. CPT has demonstrated efficacy in several studies that have investigated its utility with sexual assault survivors (Nishith, Resick, & Griffin, 2002;Resick, Nishith, Weaver, Astin, & Feuer, 2002).…”