Epidemiology and Treatment of Post-Traumatic Thesis

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Participants were included if they had experienced sexual or physical assault in childhood or adulthood and met criteria for PTSD at the time of the initial assessment, were at least 3 months posttrauma (no upper limit), and if on medication, were stabilized. Women with current substance dependence were included if/when they had been abstinent for 6 months. Those with substance abuse were permitted to participate if they agreed to desist in usage during the period of treatment. Following telephone screening, potential participants were invited to be assessed for possible participation, at which time they discussed and signed informed consent for participation.

Subjects. A total of 256 women were assessed for possible participation by assessors who were blind to group assignment. The most common reasons for exclusion from the study (n = 94) were not meeting the criteria for PTSD (n = 28), current substance dependence (n = 12), medication instability (n = 11), and current abuse or stalking Sixteen women failed to complete the initial assessment. Of 162 women randomized into the trial, 12 were terminated from the study, by design, for meeting exclusion criteria subsequent to new violence (women had to be at least 3 months posttrauma), changes in medication, or psychosis. Among them, one WA participant was terminated from the trial when the therapist stopped the protocol because of increased suicidal ideation. These terminations were evenly distributed across groups. Therefore, the intent-to-treat (ITT) sample included 150 women. There was one other unrelated adverse event during the trial.

Research design. Interviews using the Clinician-Administered PTSD Scale (CAPS) were used to assess DSM-IV PTSD diagnosis and PTSD symptom severity; in addition, Structured Clinical Interview for DSM-IV Axis I Disorders -- Patient Edition (SCID) were used. In this study, we assessed panic disorder, major depressive disorder (MDD), and substance abuse/dependence. The psychotic screen of the SCID was used for exclusion purposes. The Beck Depression Inventory -- II (BDI-II), the Experience of Shame Scale (ESS) and the Personal Beliefs and Reactions Scale (PBRS), the State-Trait Anger Expression Inventory (STAXI), State-Trait Anxiety Inventory (STAI), the Therapeutic Outcome Questionnaire, and the Trauma-Related Guilt Inventory (TRGI) were used for the study's self-report scales. The study subjects were randomly assigned to CPT, CPT-C, or WA.

Statistics. Multiple paired t tests.

Results. Analyses with the ITT sample and with study completers indicate that patients in all three treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment; however, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. Both components of CPT as well as the full protocol were successful in treating PTSD and other secondary symptoms in this highly traumatized and chronic sample, as evidenced by the large decreases in PTSD and depression symptoms. The results of the trial were quite similar to other trials of cognitive behavioral treatments for PTSD, with large improvements realized over the 6 weeks of treatment and maintained throughout the follow-up period. Participants improved, across conditions, not only on PTSD symptoms but also on depression, anxiety, anger, guilt, shame, and cognitive distortions.

Discussion

All three of the studies reviewed complied with internal review board requirements and followed established protocols for administering the instruments used. Further, all three studies evinced some degree of effectiveness of the CPT approach in treating their respective populations.

Conclusion

References

Barlow, DH (ed.). Clinical handbook of psychological disorders (3rd ed.).

Monson, C.M., Schnurr, P.P., Resick, P.A.., Friedman, M.J., Young-Xu, Y. & Stevens, S.P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74(5), 898-907.

Mueser, K.T., Rosenberg, S.D., Xie, H., Jankowski, M.K.

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, Bolton, E.E., Lu, W. Rosenberg, H.J., McHugo, G.J. & Wolfe, R. (2008). A randomized controlled trial of cognitive- behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76(2), 259-271.

Resick, P.A., Galovski, T.E., Uhlmansiek, M.O., Scher, C.D., Clum, G.A. & Young-Xu, Y.

2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76(2), 243-258.

Draft: The Epidemiology and Treatment of Posttraumatic Stress Disorder

Introduction

Description of PTSD symptoms.

Epidemiology of PTSD.

Common contextual features.

Theoretical Conceptualization

Study One -- Introduction. In their study, "Cognitive Processing Therapy for Veterans With Military-Related Posttraumatic Stress Disorder," Monson, Schnurr, Resick, Friedman, Young-Xu and Stevens (2006) report that their trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments for this veteran population.

Methods. The researchers established a three-phase screening process using some straightforward criteria for participation in this study. Subjects were required to have been diagnosed with some type of military-related PTSD in order to be eligible; furthermore, those subjects that were actively receiving psychopharmacological treatment were allowed to continue their treatment but were deemed eligible only if they had been on a stable regimen for at minimum of 2 months prior to entry into the study entry. In addition, psychotherapeutic interventions that were not specifically focused on PTSD treatment were allowed to continue as well. Any of the following criteria would prevent a subject from participating in the study: (a) current uncontrolled psychotic or bipolar disorder; (b) substance dependence, but subjects with substance abuse diagnoses were included in the study; - prominent current suicidal or homicidal ideation; and (d) significant cognitive impairment.

Subjects. Of the 93 patients referred by a VAMC for participation, 64 (or 68.8%) were deemed to meet the study criteria. Of these, 60 subjects (54 men, 6 women) were randomized into the trial with an overall dropout rate of 16.6% (20% from the CPT treatment and 13% from the wait-list condition). The authors report, "There were no statistically significant differences between the two conditions in baseline characteristics. These sample characteristics are consistent with those found in veterans seeking PTSD treatment within the VA" (Monson et al., p. 898).

Research Design. This study used a wait-list controlled trial of cognitive processing therapy (CPT). Both clinician-administered instruments for structured interviews and a self-report instrument were used to assess the study subjects. Subjects found to be eligible for participation were randomized to receive the treatment immediately or to wait for 10 weeks to receive the treatment (10 weeks was equivalent to the ideal 6 weeks of the two-times-a-week sessions and the 1-month follow-up period for those in the CPT condition); the videotaped sessions were evaluated by an independent expert and adherence to the research design was determined to be good at 93% adherence.

Statistics. Estimates of sample size were calculated by the study's biostatistician to confirm or refute the primary hypothesis that CPT would result in significantly lower clinician-rated overall PTSD symptoms in comparison with the wait-list condition.

Results. These researchers found that random regression analyses of the intention-to-treat sample identified significant improvements in PTSD and the comorbid symptoms in the CPT condition when compared with the wait-list condition. Just under half (40%) of the intention-to-treat sample who received CPT failed to meet criteria for a PTSD diagnosis, and exactly half (50%) were determined to have experienced a reliable change in their PTSD symptoms at posttreatment assessment (the authors also note that there was no relationship between PTSD disability status and outcomes).

Study Two -- Introduction......

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