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Psychological

and Physiological

Trauma Research

 

 

Seize Your Journeys

 

_______________________

Traumatic stress is found in many competent, healthy, strong, good people.  No one can completely protect themselves from traumatic experiences.  Many people have long-lasting problems following exposure to trauma.  Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy.  What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences.  Having symptoms after a traumatic event is NOT a sign of personal weakness.  Given exposure to a trauma that is bad enough, probably all people would develop PTSD.

By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment.

_______________________

 

 

DID-PTSD-EMDR

Dissociative Identity Disorder (DID)

"The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B).  There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C).  The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.).  In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play.

Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness.  Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name.  Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed.  The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive).  Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect.  Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict.  Occasionally, one or more powerful identities allocate time to the others.  Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations.

Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent.  The amnesia is frequently asymmetrical.  The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories.  An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions).  Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought).  There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood.  Transitions among identities are often triggered by psychosocial stress.  The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual.  Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts.  The number of identities reported ranges from 2 to more than 100.  Half of reported cases include the individuals with 10 or fewer identities."

Diagnostic and Statistical Manual of Mental Disorders. 2000.  4th ed. Washington, D.C.: American Psychiatric Association.

PTSD, DID, and EMDR

Posttraumatic Stress Disorder

"The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1).  The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2).  The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).

Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.  For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury.  Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts.  Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease.  The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase.

The traumatic event can be reexperienced in various ways.  Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3).  These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal.  Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator).

Stimuli associated with the trauma are persistently avoided.  The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2).  This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3).  Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event.  The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6).  The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7).

The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma.  these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5).  Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."

 

EMDR

Eye Movement Desensitization and Reprocessing

"Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach.

During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session.

Eight Phases of Treatment

The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations.

During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete.

In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions.

After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced.

In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two.

The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system.

After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com

 1Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.

2Shapiro, F. (2002). EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

 

 

 

 

EMDR PTSD Dissociation

 

Exposure Therapy and PTSD

 

Title:

Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders.

Author(s):

Ouimette, Paige, (Ed), Washington State U, Pullman, WA, US
Brown, Pamela J., (Ed), Private Practice, New Bedford, MA, US

Source:

Washington, DC, US: American Psychological Association, 2003. xiii, 315 pp.
Publisher URL: http://www.apa.org/books

Abstract:

(from the publicity materials) This book explores the underdiagnosed connection between drug use and posttraumatic stress disorder (PTSD). Patients with trauma-related distress such as PTSD often use alcohol and drugs in a problematic manner classifiable as substance use disorder (SUD). By not recognizing the connection between symptoms, providers frequently misdiagnose or do not fully attend to SUD-PTSD comorbidity. This book presents research on how often the two disorders co-occur and why. Authors describe the self-medication model and explore how specific PTSD and substance use symptoms are functionally related to each other. In addition, they suggest assessment approaches and practice guidelines to facilitate proper diagnosis and treatment. Particularly valuable are descriptions of several new treatment approaches that have been developed specifically for SUD-PTSD, including cognitive-behavioral and exposure therapy


 

Title:

Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: A case report.

Author(s):

Difede, Joann, Cornell U, Weill Medical Coll, New York, NY, US, jidefede@med.cornell.edu
Hoffman, Hunter G., U Washington, Human Interface Technology Lab, Seattle, WA, US

Address:

Difede, Joann, Helmsley Medical Tower, 1320 York Ave., Ste. 610, New York, NY, US, jidefede@med.cornell.edu

Source:

CyberPsychology & Behavior, Vol 5(6), Dec 2002. pp. 529-535.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

Describes the treatment of a survivor (aged 26 yrs) of the World Trade Center (WTC) attack of 9-11-01 who had developed acute Post-traumatic Stress Disorder (PTSD). After she failed to improve with traditional imaginal exposure therapy, the authors sought to increase emotional engagement and treatment success using virtual reality (VR) exposure therapy. Over the course of 6 1-hr VR exposure therapy sessions, they gradually and systematically exposed the PTSD patient to virtual planes flying over the WTC, jets crashing into the WTC with animated explosions and sound effects, virtual people jumping to their deaths from the burning buildings, towers collapsing, and dust clouds. VR graded exposure therapy was successful for reducing acute PTSD symptoms. Depression and PTSD symptoms as measured by the Beck Depression Inventory and the Clinician Administered PTSD Scale indicated a large (83%) reduction in depression, and large (90%) reduction in PTSD symptoms after completing VR exposure therapy. Although case reports are scientifically inconclusive by nature, these strong preliminary results suggest that VR exposure therapy is a promising new medium for treating acute PTSD.


 

Title:

EMDR for women who experience traumatic events.

Author(s):

Peterson, Gary, Southeast Inst for Group & Family Therapy, Chapel Hill, NC, US

Source:

Journal of Clinical Psychiatry, Vol 63(11), Nov 2002. pp. 1047-1048.

Publisher:

US: Physicians Postgraduate Press

Abstract:

Comments on an article by E. B. Foa and G. P. Street (see record 2001-11162-005) regarding psychotherapeutic interventions for women with PTSD. It is noted that Foa and Street describe other psychotherapy procedures, but do not mention eye movement desensitization and reprocessing (EMDR). Peterson cites that in Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies [ISTSS] , 2 psychotherapy treatments for PTSD are listed as having been shown to be effective: exposure therapy and EMDR. SIT is reported to have had 2 well-controlled studies published on the treatment of PTSD. Both SIT studies were with female sexual assault victims. It is concluded that given that EMDR has been established as effective in the ISTSS guidelines, it may be important for the reader to know that this form of therapy may be applied when confronting the issues addressed in this article. A comment by Foa follows.


 

Title:

Diagnosen akutt stresslidelse og forebygging av posttraumatisk stresslidelse.

Translated Title:

Acute stress disorder and prevention of posttraumatic stress disorder.

Author(s):

Eid, Jarle, U Bergen, Sjokrigsskolen, Bergen, Norway, jeid@sksk.mil.no
Johnsen, Bjorn Helge, U Bergen, Sjokrigsskolen, Bergen, Norway

Source:

Tidsskrift for Norsk Psykologforening, Vol 39(11), Nov 2002. pp. 987-995.

Publisher:

Norway: Norsk Psykologforening

Abstract:

The diagnosis of acute stress disorder (ASD) was introduced in DSM-IV in 1994 in order to identify trauma victims with a high potential for later posttraumatic stress disorder (PTSD). This article reviews current diagnostic criteria and available assessment instruments for ASD. Recent studies have suggested that ASD is highly predictive of later PTSD. Theoretical models and randomized controlled clinical trials have indicated that early exposure and emotional processing of traumatic memories could be an effective early intervention following trauma. However, evidence indicates that some survivors seem to gain less from exposure treatment. A casuistic presentation of early interventions after a naval shipwreck is used to discuss benefits and limitations of early exposure as a preventive intervention.


 

Title:

Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse.

Author(s):

Cloitre, Marylene, New York Presbyterian Hosp, Anxiety & Traumatic Stress Program, New York, NY, US, mcloitre@med.cornell.edu
Koenen, Karestan C., Columbia U, Dept of Public Health, New York, NY, US
Cohen, Lisa R., St. Luke's-Roosevelt Hosp, Dept of Psychiatry, New York, NY, US
Han, Hyemee, Weill Medical Coll of Cornell U, Dept of Psychiatry, New York, NY, US

Address:

Cloitre, Marylene, 418 East 59th Street, Apartment 25B, New York, NY, US, mcloitre@med.cornell.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 70(5), Oct 2002. pp. 1067-1074.

Publisher:

US: American Psychological Assn

Abstract:

Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations.


 

Title:

Fear activation and habituation patterns as early process predictors of response to prolonged exposure treatment in PTSD.

Author(s):

van Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology & Personality, Nijmegen, Netherlands, minnen@psych.kun.nl
Hagenaars, Muriel, U Nijmegen, Dept of Clinical Psychology & Personality, Nijmegen, Netherlands

Address:

van Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology, PO Box 9104, 6500 HE, Nijmegen, Netherlands, minnen@psych.kun.nl

Source:

Journal of Traumatic Stress, Vol 15(5), Oct 2002. pp. 359-367.

Publisher:

US: John Wiley & Sons

Abstract:

Improved (n=21) and nonimproved (n=13) posttraumatic stress disorder (PTSD) patients (a mixed trauma population) were compared for fear activation and habituation patterns during and between the 1st and 2nd prolonged exposure sessions. Drop-outs (n=11) were also evaluated. Nonimproved patients had significantly higher ratings of anxiety at the start of the first exposure session. Improved patients showed more within-session habituation during the self-exposures at home and more between-session habituation. Even after controlling for initial PTSD and depression symptom severity, habituation between the first and second exposure sessions was significantly related to treatment outcome. Patients who dropped out of the treatment were found not to differ from completers on fear activation and within-session habituation during the first exposure session.


 

Title:

Effectiveness of exposure therapy: A case study of posttraumatic stress disorder and mental retardation.

Author(s):

Lemmon, Valerie A., Riverside Associates, P.C., Harrisburg, PA, US, vlemmon@messiah.edu
Mizes, J. Scott, West Virginia University, Morgantown, WV, US

Address:

Lemmon, Valerie A., Riverside Associates, P.C., 2818 Green Street, Harrisburg, PA, US, vlemmon@messiah.edu

Source:

Cognitive and Behavioral Practice, Vol 9(4), Fal 2002. pp. 317-323.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Posttraumatic stress disorder (PTSD) is a common disorder following sexual assault. There is significant empirical evidence that cognitive-behavioral interventions are efficacious in the treatment of PTSD. People with mental retardation (MR) often are victims of sexual assaults, but the presence of comorbid PTSD and MR was not found in the current literature. In addition, there is no evidence showing that any specific short-term intervention is effective in treating PTSD with comorbid MR. The present article describes a case study in which short-term exposure therapy following numerous sexual assaults was effective in reducing the symptoms of PTSD in a woman with comorbid MR.


 

Title:

Treatment of PTSD: Stress Inoculation Training with Prolonged Exposure compared to EMDR.

Author(s):

Lee, Christopher, Sir Charles Gairdner Hosp, QEII Medical Ctr, Perth, Australia, chlee@central.murdoch.edu.au
Gavriel, Helen, HMAS Stirling, Royal Australian Navy, Australia
Drummond, Peter, Murdoch U, School of Psychology, Perth, Australia
Richards, Jeff, U Ballarat, Ballarat, Australia
Greenwald, Ricky, Mount Sinai School of Medicine, New York, NY, US

Address:

Lee, Christopher, 88 Palmerston St., Mosman Park, WAU, Australia, chlee@central.murdoch.edu.au

Source:

Journal of Clinical Psychology, Vol 58(9), Sep 2002. pp. 1071-1089.

Publisher:

US: John Wiley & Sons

Abstract:

The effectiveness of Stress Inoculation Training with Prolonged Exposure (SITPE) was compared to Eye Movement Desensitization and Reprocessing (EMDR). 24 participants (mean age 35.3 yrs) who had a diagnosis of Post Traumatic Stress Disorder (PTSD) were randomly assigned to one of the treatment conditions. Participants were also their own wait-list control. Outcome measures included self-report and observer-rated measures of PTSD, and self-report measures of depression. On global PTSD measures, there were no significant differences between the treatments at the end of therapy. However on the subscale measures of the degree of intrusion symptoms, EMDR did significantly better than SITPE. At follow-up EMDR was found to lead to greater gains on all measures.


Record: 9

Title:

Innovative use of virtual reality technology in the treatment of PTSD in the aftermath of September 11.

Author(s):

Difede, JoAnn, Cornell U, Weill Medical Coll, Dept of Psychiatry, New York, NY, US, jdifede@med.cornell.edu
Hoffman, Hunter, U Washington, Human Interface Technology Lab, Seattle, WA, US
Jaysinghe, Nimale, Cornell U, Weill Medical Coll, Dept of Psychiatry, New York, NY, US

Address:

Difede, JoAnn, jdifede@med.cornell.edu

Source:

Psychiatric Services, Vol 53(9), Sep 2002. pp. 1083-1085.

Publisher:

US: American Psychiatric Assn

Abstract:

Highlights developing research on and clinical applications of virtual reality technology to established psychotherapeutic principles and techniques for the treatment of anxiety disorders. In particular, the application of virtual reality technology in the treatment of posttraumatic stress disorder related to September 11th is addressed. Until now, psychotherapy in general and imaginal exposure in particular have relied on the capacities of a patient's imagination and memory. However, virtual environments afford opportunities not only to capitalize on a patient's capacities, but also to augment them with visual, auditory, and even haptic computer-generated experiences.


 

Title:

Cognitive-behavior therapy for PTSD in rape survivors.

Author(s):

Jaycox, Lisa H., RAND, Arlington, VA, US, Jaycox@rand.org
Zoellner, Lori, U Washington, WA, US
Foa, Edna B., U Pennsylvania, PA, US

Address:

Jaycox, Lisa H., RAND, 1200 South Hayes Street, Arlington, VA, US, Jaycox@rand.org

Source:

Journal of Clinical Psychology, Vol 58(8), Aug 2002. pp. 891-906.

Publisher:

US: John Wiley & Sons

Abstract:

Notes that in recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, the authors present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor (aged 25 yrs) is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a 1-yr follow-up assessment.


 

Title:

Trauma focus group therapy for combat-related PTSD: An update.

Author(s):

Foy, David W., Pepperdine U, Graduate School of Education & Psychology, Encino, CA, US, dfoy@pepperdine.edu
Ruzek, Josef I., National Ctr for PTSD, Palo Alto, CA, US
Glynn, Shirley M., West Los Angeles Veterans Medical Ctr, Los Angeles, CA, US
Riney, Sherry J., National Ctr for PTSD, Palo Alto, CA, US
Gusman, Fred D., National Ctr for PTSD, Palo Alto, CA, US

Address:

Foy, David W., Pepperdine U, Graduate School of Education & Psychology, 16830 Ventura Boulevard, Suite #200, Encino, CA, US, dfoy@pepperdine.edu

Source:

Journal of Clinical Psychology, Vol 58(8), Aug 2002. pp. 907-918.

Publisher:

US: John Wiley & Sons

Abstract:

Individual cognitive-behavioral therapy involving directed exposure to memories of traumatic events has been found to be effective in treating posttraumatic stress disorder. In this article, the authors present updated information on an alternative group form of exposure therapy: manualized trauma-focus group therapy (TFGT), designed as an efficient means of conducting directed exposure. The cognitive-behavioral and developmental models from which the approach was derived are described, and an overview of session topics and a case illustration are presented. The authors also provide guidelines for referring individuals to TFGT, and offer suggestions for future research. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

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.

Author(s):

Resick, Patricia A., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US, resick@umsl.edu
Nishith, Pallavi, U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US
Weaver, Terri L., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US
Astin, Millie C., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US
Feuer, Catherine A., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US

Address:

Resick, Patricia A., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, Weinman Bldg, 8001 Natural Bridge Road, St Louis, MO, US, resick@umsl.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 70(4), Aug 2002. pp. 867-879.

Publisher:

US: American Psychological Assn

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 Clinician-Administered 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. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


Record: 13

Title:

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

Author(s):

Nishith, Pallavi, U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US, pnishith@umsl.edu
Resick, Patricia A., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US
Griffin, Michael G., U Missouri, Dept of Psychology, Ctr for Trauma Recovery, St Louis, MO, US

Address:

Nishith, Pallavi, U Missouri, Dept of Psychology, Ctr for Trauma Recovery, Weinman Bldg, 8001 Natural Bridge Rd, St Louis, MO, US, pnishith@umsl.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 70(4), Aug 2002. pp. 880-886.

Publisher:

US: American Psychological Assn

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 Stres 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.


 

Title:

Does imaginal exposure exacerbate PTSD symptoms?

Author(s):

Foa, Edna B., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US, foa@mail.med.upenn.edu
Zoellner, Lori A., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Feeny, Norah C., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Hembree, Elizabeth A., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Alvarez-Conrad, Jennifer, U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US

Address:

Foa, Edna B., U Pennsylvania, Ctr for the Treatment & Study of Anxiety, 3535 Market St, Philadelphia, PA, US, foa@mail.med.upenn.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 70(4), Aug 2002. pp. 1022-1028.

Publisher:

US: American Psychological Assn

Abstract:

Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concern that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation was examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method of incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptoms exacerbation. Individuals who reported symptom exacerbation benefited comparably from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.


Record: 15

Title:

Changes in PTSD patients' narratives during prolonged exposure therapy: A replication and extension.

Author(s):

van Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology & Personality, Nijmegen, Netherlands, minnen@psych.kun.nl
Wessel, Ineke, Maastricht U, Dept of Psychology, Maastricht, Netherlands
Dijkstra, Ton, U Nijmegen, Nijmegen Inst for Cognition & Information, Nijmegen, Netherlands
Roelofs, Karin, U Nijmegen, Dept of Clinical Psychology & Personality, Nijmegen, Netherlands

Address:

van Minnen, Agnes, U Nijmegen, Dept of Clinical Psychology & Personality, PO Box 9104, 6500 HE, Nijmegen, Netherlands, minnen@psych.kun.nl

Source:

Journal of Traumatic Stress, Vol 15(3), Jul 2002. pp. 255-258.

Publisher:

US: John Wiley & Sons

Abstract:

Replicated and extended the findings of E. B. Foa et al (1995), who explored the process of narrative organization during posttraumatic stress disorder (PTSD) treatment. Narrative changes from the first to the last exposure session were compared for improved and nonimproved PTSD patients (mean age 38.4 yrs) on fragmentation, organization, internal, and external events. The 8 improved and 12 nonimproved patients did not differ regarding changes in fragmentation or organized thoughts. However, improved patients showed a greater decrease in disorganized thoughts during treatment. Furthermore, all patients, independent of improvement, showed significant changes in the same direction; a decrease in disorganized thoughts and external events and an increase in internal events. Although previous results were partly replicated, it is concluded that narrative changes may be due to exposure treatment itself rather than to changes in memory representation.


 

Title:

Intrusive thoughts in posttraumatic stress disorder.

Author(s):

Falsetti, Sherry A., Medical U of South Carolina, Charleston, SC, US
Monnier, Jeannine, Medical U of South Carolina, Charleston, SC, US
Davis, Joanne L., Medical U of South Carolina, Charleston, SC, US
Resnick, Heidi S., Medical U of South Carolina, Charleston, SC, US

Address:

Falsetti, Sherry A., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, 165 Cannon Street, P.O. Box 250852, Charleston, SC, US

Source:

Journal of Cognitive Psychotherapy, Vol 16(2), Sum 2002. Special issue: Special Issue on Intrusions in Cognitive Behavioral Therapy. pp. 127-143.

Publisher:

US: Springer Publishing

Abstract:

Reviews the literature on prevalence, associated features, assessment, and treatment of intrusive symptoms associated with posttraumatic stress disorder (PTSD). Research indicates that among trauma survivors, intrusive thoughts and imagery are quite common and distressing. It appears that early intrusions may be predictive of long-term distress and that avoidance and suppression can maintain intrusions. The treatment outcome literature for PTSD indicates that current cognitive behavioral treatments are effective in reducing intrusions. New data from a recent treatment outcome study for PTSD with comorbid panic attacks, using Multiple Channel Exposure Therapy, also suggest that this treatment is effective in significantly reducing intrusions. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout.

Author(s):

van Minnen, A., U Nijmegen, Dept of Clinical Psychology, Nijmegen, Netherlands, minnen@psych.kun.nl
Arntz, A., U Maastricht, Dept of Medical, Clinical & Experimental Psychology, Maastricht, Netherlands
Keijsers, G. P. J., U Nijmegen, Dept of Clinical Psychology, Nijmegen, Netherlands

Address:

van Minnen, A., U Nijmegen, Dept of Clinical Psychology, PO Box 9104, 6500, Nijmegen, Netherlands, minnen@psych.kun.nl

Source:

Behaviour Research and Therapy, Vol 40(4), Apr 2002. pp. 439-457.

Publisher:

Netherlands: Elsevier Science

Abstract:

Investigated predictors of treatment outcome and dropout in 2 samples (N=59 and 63) of posttraumatic stress disorder (PTSD) patients with mixed traumas treated using prolonged imaginal exposure. Possible predictors were analysed in both samples separately, in order to replicate in one sample findings found in the other. The only stable finding across the two groups was that patients who showed more PTSD-symptoms at pre-treatment, showed more PTSD-symptoms at post-treatment and follow-up. Indications were found that benzodiazepine use was related to both treatment outcome and dropout, and alcohol use to dropout. Demographic variables, depression and general anxiety, personality, trauma characteristics, feelings of anger, guilt, and shame and nonspecific variables regarding therapy were not related to either treatment outcome or dropout, disconfirming generally held beliefs about these factors as contra-indications for exposure therapy. It is concluded that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome or dropout. Clinically seen, it is therefore argued that exclusion of PTSD-patients from prolonged exposure treatment on the basis of pre-treatment characteristics is not justified.


 

Title:

A narrative exposure treatment as intervention in a refugee camp: A case report.

Author(s):

Neuner, Frank, U Konstanz, Konstanz, Germany, frank.neuner@uni-konstanz.de
Schauer, Margarete, U Konstanz, Konstanz, Germany
Roth, Walton T., Stanford U, Stanford, CA, US
Elbert, Thomas, U Konstanz, Konstanz, Germany

Address:

Neuner, Frank, U Konstanz, Dept of Psychology, Fach D25, D-78457, Konstanz, Germany, frank.neuner@uni-konstanz.de

Source:

Behavioural and Cognitive Psychotherapy, Vol 30(2), Apr 2002. pp. 205-210.

Publisher:

US: Cambridge Univ Press

Abstract:

The authors applied Narrative Exposure Treatment (NET) to a severely traumatized Kosovar refugee (aged 24 yrs) living in a Macedonian refugee camp during the Balkan War. NET is a pragmatic short-term approach that integrates effective therapeutic components deriving from Cognitive Behavior Therapy and Testimony Therapy. Outcome was evaluated by clinical examination and the Posttraumatic Stress Diagnostic Scale. Three sessions of NET were enough to afford considerable relief, although some posttraumatic stress disorder (PTSD) symptoms remained. The authors' experience indicates that Narrative Exposure is a promising and realistic approach for the treatment of even severely traumatized refugees living in camps. In addition, it can prove valid testimonies about human fights violations without humiliating the witness.


 

Title:

Prolonged exposure counterconditioning (PEC) as a treatment for chronic post-traumatic stress disorder and major depression in an adult survivor of repeated child sexual and physical abuse.

Author(s):

Paunovic, Nenad, Stockholm U, Stockholm, Sweden

Source:

Clinical Case Studies, Vol 1(2), Apr 2002. pp. 148-169.

Publisher:

US: Sage Publications

Abstract:

Prolonged exposure counterconditioning (PEC) was tested as a treatment for chronic post-traumatic stress disorder (PTSD) in an adult male survivor (aged 42 years) of repeated child sexual and physical abuse. PEC utilizes imaginal reliving of very pleasurable life moments in order to weaken traumatic conditioned emotional responses (CERs). A higher-order conditioned stimuli (CS) is used as a traumatic CER elicitor. Prolonged imaginal reliving of pleasurable CSs is used as a counterconditioner to the traumatic CERs. A statistical technique for analyzing single-case subject designs based on classical test theory was used to evaluate the client's progress in treatment. Results showed that PEC effectively decreased the client's PTSD symptoms, depression, and anxiety. In addition, the client's negative cognitions became considerably more positive. Also, the client lost his comorbid conditions of chronic major depressive disorder and social phobia. Finally, other clinically observed symptoms, which are described in the article, improved markedly. All results were maintained at a 3-month follow-up. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Integrated behavioral treatment of comorbid OCD, PTSD, and borderline personality disorder: A case report.

Author(s):

Becker, Carolyn Black, Trinity U, San Antonio, TX, US, carolyn.becker@trinity.edu

Address:

Becker, Carolyn Black, Trinity U, Dept of Psychology, 715 Stadium Dr, San Antonio, TX, US, carolyn.becker@trinity.edu

Source:

Cognitive and Behavioral Practice, Vol 9(2), Spr 2002. pp. 100-110.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

According to critics of empirically supported treatments, comorbidity represents a significant barrier to the implementation of such interventions in standard clinical practice. Advocates of empirically supported treatment have noted that comorbid disorders can be addressed concurrently. There is, however, little guidance in the literature regarding implementation of concurrently delivered protocols. The present case report describes the successful treatment of a 43-year-old woman diagnosed with comorbid obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and borderline personality disorder. Treatment utilized a concurrent approach that integrated exposure and response prevention for OCD, exposure therapy for PTSD, and components of dialectical behavior therapy for borderline personality disorder. Both 12-month formal and 18-month informal follow-up assessment indicated that improvement was maintained after termination. Results suggest that integrated delivery of empirically supported interventions can be utilized to successfully treat complex, comorbid cases.


 

Title:

Marked lability in urinary cortisol levels in subgroups of combat veterans with posttraumatic stress disorder during an intensive exposure treatment program.

Author(s):

Mason, John W., Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US, jwmason@pol.net
Wang, Sheila, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US
Yehuda, Rachel, Mount Sinai Medical School, Dept of Psychiatry, New York, NY, US
Lubin, Hadar, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US
Johnson, David, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US
Bremner, J. Douglas, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US
Charney, Dennis, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US
Southwick, Steven, Yale U School of Medicine, Dept of Psychiatry, New Haven, CT, US

Address:

Mason, John W., 32 Maple Vale Drive, Woodbridge, CT, US, jwmason@pol.net

Source:

Psychosomatic Medicine, Vol 64(2), Mar-Apr 2002. pp. 238-246.

Publisher:

US: Lippincott Williams & Wilkins

Abstract:

Examined longitudinal data on lability of cortisol levels in posttraumatic stress disorder (PTSD) because previous studies have largely been based on sampling at a single time point and have yielded varying results. This study measured urinary cortisol levels at admission, midcourse, and discharge during a 90-day hospitalization period in 51 male Vietnam combat veterans (mean age 42.7 yrs) with PTSD. Although there were no significant differences in the mean urinary cortisol levels between the admission, midcourse, and discharge values, marked lability of cortisol levels in individual patients was observed over time. In addition, this hormonal lability defined discrete subgroups of patients on the basis of the longitudinal pattern of cortisol change during exposure treatment, and there were significant psychometric differences in the level of social functioning between these subgroups. The findings suggest a psychogenic basis for cortisol alterations in PTSD in relation to psychosocial stress and indicate a central regulatory dysfunction of the hypothalamic-pituitary-adrenal axis characterized by a dynamic tendency to overreact in both upward and downward directions.


 

Title:

Exposure therapy for posttraumatic stress disorder.

Author(s):

Rothbaum, Barbara Olasov, Emory U School of Medicine, Trauma & Anxiety Recovery Program, Atlanta, GA, US, brothba@emory.edu
Schwartz, Ann C., Emory U School of Medicine, Atlanta, GA, US

Address:

Rothbaum, Barbara Olasov, The Emory Clinic, 1365 Clifton Road, Atlanta, GA, US, brothba@emory.edu

Source:

American Journal of Psychotherapy, Vol 56(1), 2002. pp. 59-75.

Publisher:

US: Assn for the Advancement of Psychotherapy

Abstract:

Exposure therapy is a well-established treatment for posttraumatic stress disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on exposure therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about exposure therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that exposure therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.


 

Title:

Trastorno de estrés postraumáitico en víctimas de maltrato doméstico: Evaluación de un programa de intervención.

Translated Title:

Posttraumatic stress disorder in battered women: evaluation of an intervention program.

Author(s):

Labrador, Francisco Javier, Universidad Complutense de Madrid, Madrid, Spain
Rincón, Paulina Paz, Universidad Complutense de Madrid, Departamento de Psicología Clínica, Madrid, Spain, psper30@sis.ucm.es

Address:

Rincón, Paulina Paz, Departamento de Psicologia Clinica, Universidad Complutense de Madrid, Campus de Somosaguas s/n, 28223, Madrid, Spain, psper30@sis.ucm.es

Source:

Análisis y Modificación de Conducta, Vol 28(122), 2002. pp. 905-932.

Publisher:

Spain: Editorial Promolibro

Abstract:

This study was directed to develop and prove an effective, short length, treatment programme for posttraumatic stress disorder (PTSD) among battered women. The treatment program was applied to nine female PTSD patients, according to the DSM-IV criteria, grouped in 3 member groups. The treatment program included 8 sessions (2 months), whose main components were psychoeducation, training relaxation, cognitive therapy and exposure therapy. The results on the posttreatment and on the first and third month follow-up sessions, show that the programme was effective to reduce the TEPT on the 100% of the patients. The results also point out an improvement in variables such as depression, self-esteem, social inadaptation, and posttraumatic cognitions. The implications of this study for clinical practice and future research in PTSD are discussed.


 

Title:

Cognitive restructuring within reliving: A treatment for peritraumatic emotional 'hotspots' in posttraumatic stress disorder.

Author(s):

Grey, Nick, Ctr for Anxiety Disorders & Trauma, London, United Kingdom, n.grey@iop.kcl.ac.uk
Young, Kerry, Traumatic Stress Clinic, London, United Kingdom
Holmes, Emily, Traumatic Stress Clinic, London, United Kingdom

Address:

Grey, Nick, Inst of Psychiatry, Ctr for Anxiety Disorders & Trauma, 99 Denmark Hill, London, United Kingdom, SE5 8AF, n.grey@iop.kcl.ac.uk

Source:

Behavioural and Cognitive Psychotherapy, Vol 30(1), Jan 2002. pp. 37-56.

Publisher:

US: Cambridge Univ Press

Abstract:

This paper describes a distinct clinical approach to the treatment of Posttraumatic Stress Disorder (PTSD). It is theoretically guided by recent cognitive models of PTSD and explicitly combines cognitive therapy techniques within exposure/reliving procedures. A clinically pertinent distinction is made between the cognitions and emotions experienced at the time of the trauma and, subsequently, in flashback experiences, and secondary negative appraisals. The term peritraumatic emotional "hotspot" is used to describe moments of peak distress during trauma. It is argued that a focus on cognitively restructuring these peritraumatic emotional hotspots within reliving can significantly improve the effectiveness of the treatment of PTSD and help explain some treatment failures with traditional prolonged exposure. An approach to the identification and treatment of these hotspots is detailed for a range of cognitions and emotions not limited to fear.


 

Title:

Behavioral/cognitive approaches to post-traumatic stress: Theory-driven, empirically based therapy.

Series Title:

Contributions in psychology; no. 39

Author(s):

Roemer, Lizabeth, U Massachusetts, Dept of Psychology, Boston, MA, US
Harrington, Nicole T., Mental Health & Substance Abuse Services of the Berkshires, Family Ctr of the Berkshires, US
Riggs, David S., State U New York at Stony Brook, Stony Brook, NY, US

Source:

Brief treatments for the traumatized: A project of the Green Cross Foundation. Figley, Charles R. (Ed); pp. 59-80.
Westport, CT, US: Greenwood Press/Greenwood Publishing Group, Inc, 2002. xxiv, 337 pp.

Abstract:

(from the chapter) Provides an overview of the authors' behavioral/cognitive approach to the treatment of trauma-related psychological difficulties. This chapter is meant to be read with the chapter in this volume about behavioral/cognitive theories (see record 2003-04267-002), which provides the conceptual basis for the therapeutic approach outlined here. This chapter is divided into a section on the initial phase of treatment, including assessment, monitoring, psychoeducation, and establishing a therapeutic relationships, followed by separate sections for exposure-based, cognitive, and skills-training interventions as well as relapse prevention. These treatments have been designated as active ingredients in the treatment of posttraumatic stress disorder (PTSD) and studies have supported their efficacy.


 

Title:

Posttraumatic stress disorder.

Author(s):

Scotti, Joseph R., West Virginia U, Dept of Psychology, Morgantown, WV, US
Morris, Tracy L., West Virginia U, Dept of Psychology, Morgantown, WV, US
Ruggiero, Kenneth J., West Virginia U, Dept of Psychology, Morgantown, WV, US
Wolfgang, Julie, West Virginia U, Dept of Psychology, Morgantown, WV, US

Source:

Clinical behavior therapy: Adults and children. Hersen, Michel; pp. 361-382.
Hoboken, NJ, US: John Wiley & Sons, Inc, 2002. xiv, 513 pp.

Abstract:

(from the create) Two children were passengers in a car accident in which the children were in extreme distress when their mothers injuries appeared serious and the threesome had to wait an inordinate amount of time until help arrived. This chapter describes the use of a complex therapy for posttraumatic stress disorder (PTSD) in these children, aged 3 and 9 yrs. A treatment choice was made for the use of behavior therapy (BT), involving anxiety management, exposure-based procedures, and contingency management procedures. A general description of the disorder and a specific case history and accident description are provided. Results of a clinical assessment and a medical consultation are then followed by a case conceptualization and finally the rationale for treatment choice and planning. A detailed course of treatment is then related, including therapist-client factors, course of termination, follow-up, and a commentary on managed care considerations. The overall effectiveness of BT in this case is then discussed.


 

Title:

Cortisol and imaginal exposure in posstraumatic stress disorder: A case report.

Author(s):

Otte, Christian, University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany, otte@uke.uni-hamburg.de
Arlt, Josef, University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Wiedemann, Klaus, University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany
Kellner, Michael, University Hosp Hamburg-Eppendorf, Dept of Psychiatry & Psychotherapy, Hamburg, Germany

Address:

Otte, Christian, Dept of Psychiatry & Psychotherapy, U of Hamburg, Martinistrasse 52, 20246, Hamburg, Germany, otte@uke.uni-hamburg.de

Source:

German Journal of Psychiatry, Vol 5(3), 2002. pp. 75-77.

Publisher:

Germany: German Journal of Psychiatry

Abstract:

Imaginal exposure is closely associated with hippocampal processing of traumatic memory. The hippocampus is a target for glucocorticoids which influence memory retrieval and stress response. Glucocorticoid secretion in response to imaginal exposure has not been investigated. We measured subjective distress and salivary cortisol during the 1st and the 20th exposure session in a female patient (aged 45 yrs) with PTSD. Despite considerable arousal and anxiety, cortisol did not increase during the first exposure. During the 20th exposure there was a marked reduction of distress, although cortisol values did not differ from exposure 1. The response of glucocorticoids to imaginal exposure and mechanisms of the lacking cortisol response need further research.

Tests & Measures:

Posttraumatic Stress Diagnostic Scale


 

Title:

Managing obstacles to the utilization of exposure therapy With PTSD patients.

Author(s):

Zayfert, Claudia, Dept of Psychiatry, Dartmouth Medical School, Lebanon, NH, US, claudia.zayfert@dartmouth.edu
Becker, Carolyn B., Trinity U, San Antonio, TX, US, cbecker@trinity.edu
Gillock, Karen L., Dartmouth Medical School, Lebanon, NH, US, Karen.l.gillock@dartmouth.edu

Address:

Zayfert, Claudia, Dept of Psychiatry, Dartmouth Medical School, One Medical Center Dr., Lebanon, NH, US, claudia.zayfert@dartmouth.edu

Source:

Innovations in clinical practice: A source book (Vol. 20). VandeCreek, Leon (Ed); Jackson, Thomas L. (Ed); pp. 201-222.
Sarasota, FL, US: Professional Resource Press/Professional Resource Exchange, Inc, 2002. x, 501 pp.

Abstract:

(from the chapter) This chapter relies heavily on the authors' experiences implementing exposure therapy (ET) in the anxiety disorders clinic of a rural tertiary care medical center. The authors explore factors pertinent to the utilization of ET in a clinical context. They begin with an overview of ET for posttraumatic stress disorder (PTSD), and assert that, despite the limitations of existing data and problems in the implementation of ET, the goal of increasing its clinical use is justifiable. Next, they offer a framework for conceptualizing difficulties in ET implementation that incorporates recent theoretical explanations of ET process and draws upon empirical work on motivation and process in behavior therapy. Within this framework, the remainder of the chapter elaborates on specific methods to facilitate implementation and completion of ET.


 

Title:

Is EMDR an exposure therapy? A review of trauma protocols.

Author(s):

Rogers, Susan, VA Medical Ctr, Coatsville, PA, US, rogers.susan@coatsville.va.gov
Silver, Steven M.

Address:

Rogers, Susan, DVA Medical Ctr, PTSD Program 116P, Coatsville, PA, US, rogers.susan@coatsville.va.gov

Source:

Journal of Clinical Psychology, Vol 58(1), Jan 2002. pp. 43-59.

Publisher:

US: John Wiley & Sons

Abstract:

Presents the well established theoretical base and clinical practice of exposure therapy for trauma. Necessary requirements for positive treatment results and contraindicated procedures are reviewed. Eye Movement Desensitization and Reprocessing (EMDR) is contrasted with these requirements and procedures. By the definitions and clinical practice of exposure therapy, the classification of EMDR poses some problems. As seen from the exposure therapy paradigm, its lack of physiological habituation and use of spontaneous association should result in negligible or negative effects rather than the well researched positive outcomes. Possible reasons for the effectiveness of EMDR are discussed, ranging from the fundamental nature of trauma reactions to the nonexposure mechanisms utilized in information processing models.


 

Title:

Comparison for two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure.

Author(s):

Ironson, Gail, U Miami, Cable Gables, FL, US, gironson@aol.com
Freud, B.
Strauss, J. L.
Williams, J.

Address:

Ironson, Gail, U Miami, Behavioral Medicine Program, P.O. Box 248185, Coral Gables, FL, gironson@aol.com

Source:

Journal of Clinical Psychology, Vol 58(1), Jan 2002. pp. 113-128.

Publisher:

US: John Wiley & Sons

Abstract:

This pilot study compared the efficacy of 2 treatments for postraumatic stress disorder (PTSD): Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE). Data were analyzed for 22 patients (aged 16-62 yrs) from a university based clinic serving the outside community (predominantly rape and crime victims) who completed at least 1 active session of treatment after 3 preparatory sessions. Results showed both approaches produced a significant reduction in PTSD and depression symptoms, which were maintained at 3-month follow-up. Successful treatment was faster with EMDR as a larger number of people (7 of 10) had a 70% reduction in PTSD symptoms after 3 active sessions compared to 2 of 12 with PE. EMDR appeared to be better tolerated as the dropout rate was significantly lower in those randomized to EMDR versus PE (0 of 10 vs 3 of 10). However all patients who remained in treatment with PE had a reduction in PTSD scores. Finally, Subjective Units of Distress (SUDS) ratings decreased significantly during the initial session of EMDR, but changed little during PE. Postsession SUDS were significantly lower for EMDR than for PE. Suggestions for future research are discussed.


 

Title:

Post-traumatic stress disorder.

Author(s):

Yehuda, Rachel, Mount Sinai School of Medicine, Dept of Psychiatry, NY, US, rachel.yehuda@med.va.gov

Address:

Yehuda, Rachel, Bronx Veterans Affairs Medical Ctr, 130 Kingsbridge Road, Bronx, NY, US, rachel.yehuda@med.va.gov

Source:

New England Journal of Medicine, Vol 346(2), Jan 2002. pp. 108-114.

Publisher:

US: Massachusetts Medical Society

Abstract:

Although most people will gradually recover from the psychological effects of a traumatic event, posttraumatic stress disorder (PTSD) will develop in a substantial proportion. PTSD appears to represent a failure to recover from a nearly universal set of emotions and reactions and is typically manifested as distressing memories or nightmares related to the traumatic event, attempts to avoid reminders of the trauma, and a heightened state of physiological arousal. The treatment of PTSD involves educating the patient about the nature of the disorder, providing a safe and supportive environment for discussing traumatic events and their impact, and relieving the distress associated with memories and reminders of the event. A variety of approaches, such as exposure therapy, cognitive therapy, and pharmacotherapy, have been found to be effective in the treatment of PTSD.


 

Title:

Beliefs, sense of control and treatment outcome in post-traumatic stress disorder.

Author(s):

Livanou, Maria, U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
Basoglu, M., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
Marks, I. M., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
De Silva, P., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
Noshirvani, H., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
Lovell, K., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England
Thrasher, S., U London, Inst of Psychiatry, Div of Psychological Medicine, Section of Trauma Studies, London, England

Address:

Livanou, Maria, Inst of Psychiatry, Dept of Psychiatry, Section of Trauma Studies, 38 Carver Road, London, England, SE24 9LT

Source:

Psychological Medicine, Vol 32(1), Jan 2002. pp. 157-165.

Publisher:

US: Cambridge Univ Press

Abstract:

Few studies have shown that maladaptive beliefs relate to treatment outcome. In a randomized controlled study, 87 outpatients (aged 16-65 yrs) with posttraumatic stress disorder (PTSD) had exposure therapy alone or cognitive restructuring alone, or both combined, or relaxation. Independent blind assessors assessed patients at pre-, mid-, and post-treatment and at follow-up; at those times patients rated cognitive, behavioral, and emotional aspects of their disorder. Baseline beliefs about mistrust, helplessness, meaninglessness, and unjustness of the world related to baseline PTSD symptoms but did not predict treatment outcome, though improvement in certain beliefs correlated with more symptom improvement. Several "key" beliefs changed after, and none before, symptoms improved. At posttreatment, sense of control and attribution of gains to personal efforts predicted maintenance of gains at follow-up. Baseline beliefs and improvement in beliefs did not predict outcome. Post-treatment sense of control/internal attribution predicted maintenance of gains at follow-up.


 

Title:

Cognitive-behavioral treatment of PTSD.

Author(s):

Zoellner, Lori A., Hahnemann U, Medical Coll of Philadelphia, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Foa, Edna B., Hahnemann U, Medical Coll of Philadelphia, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Fitzgibbons, Lee A., Hahnemann U, Medical Coll of Philadelphia, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US

Source:

Simple and complex post-traumatic stress disorder: Strategies for comprehensive treatment in clinical practice. Williams, Mary Beth (Ed); Sommer, John F. Jr. (Ed); pp. 75-98.
Binghamton, NY, US: Haworth Maltreatment and Trauma Press/The Haworth Press, Inc, 2002. xxiii, 408 pp.

Abstract:

(from the chapter) The most studied psychosocial treatment programs for posttraumatic stress disorder (PTSD) have utilized cognitive-behavioral techniques. These consist of a variety of treatment programs including exposure procedures, cognitive restructuring, and anxiety management. Treatment is conceived as promoting emotional processing of the traumatic event. Two conditions are necessary for emotional processing to take place during treatment. First, fear-relevant information must be made available so that the fear memory can be activated. Second, information made available must contain elements that are incompatible with some of those that exist so that a new memory can be formed. This new information must then be integrated into the evoked memory structure in order for emotional change to occur. Accordingly, therapy for PTSD aims at modifying the victims' exaggerated perception of the world as entirely dangerous and of themselves as entirely incompetent and worthless.


 

Title:

Cognitive Processing Therapy for PTSD in a Survivor of the World Trade Center Bombing: A Case Study.

Author(s):

Difede, JoAnn, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, US, jdifede@mail.med.cornell
Eskra, David, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, US

Address:

Difede, JoAnn, The New York Hospital-Cornell Medical Center, 525 East 68th Street, Box 200, New York, NY, US, jdifede@mail.med.cornell

Source:

Trauma Practice in the Wake of September 11, 2001. Gold, Steven N. (Ed); Faust, Jan (Ed); pp. 155-165.
New York, NY, US: Haworth Press, 2002. 170 pp.

Abstract:

(from the chapter) The present case study describes the successful treatment, including long-term follow-up of a survivor of the first World Trade Center (WTC) bombing who developed posttraumatic stress disorder (PTSD). The literature indicates that behavioral, particularly exposure based techniques, and cognitive applications have shown promising results in reducing symptoms of PTSD, in adults exposed to combat and rape. To our knowledge, no treatment protocol has been developed for PTSD following a terrorist incident. This paper presented the application of a PTSD treatment protocol based on Cognitive Processing Therapy (CPT) (Resick & Schnicke, 1992, 1993) in the treatment of an adult female exposed to such terrorist trauma.

Tests & Measures:

Structured Clinical Interview for the DSM III-R
PTSD Symptoms Scale
Brief Symptom Inventory
Clinician-Administered PTSD Scale


 

Title:

Innovations in clinical practice: A source book (Vol. 20).

Author(s):

VandeCreek, Leon, (Ed), School of Professional Psychology, Wright State U, Dayton, OH, US, leon.vandecreek@wright.edu
Jackson, Thomas L., (Ed), Aggression & Violence Prevention Consultants, US, AvertViolence@aol.com

Address:

VandeCreek, Leon, School of Professional Psychology, 3640 Colonel Glenn Hwy, Wright State U, Dayton, OH, US, leon.vandecreek@wright.edu

Source:

Sarasota, FL, US: Professional Resource Press/Professional Resource Exchange, Inc, 2002. x, 501 pp.

Abstract:

(from the introduction) As in previous volumes, Innovations in Clinical Practice: A Source Book (Volume 20) is organized into five sections that reflect the diversity of contributions to the series. The first section, "Clinical Issues and Applications", deals primarily with therapeutic concerns. The second section addresses "Practice Management and Professional Development" and is included because of the increasing number of clinicians who work independently. The third section includes "Assessment Instruments and Office Forms". The instruments are primarily informal and designed to assist clinicians in collecting information about clients. "Community Interventions" and "Selected Topics" cover the fourth and fifth sections, respectively.


 

Title:

Linguistic predictors of trauma pathology and physical health.

Author(s):

Alvarez-Conrad, Jennifer, U Pennsylvania School of Medicine, PA, US
Zoellner, Lori A., U Pennsylvania School of Medicine, PA, US, zoellner@u.washington.edu
Foa, Edna B., U Pennsylvania School of Medicine, PA, US

Address:

Zoellner, Lori A., U Washington, Dept of Psychology, Box 351525, Seattle, WA, US, zoellner@u.washington.edu

Source:

Applied Cognitive Psychology, Vol 15(7), Dec 2001. Special issue: Trauma, stress, and autobiographical memory. pp. S159-S170.

Publisher:

US: John Wiley & Sons

Abstract:

The present study examined how specific linguistic elements in trauma narratives were associated with post-treatment psychopathology and physical symptoms. The authors analyzed the narratives of 28 female assault victims (mean age 31 yrs) being treated for chronic posttraumatic stress disorder (PTSD). During exposure therapy, participants were asked to recount their assault 'as if it was happening now.' These trauma narratives were videotaped, transcribed, and analyzed using a linguistic coding program. In particular, narratives containing words about death and dying were associated with worse post-treatment functioning. This relationship could not be accounted for by assault-related characteristics. The focus on death and dying in the trauma narrative may reflect the concept of mental defeat, suggesting a possible target for intervention in cognitive-behavioral treatment of PTSD.


 

Title:

Treatment of posttraumatic stress disorder with comorbid panic attacks: Combining cognitive processing therapy with panic control treatment techniques.

Author(s):

Falsetti, Sherry A., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Ctr, Charleston, SC, US
Resnick, Heidi S.
Davis, Joanne
Gallagher, Natalie G.

Address:

Falsetti, Sherry A., Medical U of South Carolina, National Crime Victims Research & Treatment Ctr, 165 Cannon Street, P. O. Box 250852, Charleston, SC, US

Source:

Group Dynamics: Theory, Research, and Practice, Vol 5(4), Dec 2001. Special issue: Group-based interventions for trauma survivors. pp. 252-260.

Publisher:

US: Educational Publishing Foundation

Abstract:

A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet currently available PTSD treatment programs do not address this problem. This report provides an initial evaluation of a newly developed treatment, multiple channel exposure therapy (M-CET), for comorbid PTSD and panic attacks. The treatment uses elements of cognitive processing therapy treatment for PTSD and elements of panic control treatment to target physiological, cognitive, and behavioral symptoms. Results suggest that M-CET may be a promising treatment program for a subset of PTSD patients who experience panic attacks. Preliminary guidelines for conducting M-CET in a group format with participants exposed to diverse traumatic events are provided.


 

Title:

Cognitive therapy for posttraumatic stress disorder.

Author(s):

Resick, Patricia A., U Missouri, St Louis, MO, US

Address:

Resick, Patricia A., Ctr for Trauma Recovery, Weinman Building, U Missouri-St. Louis, 8001 Natural Bridge Road, St. Louis, MO, US

Source:

Journal of Cognitive Psychotherapy, Vol 15(4), Win 2001. Special issue: Review of cognitive behavioral therapy. pp. 321-329.

Publisher:

US: Springer Publishing

Abstract:

Examines 7 controlled studies that included at least a component of cognitive therapy for posttraumatic stress disorder (PTSD). Two studies specifically focused on early intervention to treat PTSD and included both cognitive therapy and exposure therapy. Three studies examined cognitive processing therapy, which is predominantly cognitive therapy. Two other studies compared pure cognitive therapy with exposure therapy. The author maintains that overall, cognitive therapy for PTSD appears to be highly effective compared to no-treatment, relaxation, or supportive counseling, and similar to exposure treatments. Treatment effects appear to continue through follow-up periods of up to 1 yr. However, little is known about who benefits best with cognitive therapy or predictors of treatment outcome.


 

Title:

Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees.

Author(s):

Paunovic, Nenad, Stockholm U, Dept of Psychology, Stockholm, Sweden
Öst, Lars-Göran

Address:

Paunovic, Nenad, Stockholm U, Dept of Psychology, 106 91, Stockholm, Sweden, npc@psychology.su.se

Source:

Behaviour Research and Therapy, Vol 39(10), Oct 2001. pp. 1183-1197.

Publisher:

Netherlands: Elsevier Science

Abstract:

Investigated the efficacy of cognitive-behavior therapy (CBT) and exposure therapy (E) in the treatment of post-traumatic stress disorder (PTSD) in refugees. 16 outpatients (aged 22-48 yrs) fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for PTSD were randomized to one of the two treatments. Assessor and self-report measures of PTSD-symptoms, generalized anxiety, depression, quality of life and cognitive schemas were administered before and after treatment, and at a 6-mo follow-up. The patients were treated individually for 16-20 weekly sessions. The results showed that both treatments resulted in large improvements on all the measures, which were maintained at the follow-up. There was no difference between E and CBT on any measure. E and CBT led to a 48 and 53% reduction on PTSD-symptoms, respectively, a 49 and 50% reduction on generalized anxiety, and a 54 and 57% reduction on depression. The results were maintained at the 6-mo follow-up. The conclusion that can be drawn is that both E and CBT can be effective treatments for PTSD in refugees.


 

Title:

Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder.

Author(s):

Rothbaum, Barbara O., Emory Clinic, Dept of Psychiatry, Atlanta, GA, US, brothba@emory.edu
Hodges, Larry F.
Ready, David
Graap, Ken
Alarcon, Renato D.

Source:

Journal of Clinical Psychiatry, Vol 62(8), Aug 2001. pp. 617-622.

Publisher:

US: Physicians Postgraduate Press

Abstract:

Virtual reality (VR) integrates real-time computer graphics, body-tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. This report presents the results of an open clinical trial using VR exposure to treat Vietnam combat veterans who have posttraumatic stress disorder (PTSD). In 8-16 sessions, 10 male patients (mean age 51 yrs) were exposed to 2 virtual environments: a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. Clinician-rated PTSD symptoms as measured by the Clinician Administered PTSD Scale, the primary outcome measure, at 6-month follow-up indicated an overall statistically significant reduction from baseline in symptoms associated with specific reported traumatic experiences. All 8 Ss interviewed at the 6-month follow-up reported reductions in PTSD symptoms ranging from 15-67%. Significant decreases were seen in all 3 symptom clusters. Patient self-reported intrusion symptoms as measured by the Impact of Event Scale were significantly lower at 3 mo than at baseline but not at 6 mo, although there was a clear trend toward fewer intrusive thoughts and somewhat less avoidance.


 

Title:

Tratamientos psicológicos eficaces para el estrés post-traumático.

Translated Title:

Efficacious psychological treatments for post-traumatic stress disorder.

Author(s):

Báguena Puigcerver, María José, U Valencia, Facultad de Psicología, Valencia, Spain, maria.j.baguena@uv.es

Source:

Psicothema, Vol 13(3), Aug 2001. pp. 479-492.

Publisher:

Spain: Colegio Oficial de Psicólogos del Principado de Asturias

Abstract:

Reviews the most effective psychological and pharmacological therapies for the treatment of posttraumatic stress disorder (PTSD). The empirical findings on cognitive-behavioral approaches (exposure therapy, cognitive restructuring, and anxiety management training), hypnotherapy, and pharmacotherapy (antidepressants, valproic acid, lithium, carbamazepine, and other substances) are examined. The recent emphasis on designing treatment programs that integrate several therapies is discussed.


 

Title:

Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Description of procedures.

Author(s):

Back, Sudie E., U Georgia, Dept of Psychology, Athens, GA, US, sback@arches.uga.edu
Dansky, Bonnie S.
Carroll, Kathleen M.
Foa, Edna B.
Brady, Kathleen T.

Source:

Journal of Substance Abuse Treatment, Vol 21(1), Jul 2001. pp. 35-45.

Publisher:

Netherlands: Elsevier Science

Abstract:

An estimated 30% to 50% of cocaine-dependent individuals meet criteria for lifetime posttraumatic stress disorder (PTSD). Cocaine dependence is associated with increased rates of exposure to trauma, more severe symptoms, higher rates of treatment attrition and retraumatization, and greater vulnerability to PTSD when compared to other substance use disorders. These associations underscore the need for effective treatments that address issues particular to PTSD in a manner tolerable to cocaine-dependent individuals. This article describes a manualized psychotherapy developed specifically for individuals with PTSD and cocaine dependence. Concurrent Treatment of PTSD and Cocaine Dependence (CTPCD) provides coping skills training, cognitive restructuring techniques, and relapse prevention strategies to reduce cocaine use. In-vivo and imaginal exposure therapy techniques are incorporated to reduce PTSD symptom severity. Primary treatment goals include psychoeducation specific to the interrelationship between PTSD and cocaine dependence, and clinically meaningful reductions in cocaine use and PTSD symptomatology. Secondary goals include a reduction in HIV high-risk behaviors and improved functioning in associated areas, such as anger and negative affect management.


 

Title:

Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings.

Author(s):

Brady, Kathleen T., Medical U South Carolina, Ctr for Drug & Alcohol Programs, Dept of Psychiatry & Behavioral Sciences, Charleston, SC, US
Dansky, Bonnie S.
Back, Sudie E., sback@arches.uga.edu
Foa, Edna B.
Carroll, Kathleen M.

Source:

Journal of Substance Abuse Treatment, Vol 21(1), Jul 2001. pp. 47-54.

Publisher:

Netherlands: Elsevier Science

Abstract:

39 Ss participated in an outpatient, 16-session individual, manual-guided psychotherapy designed to treat concurrent posttraumatic stress disorder (PTSD) and cocaine dependence. Therapy consisted of a combination of imaginal and in-vivo exposure therapy techniques to treat PTSD symptoms and cognitive-behavioral techniques to treat cocaine dependence. The dropout rate was high, but treatment completers demonstrated significant reductions in all PTSD symptom clusters and cocaine use from baseline to end of treatment. Significant reductions in depressive symptomatology, as measured by the Beck Depression Inventory, and psychiatric and cocaine use severity, as measured by the Addiction Severity Index, were also observed. These improvements in PTSD symptoms and cocaine use were maintained over a 6-month follow-up period among completers. Baseline comparisons between treatment completers and noncompleters revealed significantly higher avoidance symptoms, as measured by the Impact of Events Scale, and fewer years of education among treatment noncompleters as compared to completers. This study provides preliminary evidence to suggest that exposure therapy can be used safely and may be effective in the treatment of PTSD in some individuals with cocaine dependence.


 

Title:

Dreams and exposure therapy in PTSD.

Author(s):

Rothbaum, Barbara Olasov, Emory U, School of Medicine, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US, brothba@emory.edu
Mellman, Thomas Alan

Address:

Rothbaum, Barbara Olasov, Emory Clinic, Dept of Psychiatry & Behavioral Sciences, 1365 Clifton Road, Atlanta, GA, US, brothba@emory.edu

Source:

Journal of Traumatic Stress, Vol 14(3), Jul 2001. pp. 481-490.

Publisher:

US: John Wiley & Sons

Abstract:

Exposure therapy is a well-established treatment for posttraumatic stress disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Nightmares that refer to or replicate traumatic experiences are prominent and distressing symptoms of PTSD and appear to exacerbate the disorder. With this apparent paradox in mind, exposure therapy and the literature on sleep and PTSD are reviewed in the context of the relationship between therapeutic exposure and exposure to trauma-related stimuli that occurs in dreams. It is concluded that nightmares that replay the trauma and disrupt sleep do not meet requirements for therapeutic exposure, whereas other dreaming may aid in the recovery from trauma.


 

Title:

Treatment of a 50-year-old African American woman whose chronic posttraumatic stress disorder went undiagnosed for over 20 years.

Author(s):

Cooke, Alice L., U Pittsburgh, Western Psychiatric Inst & Clinic, Dept of Psychiatry, Pittsburgh, PA, US
Shear, M. Katherine, shearmk@msc.umpx.edu

Source:

American Journal of Psychiatry, Vol 158(6), Jun 2001. pp. 866-870.

Publisher:

US: American Psychiatric Assn

Abstract:

Presents the case of an African-American woman who met Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for posttraumatic stress disorder (PTSD) and was treated at a mental health clinic serving low-income African Americans. The diagnosis of PTSD was first made 22 yrs after the initial presentation, and only then did she reveal her experience of having been held hostage, bound, beaten, and repeatedly raped, narrowly escaping with her life. The PTSD diagnosis was made only after the patient underwent a structured diagnostic interview and a targeted treatment was provided under the auspices of a research project. The S was originally treated for panic disorder with agoraphobia, and then obsessive-compulsive disorder, before the accurate diagnosis of PTSD was given and the S was able to discuss her traumatic experience. The PTSD treatment course included in-session re-experiencing exposure to the traumatic event and between-session in vivo exposure to feared situations.

Tests & Measures:

Geriatric Depression Scale


 

Title:

Family and past history of mental illness as predisposing factors in post-traumatic stress disorder.

Author(s):

McKenzie, Nigel, U London, Inst of Psychiatry, Dept of Experimental Psychopathology, London, England
Marks, Isaac
Liness, Sheena

Source:

Psychotherapy and Psychosomatics, Vol 70(3), May-Jun 2001. pp. 163-165.

Publisher:

Switzerland: Karger

Abstract:

Family studies of posttraumatic stress disorder (PTSD) have given inconsistent results to date. Identifying predisposing factors in PTSD compared to anxiety disorders may help to clarify the classification of PTSD as a diagnostic entity. The present study used a retrospective case note study of 87 PTSD patients (mean age 37 yrs) who participated in exposure or cognitive restructuring therapy, and 51 PTSD patients (mean age 38 yrs) and 87 patients with agoraphobia (mean age 39 yrs) treated routinely as outpatients. Compared to those with agoraphobia, PTSD patients had significantly less family history of anxiety disorder but not mental illness in general. They also had significantly less personal history of mental illness prior to the index episode. Trauma precipitated PTSD in Ss who had significantly fewer premorbid predisposing factors than did Ss with agoraphobia. Such factors may predispose agoraphobia Ss to become psychiatrically ill after more minor trauma. Research is needed to systematically compare the events which precipitate PTSD as opposed to agoraphobia and other anxiety disorders.


 

Title:

Integrating DBT-based techniques and concepts to facilitate exposure treatment for PTSD.

Author(s):

Becker, Carolyn Black, Trinity U, San Antiono, TX, US, carolyn.becker@trinity.edu
Zayfert, Claudia, Dartmouth Medical School, NH, US

Address:

Becker, Carolyn Black, Trinity U, Dept of Psychology, 715 Stadium Drive, San Antonio, TX, US, carolyn.becker@trinity.edu

Source:

Cognitive and Behavioral Practice, Vol 8(2), Spr 2001. pp. 107-122.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

While considerable evidence supports the use of exposure-based treatment for posttraumatic stress disorder (PTSD), its utilization in clinical practice remains limited. This article presents a systematic and empirically grounded approach to the flexible application of PTSD treatment research in a "true" clinical setting. High rates of attrition, suicidality, dissociation, destructive impulsivity, and chaotic life problems are reasons cited by clinicians for abandoning empirically supported exposure treatment. M. M. Linehan's (1993) dialectical behavior therapy (DBT), designed to address many of these issues, offers useful strategies for addressing the needs of patients considered poor candidates for exposure therapy. This article offers a model for integrating DBT-based theory, concepts, and skills with manualized exposure-based cognitive-behavior therapy for PTSD in order to improve patient (and therapist) tolerance of this treatment.


 

Title:

The investigation of exposure and cognitive therapy: Comment on Tarrier et al. (1999).

Author(s):

Devilly, Grant J., U Melbourne, Dept of Criminology, Parkville, VIC, Australia
Foa, Edna B.

Source:

Journal of Consulting and Clinical Psychology, Vol 69(1), Feb 2001. pp. 114-116.

Publisher:

US: American Psychological Assn

Abstract:

This article outlines concerns relating to the N. Tarrier et al. (1999) investigation (see record 1999-00242-002) comparing imaginal exposure and cognitive therapy. Specifically, the authors offer N. Tarrier et al. the opportunity to operationally define and clarify the claim that more patients treated by imaginal exposure "worsened" during treatment. Equally, in light of N. Tarrier et al.'s low effect sizes in relation to past research the authors also highlight the need to utilize accountable treatment integrity checks.


 

Title:

What can be learned from clinical trials? Reply to Devilly and Foa (2001).

Author(s):

Tarrier, Nicholas, U Manchester, Withington Hosp, Dept of Clinical Psychology, Manchester, England

Source:

Journal of Consulting and Clinical Psychology, Vol 69(1), Feb 2001. pp. 117-118.

Publisher:

US: American Psychological Assn

Abstract:

G. Devilly and E. B. Foa (see record 2001-14541-013) claimed that the results of the Manchester posttraumatic stress disorder (PTSD) trial (Tarrier, Pilgrim, et al., see record 1999-00242-002) "significantly differ" from the results of other groups. This claim does not survive scrutiny. G. Devilly and E. B. Foa are unhappy with our report of treatment failures being overrepresented by patients receiving exposure. However, the failure of some patients to respond to exposure is in agreement with the literature, including E. B. Foa's own writing (A. Ehlers et al., 1998). Possible reasons the magnitude of change may differ from other studies are discussed, including differences in sample populations, methods of recruitment, and participant attrition. Attention is drawn to unique characteristics of the Manchester PTSD study, including the use of a baseline symptom-monitoring phase to exclude patients who would respond to minimal intervention and measurement of the psychosocial environment (expressed emotion).


 

Title:

Treatment of reactivated post-traumatic stress disorder: Imaginal exposure in an older adult with multiple traumas.

Author(s):

Russo, Stephen A., Nova Southeastern U, Ft Lauderdale, FL, US
Hersen, Michel
Van Hasselt, Vincent B.

Source:

Behavior Modification, Vol 25(1), Jan 2001. pp. 94-115.

Publisher:

US: Sage Publications

Abstract:

A single-case analysis was used to assess the effects of imaginal exposure in a 57-yr-old female suffering from current and reactivated posttraumatic stress disorder (PTSD) following a transient ischemic attack. The client's responses to self-reported depression, anxiety, and PTSD symptoms were repeatedly recorded during 4 phases: (1) initial psychotherapy, (2) imaginal exposure, (3) skill generalization, and (4) fading of treatment. In addition to dramatic reduction in levels of depression and anxiety, results showed a significant improvement in PTSD symptoms relating to recent and remote traumatic experiences. Improvements were maintained approximately 16 mo after imaginal exposure ended,

 

 

Title:

Designing a virtual environment for post-traumatic stress disorder in Israel: A protocol.

Author(s):

Josman, Naomi, Department of Occupational Therapy, University of Haifa, Haifa, Israel, naomij@research.haifa.ac.il
Somer, Eli, School of Social Work University of Haifa, Haifa, Israel
Reisberg, Ayelet, Department of Occupational Therapy, University of Haifa, Haifa, Israel
Weiss, Patrice L. (Tamar), Department of Occupational Therapy, University of Haifa, Haifa, Israel
Garcia-Palacios, Azucena, Jaume I University, Castellon, Israel
Hoffman, Hunter, HIT Lab, University of Washington, Seattle, WA, US

Address:

Josman, Naomi, Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, Israel, 31905, naomij@research.haifa.ac.il

Source:

CyberPsychology & Behavior, Vol 9(2), Apr 2006. Special issue: Virtual and physical toys: Open-ended features for non-formal learning. pp. 241-244.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

A number of carefully controlled studies have documented the effectiveness of traditional imaginal exposure for the treatment of post-traumatic stress disorder (PTSD). Virtual reality (VR) exposure therapy is based on a similar logic but rather than self-generating imagery, patients wear a VR helmet and go into a three-dimensional (3-D) computer generated virtual world to help them gain access to their memory of the traumatic event. Recent preliminary research has shown that some patients who fail to respond to traditional therapy benefit from virtual reality exposure therapy, presumably because VR helps the patient become emotionally engaged while recollecting/recounting/re-interpreting/emotionally processing what happened during the traumatic event. The present paper presents a brief overview of a new VR World we developed to provide virtual reality therapy for terrorist bus bombing victims in Israel, and a brief description of our research protocol and measures (for details, see www.vrpain.com).


 

Title:

Simulation and virtual reality in medical education and therapy: A protocol.

Author(s):

Roy, Michael J., Department of Medicine, Uniformed Services University, Bethesda, MD, US, mroy@usuhs.mil
Sticha, Deborah l., SIMmersion LLC, Columbia, MD, US
Kraus, Patricia L., Department of Medicine, Uniformed Services University, Bethesda, MD, US
Olsen, Dale E., SIMmersion LLC, Columbia, MD, US

Address:

Roy, Michael J., Department of Medicine, Uniformed Services University, Rm. A3062, 4301 Jones Bridge Rd., Bethesda, MD, US, mroy@usuhs.mil

Source:

CyberPsychology & Behavior, Vol 9(2), Apr 2006. Special issue: Virtual and physical toys: Open-ended features for non-formal learning. pp. 245-247.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.


 

Title:

Taking Charge: A Pilot Curriculum of Self-Defense and Personal Safety Training for Female Veterans With PTSD Because of Military Sexual Trauma.

Author(s):

David, Wendy S., University of Washington, Seattle, Seattle, WA, US, wendy.david@med.va.gov
Simpson, Tracy L., University of Washington, Seattle, Seattle, WA, US
Cotton, Ann J., University of Washington, Seattle, Seattle, WA, US

Address:

David, Wendy S., VA Puget Sound Health Care System, (116-MHC) 1660 S. Columbian Way, Seattle, WA, US, wendy.david@med.va.gov

Source:

Journal of Interpersonal Violence, Vol 21(4), Apr 2006. pp. 555-565.

Publisher:

US: Sage Publications

Abstract:

The authors describe an overview of the pilot project Taking Charge, a 36-hour comprehensive behavioral intervention involving psychoeducation, personal safety, and self-defense training for 12 female veterans with posttraumatic stress disorder (PTSD) from military sexual trauma. Self-defense training can incorporate the benefits of repeated exposure while teaching proactive cognitive and behavioral responses to the feared stimuli, and thus facilitate emotional and physical rescripting of and mastery over the trauma. Results up to 6 months follow-up indicate significant reductions in behavioral avoidance, PTSD hyperarousal, and depression, with significant increases in interpersonal, activity, and self-defense self-efficacy. The authors propose that this therapeutic self-defense curriculum provides an enhanced exposure therapy paradigm that may be a potent therapeutic tool in the treatment of PTSD.

Tests & Measures:

PTSD Checklist-Civilian version (PCL-C)
Self-Defense Scale
General Self-Efficacy Scale
Beck Depression Inventory
Aggression Questionnaire


 

Title:

The Active Ingredient in EMDR: Is It Traditional Exposure or Dual Focus of Attention?

Author(s):

Lee, Christopher W., School of Psychology, Murdoch University, Perth, WAU, Australia, chlee@murdoch.edu.au
Taylor, Graham, Private Practice, Australia
Drummond, Peter D., School of Psychology, Murdoch University, Perth, WAU, Australia

Address:

Lee, Christopher W., School of Psychology, Murdoch University, South Street, Murdoch, WAU, Australia, 6150, chlee@murdoch.edu.au

Source:

Clinical Psychology & Psychotherapy, Vol 13(2), Mar-Apr 2006. pp. 97-107.

Publisher:

US: John Wiley & Sons

Abstract:

Very little is known about the mechanisms that underlie the therapeutic effectiveness of eye movement desensitization and reprocessing (EMDR). This study tested whether the content of participants' responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing, which would be expected given Shapiro's proposal of dual process of attention. The responses made by 44 participants with post-traumatic stress disorder (PTSD) were examined during their first EMDR treatment session. An independent rater coded these responses according to whether they were consistent with reliving, distancing or focusing on material other than the primary trauma. The coding system was found to have satisfactory inter-rater reliability. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner. Cross-lagged panel correlations suggest that processing in a more detached manner was a consequence of the EMDR procedure rather than a measure that covaried with improvement.

Tests & Measures:

Structured Interview for PTSD
Impact of Event Scale


 

Title:

Virtual reality and other experiential therapies for combat-related posttraumatic stress disorder.

Author(s):

Spira, James L., Department of Psychiatry, University of California, San Diego, CA, US, JimSpira@aol.com
Pyne, Jeffrey M., Central Arkansas Veterans Healthcare System, North Little Rock, AR, US
Wiederhold, Brenda, Virtual Reality Medical Center, San Diego, CA, US
Wiederhold, Mark, Virtual Reality Medical Center, San Diego, CA, US
Graap, Ken, Virtually Better, Inc., Decatur, GA, US
Rizzo, Albert, University of Southern California, Los Angeles, CA, US

Address:

Spira, James L., 817 Mola Vista Way, Solana Beach, CA, US, JimSpira@aol.com

Source:

Primary Psychiatry, Vol 13(3), Mar 2006. pp. 58-64.

Publisher:

US: MBL Communications, Inc

Abstract:

Numerous experiences can lead to acute stress disorder or posttraumatic stress disorder (PTSD) in military personnel. Unfortunately, PTSD is a relatively common outcome of combat exposure. The primary focus of this article is the role of experiential psychotherapy treatments which teach skill development to better cope with combat-related PTSD. The article focuses largely on virtual-reality-assisted exposure therapies.


 

Title:

Posttraumatic stress disorder: Etiology, Epidemiology, and Treatment Outcome.

Author(s):

Keane, Terence M., VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, US, Terry.Keane@va.gov
Marshall, Amy D., VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, US, Amy.Marshall2@va.gov
Taft, Casey T., VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, US, Casey.Taft@va.gov

Address:

Keane, Terence M., VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, US, Terry.Keane@va.gov

Source:

Annual Review of Clinical Psychology, Vol 2, 2006. pp. 161-197.

Publisher:

US: Annual Reviews

Abstract:

Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.


 

Title:

Prolonged Exposure Treatment of Posttraumatic Stress Disorder.

Author(s):

Riggs, David S., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Cahill, Shawn P., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Foa, Edna B., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US

Source:

Cognitive-behavioral therapies for trauma. Follette, Victoria M. (Ed); Ruzek, Josef I. (Ed); pp. 65-95.
New York, NY, US: Guilford Press, 2006. xxiv, 472 pp.

Abstract:

(from the chapter) In the present chapter we examine the theoretical underpinnings of prolonged exposure (PE) for postraumatic stress disorder as well as the empirical support for its efficacy in treating trauma survivors. We then discuss concerns that have been raised about exposure therapy and summarize research findings relevant to these concerns. Finally, we describe recent attempts to disseminate PE to clinicians who regularly provide mental health services to trauma survivors.


 

Title:

Non-visual flashbacks: In vivo versus imaginal exposure.

Author(s):

Salyards, Carolyn J., Marquette U., US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 66(8-B), 2006. pp. 4500.

Publisher:

US: ProQuest Information & Learning

Abstract:

More than 3 million persons are injured in work-related accidents in the U.S. annually and posttraumatic stress disorder (PTSD) is a frequent psychological consequence of accidental injuries. While many patients suffering from PTSD respond positively to in vivo or imaginal exposure therapy, patients who experience non-visual flashbacks are particularly difficult to treat. This dissertation analyzed data collected in a prospective study of 80 individuals diagnosed with PTSD after work-related accidental injuries who experienced non-visual flashbacks. Injuries sustained by the participants in this study occurred on the job from industrial machinery, environmental exposure, or motor vehicle accidents. A single licensed psychologist treated all of the participants at the Medical College of Wisconsin. Participants were assessed before treatment, at the end of treatment, at 6-month follow up, and at 12-month follow up. Of the 80 participants, 40 were treated with in vivo exposure and 40 were treated with imaginal exposure. The purpose of this study was to (1) delineate the characteristics of non-visual flashbacks in victims of work-related injuries, and (2) compare the course of treatment and outcomes for in vivo exposure versus imaginal exposure treatment for this unique patient population. Types of non-visual flashbacks experienced by participants included auditory, kinesthetic, olfactory, auditory/kinesthetic, auditory/olfactory, and olfactory/kinesthetic. The results of this study supported the use of imaginal exposure for the treatment of PTSD in individuals with non-visual flashbacks following work-related traumatic injury. Participants treated with both in vivo and imaginal exposure experienced a decrease in symptoms over time. However, participants treated with imaginal exposure experienced more reduction of symptoms than participants treated with in vivo exposure at all assessment times. Positive treatment effects occurred at a greater rate with imaginal exposure than with in vivo exposure treatment. Effects were maintained and continued to improve for many participants at 12-month follow-up. In addition to symptom reduction, clinical improvement measured by return-to-work outcomes occurred at a greater rate for participants treated with imaginal exposure. In addition to statistical findings, three case studies were presented to illustrate unique patterns of change and treatment outcomes.


 

Title:

Posttraumatic Stress Disorder.

Series Title:

Dissociation, trauma, memory, and hypnosis book series

Author(s):

Lynn, Steven Jay, State University of New York at Binghamton, Binghamton, NY, US
Kirsch, Irving, University of Plymouth, United Kingdom

Source:

Essentials of clinical hypnosis: An evidence-based approach. Lynn, Steven Jay; Kirsch, Irving; pp. 159-173.
Washington, DC, US: American Psychological Association, 2006. viii, 271 pp.

Abstract:

(from the create) In this chapter the authors illustrate how exposure-based techniques can be combined with hypnosis and cognitive interventions to ameliorate PTSD symptoms. For a diagnosis of PTSD to be made, the traumatic event must be life endangering and the person's response must involve intense fear, helplessness, or horror (American Psychiatric Association, 1994). It is also necessary for the symptoms to persist for at least 1 month; otherwise the condition is diagnosed as acute stress disorder. The symptoms of PTSD include stress and hyperarousal (e.g., sleep difficulties, exaggerated and distressing startle response), emotional numbing of responsiveness (e.g., restricted range of emotional experiences, feelings of detachment and alienation from others), and persistent avoidance of situations or reminders of trauma (e.g., efforts to avoid activities, places, or people associated with the event).


 

Title:

Virtual reality exposure for veterans with posttraumatic stress disorder.

Author(s):

Ready, David J., Atlanta VA Medical Center, Atlanta, GA, US, David.Ready@med.va.gov
Pollack, Stacey, PTSD Program, Washington DC VA Medical Center, Washington, DC, US
Rothbaum, Barbara Olasov, Emory School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, US
Alarcon, Renato D., Mayo Medical School, Rochester, MN, US

Address:

Ready, David J., Atlanta VA Medical Center, (116A-4), 1670 Clarimont Road, Decatur, GA, US, David.Ready@med.va.gov

Source:

Journal of Aggression, Maltreatment & Trauma, Vol 12(1-2), 2006. pp. 199-220.

Publisher:

US: Haworth Press

Abstract:

Two open trials of Virtual Reality based exposure therapy (VRE) to desensitize Vietnam veterans with Posttraumatic Stress Disorder (PTSD) to some of their traumatic memories are described. A total of 21 patients were exposed to one of two virtual Vietnam computer-generated environments in which their individual traumatic experiences were simulated in response to their recounting these events. Although two patients experienced significant increases in symptoms during VRE, all patients' PTSD symptoms were below baseline by the 3-month posttreatment assessment. When the data from the two open trials was combined, clinically meaningful and statistically significant reductions in PTSD symptoms were found. These changes were long lasting as evidenced by the 6-month follow-up assessments. Two case examples are provided and future applications of this treatment are discussed.

Tests & Measures:

Subjective Units of Discomfort Scale
Beck Depression Inventory
Clinician-Administered PTSD Scale
Impact of Event Scale


 

Title:

Posttraumatic stress disorder: A state-of-the-science review.

Author(s):

Nemeroff, Charles B., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, US, cnemero@emory.edu
Bremner, J. Douglas, Department of Psychiatry and Radiology, Emory University School of Medicine, Atlanta, GA, US
Foa, Edna B., Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, US
Mayberg, Helen S., Department of Psychiatry and Neurology, Emory University School of Medicine, Atlanta, GA, US
North, Carol S., Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, US
Stein, Murray B., Department of Psychiatry and Family & Preventive Medicine, University of California San Diego, La Jolla, CA, US

Address:

Nemeroff, Charles B., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1639 Pierce Drive, Atlanta, GA, US, cnemero@emory.edu

Source:

Journal of Psychiatric Research, Vol 40(1), Jan 2006. pp. 1-21.

Publisher:

Netherlands: Elsevier Science

Abstract:

This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.


 

Title:

Cognitive-Behavioral Perspectives on Theory and Treatment of Posttraumatic Stress Disorder.

Author(s):

Hembree, Elizabeth A., Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, US
Feeny, Norah C., Departments of Psychiatry & Psychology, Case Western Reserve University, Cleveland, OH, US

Source:

Pathological anxiety: Emotional processing in etiology and treatment. Rothbaum, Barbara Olasov (Ed); pp. 197-211.
New York, NY, US: Guilford Press, 2006. xvi, 272 pp.

Abstract:

(from the chapter) In this chapter, we review the diagnostic criteria for and prevalence of posttraumatic stress disorder (PTSD). Next, we discuss conceptualizations of the development and maintenance of PTSD, with emphasis on emotional processing theory as presented by Foa and colleagues. We then describe several cognitive-behavioral approaches to the treatment of PTSD and provide a brief summary of current empirical support for these. Finally, we describe a specific treatment for PTSD that has received extensive empirical support--prolonged exposure therapy--and present a case example that illustrates this effective and efficient treatment.


 

Title:

Adapting Imaginal Exposure to the Treatment of Complicated Grief.

Author(s):

Shear, Katherine, Bereavement & Grief Profram, Western Psychiatric Institute & Clinic, Pittsburgh, PA, US

Source:

Pathological anxiety: Emotional processing in etiology and treatment. Rothbaum, Barbara Olasov (Ed); pp. 215-226.
New York, NY, US: Guilford Press, 2006. xvi, 272 pp.

Abstract:

(from the chapter) Complicated grief (CG) is a newly recognized, chronic, debilitating psychiatric condition. CG comprises symptoms of separation distress, along with prominent symptoms of traumatic stress. We recently undertook the task of devising a treatment for CG. CG shares features of both mood and anxiety disorders. Given the amalgam of depressive and trauma-like symptoms, we decided to develop a treatment that integrates techniques found helpful for depression with those used for PTSD. Edna Foa's PTSD treatment was highly effective and carefully studied. We consulted with her to develop the trauma-focused component of CG treatment. In the remainder of this chapter, we (1) describe the syndrome of CG and review treatments for bereavement- related distress, (2) explain the process we used to develop CG treatment (CGT), (3) present techniques we use to train therapists, and (4) give an overview of data from our studies of this condition.


 

Title:

Virtual Reality Exposure Therapy.

Author(s):

Rothbaum, Barbara Olasov, Department of Psychiatry and Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta, GA, US

Source:

Pathological anxiety: Emotional processing in etiology and treatment. Rothbaum, Barbara Olasov (Ed); pp. 227-244.
New York, NY, US: Guilford Press, 2006. xvi, 272 pp.

Abstract:

(from the chapter) This chapter provides an overview of research supporting the use of virtual reality (VR) to help treat anxiety disorders, the rationale for its use, and future directions for the field. In this chapter, I will present data on the use of VR exposure therapy in the treatment of the fear of heights, the fear of flying, social phobia, and posttraumatic stress disorder (PTSD). In general, these data support propositions about emotional processing and therapy.


 

Title:

Combining Cognitive Processing Therapy with Panic Exposure and Management Techniques.

Author(s):

Falsetti, Sherry A., Family Health Center, Department of Family and Community Medicine, College of Medicine, University of Illinois, Rockford, IL, US
Resnick, Heidi S., Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, US
Lawyer, Steven R., National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, US

Source:

Psychological effects of catastrophic disasters: Group approaches to treatment. Schein, Leon A. (Ed); Spitz, Henry I. (Ed); Burlingame, Gary M. (Ed); Muskin, Philip R. (Ed); Vargo, Shannon (Col); pp. 629-668.
New York, NY, US: Haworth Press, 2006. xxiv, 940 pp.

Abstract:

(from the chapter) In this chapter we describe multiple channel exposure therapy (M-CET), a group treatment, and its application to post-traumatic stress disorder (PTSD) and comorbid panic attacks. This treatment was developed to meet the needs of clients who had difficulty doing trauma-focused therapy because high levels of emotional arousal would often trigger panic attacks, which were very fearful to these clients. The treatment approach is designed to include exposure in all three major response channels: cognitive, behavioral, and physiological. M-CET integrates components of cognitive processing therapy (CPT) that address changes in cognitive schema following traumatic events. These include cognitive restructuring and writing about the memory of the traumatic event to reduce symptoms of PTSD and altered belief systems that result from the aftermath of traumatic events. In addition, M-CET includes adapted components of Barlow and Craske's Mastery of Your Anxiety and Panic (MAP) treatment package, a highly effective treatment for panic disorder. The MAP treatment includes in-depth psychoeducation about the physiology of panic, cognitive restructuring related to overestimation, and catastrophizing panic attacks; and provides exercises that allow for exposure to the physical sensations of panic. As adapted within M-CET, the theoretical rationale posits that panic attacks may have been initially experienced during the traumatic event but are currently experienced with or without identified event-related cues which elicit fear. Finally, M-CET incorporates in vivo exposure exercises to promote habituation to PTSD and panic-related situational cues.


 

Title:

A Clinician's Guide to STAIR/MPE: Treatment for PTSD Related to Childhood Abuse.

Author(s):

Levitt, Jill T., New York University School of Medicine, NY, US, jilllevitt@yahoo.com
Cloitre, Marylene, New York University School of Medicine, NY, US, mcloitre@med.nyu.edu

Address:

Levitt, Jill T., 425 East 86th St., New York, NY, US, jilllevitt@yahoo.com

Source:

Cognitive and Behavioral Practice, Vol 12(1), Win 2005. pp. 40-52.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Women who have PTSD related to childhood abuse have significant deficits in the areas of emotion regulation and interpersonal skills. These problems are associated with impaired functioning in social, work, and home life. In addition, there is substantial clinical concern that limited emotion-regulation skills puts this population at risk for early dropout and symptom exacerbation in treatment focusing on emotional processing of traumatic memories. Skills Training in Affective and Interpersonal Regulation plus Modified Prolonged Exposure (STAIR/MPE) is an evidence-based, 2-phase cognitive behavioral treatment designed to address these concerns. Specifically, this treatment targets PTSD symptoms, emotion-regulation deficits, and interpersonal difficulties. The purpose of this article is to describe the rationale for and clinical application of STAIR/MPE, detailing the essential clinical components and presenting relevant case examples. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


 

Title:

Review of assessment and treatment of PTSD among elderly American armed forces veterans.

Author(s):

Owens, Gina P., University of Kentucky, Lexington, KY, US, ginaowens@juno.com
Baker, Dewleen G., San Diego VA Medical Center, CA, US
Kasckow, John, Cincinnati VA Medical Center, OH, US
Ciesla, Jeffrey A., Vanderbilt University, Nashville, TN, US
Mohamed, Somaia, Cincinnati VA Medical Center, OH, US

Address:

Owens, Gina P., University of Kentucky, 251-D Dickey Hall, Lexington, KY, US, ginaowens@juno.com

Source:

International Journal of Geriatric Psychiatry, Vol 20(12), Dec 2005. pp. 1118-1130.

Publisher:

US: John Wiley & Sons

Abstract:

Background: The number of elderly combat veterans is steadily increasing in the US and estimates project that a notable percentage of these veterans experience symptoms of posttraumatic stress disorder (PTSD). Limited data exist specifically related to prevalence, assessment, and treatment of PTSD among the elderly veteran population. Objective: This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. Methods: A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. Results: Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbidities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. Conclusion: Evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary.


 

Title:

Seeking safety plus exposure therapy: An outcome study on dual diagnosis men.

Author(s):

Najavits, Lisa M., Harvard Medical School, Boston, MA, US, lisa_najavits@hms.harvard.edu
Schmitz, Martha, Harvard Medical School, Boston, MA, US
Gotthardt, Silke, McLean Hospital, Belmont, MA, US
Weiss, Roger D., Harvard Medical School, Boston, MA, US

Address:

Najavits, Lisa M., McLean Hospital, 115 Mill Street, Belmont, MA, US, lisa_najavits@hms.harvard.edu

Source:

Journal of Psychoactive Drugs, Vol 37(4), Dec 2005. pp. 425-435.

Publisher:

US: Haight-Ashbury Publications

Abstract:

This study arose out of a prominent clinical need: effective treatment for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) in civilian men. This dual diagnosis is estimated to occur in up to 38% of men in substance abuse treatment, and generally portends a more severe clinical course than SUD alone. Clinical issues include self-harm, suicidality, perpetration of violence against others, and HIV risk behaviors. This study appears to be the first outcome trial to address a sample of civilian men with PTSD and SUD using manualized psychosocial treatment. It evaluates a novel combination treatment, Seeking Safety plus Exposure Therapy-Revised. The former is a coping skills treatment designed for PTSD and SUD; the latter is an adaptation of Foa's exposure therapy, modified for PTSD and SUD. In this small sample (n = 5) outpatient pilot trial, patients with current PTSD and current SUD were offered 30 sessions over five months, with the option to select how much of each type of treatment they preferred. Outcome results showed significant improvements in drug use; family/social functioning; trauma symptoms; anxiety; dissociation; sexuality; hostility; overall functioning; meaningfulness; and feelings and thoughts related to safety. Trends indicating improvement on 11 other outcome variables were also found. Treatment attendance, satisfaction, and alliance were extremely high. The need for further evaluation using more rigorous methodology is discussed.

Tests & Measures:

Mini-International Neuropsychiatric Interview
Timeline Interview
Trauma History Questionnaire
Suicidal Behaviors Questionnaire
Trauma Symptom Checklist-40
Treatment Services Review
World Assumptions Scale
Patient Preferences Questionnaire
Core Components Questionnaire
Helping Alliance Questionnaire-II
Seeking Safety Feedback Questionnaire
Exposure Therapy-Revised Feedback Questionnaire
Addiction Severity Index
Brief Symptom Inventory
Social Adjustment Scale
Client Satisfaction Questionnaire
Clinical Global Impression Scale
Global Assessment of Functioning Scale
Structured Clinical Interview for DSM-IV


 

Title:

Stress-induced enhancement of fear learning: An animal model of posttraumatic stress disorder.

Author(s):

Rau, Vinuta, Department of Psychology, University of California, Los Angeles, Los Angeles, CA, US, vrau@ucla.edu
DeCola, Joseph P., Department of Psychology, Ohio State University, Columbus, OH, US
Fanselow, Michael S., Department of Psychology, University of California, Los Angeles, Los Angeles, CA, US

Address:

Rau, Vinuta, Department of Psychology, University of California, Los Angeles, 415 Hilgard Ave, Los Angeles, CA, US, vrau@ucla.edu

Source:

Neuroscience & Biobehavioral Reviews, Vol 29(8), Dec 2005. Special issue: Defensive Behavior. pp. 1207-1223.

Publisher:

Netherlands: Elsevier Science

Abstract:

Fear is an adaptive response that initiates defensive behavior to protect animals and humans from danger. However, anxiety disorders, such as Posttraumatic Stress Disorder (PTSD), can occur when fear is inappropriately regulated. Fear conditioning can be used to study aspects of PTSD, and we have developed a model in which pre-exposure to a stressor of repeated footshock enhances conditional fear responding to a single context-shock pairing. The experiments in this chapter address interpretations of this effect including generalization and summation or fear, inflation, and altered pain sensitivity. The results of these experiments lead to the conclusion that pre-exposure to shock sensitizes conditional fear responding to similar less intense stressors. This sensitization effect resists exposure therapy (extinction) and amnestic (NMDA antagonist) treatment. The pattern predicts why in PTSD patients, mild stressors cause reactions more appropriate for the original traumatic stressor and why new fears are so readily formed in these patients. This model can facilitate the study of neurobiological mechanisms underlying sensitization of responses observed in PTSD. (PsycINFO Database Record (c) 2006 APA, all rights reserved)(journal abstract)


 

Title:

Treating traumatic stress: Conducting imaginal exposure in PTSD.

Author(s):

Bryant, Richard A.
Mastrodomenico, Julie A.

Source:

Clinical Psychologist, Vol 9(2), Nov 2005. pp. 83.

Publisher:

United Kingdom: Taylor & Francis

Reviewed Item:

Mark Creamer, David Forbes, Andrea Phelps and Leanne Humphreys (No Year Specified). Treating traumatic stress: Conducting imaginal exposure in PTSD

Abstract:

Reviews the video, Treating Traumatic Stress: Conducting Imaginal Exposure in PTSD by Mark Creamer et al. This treatment manual commences with introductory information about exposure, reviews the evidence for exposure therapy, and guides for assessing the PTSD patient. The next section provides a clear overview of treating PTSD, including a sequential narrative of the range of treatment strategies that can be provided. The third section addresses exposure in detail. It discusses the rationale for exposure therapy, and usefully spells out when it should and should not be used. The fourth section practically spells out how to commence a hierarchy for conducting exposure, identifying the targets for exposure, and preparing the client for exposure therapy. The fifth section is really the heart of the training package. The video scenarios are exceptionally well-conducted and provide the clinician with insights into the specific clinical skills required to conduct exposure and, importantly, how to overcome difficulties that can frequently arise during exposure sessions. Overall, this training package is a very welcome resource for clinicians and clinical supervisors. The feedback is that psychiatrists, psychologists, and social workers are benefiting enormously from this brief training.


 

Title:

Simultaneous Treatment of Substance Abuse and Post-Traumatic Stress Disorder: A Case Study.

Author(s):

Davis, Joanne L., University of Tulsa, Tulsa, OK, US, joanne-davis@utulsa.edu
Davies, Stephenie, Private Practice, Ottawa, ON, Canada
Wright, David C., University of Tulsa, Tulsa, OK, US
Falsetti, Sherry, Medical University of South Carolina, Charleston, SC, US
Roitzsch, John C., Medical University of South Carolina, Charleston, SC, US

Address:

Davis, Joanne L., University of Tulsa, 600 South College Avenue, 308C Lorton Hall, Tulsa, OK, US, joanne-davis@utulsa.edu

Source:

Clinical Case Studies, Vol 4(4), Oct 2005. pp. 347-362.

Publisher:

US: Sage Publications

Abstract:

The type and timing of treatment for comorbid substance abuse and victimization has been debated in the past decade. Arguments have been made for simultaneous treatment and consecutive treatment of each difficulty. Current issues and a case study in which both problems are treated simultaneously are presented. The patient received inpatient detoxification, inpatient and outpatient group counseling following the 12-step program, and a cognitive-behavioral-oriented outpatient group in the substance treatment component. Multiple Channel Exposure Therapy (MCET), a 12-week manualized treatment developed to treat individuals suffering from both post-traumatic stress disorder and panic disorder, was implemented in the victimization component. At postassessment and at follow-up, the patient no longer met criteria for any pretreatment diagnoses, and her alcohol dependence was in remission. Clinical implications and recommendations for the treatment of substance abuse and victimization are discussed.

Tests & Measures:

Risk in Intimacy Inventory
Trauma Assessment for Adults
Symptom Checklist-90-Revised
Trauma Symptom Inventory
Beck Depression Inventory
PTSD Checklist
Impact of Event Scale
Structured Clinical Interview for DSM-IV


 

Title:

Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics.

Author(s):

Foa, Edna B., Department of Psychiatry, University of Pennsylvania, US, foa@mail.med.upenn.edu
Hembree, Elizabeth A., Department of Psychiatry, University of Pennsylvania, US
Cahill, Shawn P., Department of Psychiatry, University of Pennsylvania, US
Rauch, Sheila A. M., Department of Psychiatry, University of Pennsylvania, US
Riggs, David S., Department of Psychiatry, University of Pennsylvania, US
Feeny, Norah C., Department of Psychiatry, Case Western Reserve University, Cleveland, OH, US
Yadin, Elna, Department of Psychiatry, University of Pennsylvania, US

Address:

Foa, Edna B., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 600N, Philadelphia, PA, US, foa@mail.med.upenn.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 73(5), Oct 2005. pp. 953-964.

Publisher:

US: American Psychological Assn

Abstract:

Female assault survivors (N = 171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.

Tests & Measures:

The PTSD Symptom Scale-Interview
The PTSD Symptom Scale-Self Report
Beck Depression Inventory
Social Adjustment Scale
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-behavioral Perspectives.

Author(s):

Wetmore, Ann, Private Practice, Halifax, NS, Canada

Source:

Canadian Psychology, Vol 46(3), Aug 2005. pp. 172-173.

Publisher:

Canada: Canadian Psychological Assn

Reviewed Item:

Steven Taylor (Ed.) (2004). Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-behavioral Perspectives; New York: Springer, 2004, 336 pages

Abstract:

Reviews the book Advances in the Treatment of Posttraumatic Stress Disorder: Cognitive-behavioral Perspectives, edited by Steven Taylor (see record 2004-18734-000). This collection of articles on posttraumatic stress disorder (PTSD) intends to present reader-practitioners with a stand-alone source of descriptions of the state of the art in PTSD research and treatment. While this edited volume covers many state of the art Cognitive Behavior Therapy (CBT) approaches in Part I and Part II, ranging from Exposure Therapy and Eye Movement Desensitization Therapy (EMDR) to Cognitive Restructuring and Social Support, its unique and outstanding contribution is in Part III, which is dedicated to "Special Populations" with PTSD, specifically, Military Populations, those with predominant Anger, Chronic Pain, Dissociation, and Children and Adolescents. Overall, it is likely that this volume will serve as a stimulus for further research in treatment applications for PTSD, particularly with "special populations," as it raises many more questions than it answers, and presents many avenues for future research in a variety of PTSD-related areas.


 

Title:

Facilitation of Extinction of Conditioned Fear by D-Cycloserine: Implications for Psychotherapy.

Author(s):

Davis, Michael, Department of Psychology, Emory University, Atlanta, GA, US, mdavis4@emory.edu
Myers, Karyn M., Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, US
Ressler, Kerry J., Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, US
Rothbaum, Barbara O., Department of Psychiatry & Behavioral Sciences, Emory University, Atlanta, GA, US

Address:

Davis, Michael, Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd NE, Atlanta, GA, US, mdavis4@emory.edu

Source:

Current Directions in Psychological Science, Vol 14(4), Aug 2005. pp. 214-219.

Publisher:

United Kingdom: Blackwell Publishing

Abstract:

Excessive fear and anxiety are characteristic of disorders such as post-traumatic stress disorder (PTSD) and phobias and are believed to reflect abnormalities in neural systems governing the development and reduction of conditioned fear. Conditioned fear can be suppressed through a process known as extinction, in which repeated exposure to a feared stimulus in the absence of an aversive event leads to a gradual reduction in the fear response to that stimulus. Like conditioned fear learning, extinction is dependent on a particular protein (the N-methyl-D-aspartate or NMDA receptor) in apart of the brain called the amygdala. Blockade of this receptor blocks extinction and improving the activity of this receptor with a drug called D-cycloserine speeds up extinction in rats. Because exposure-based psychotherapy for fear disorders in humans resembles extinction in several respects, we investigated whether D-cycloserine might facilitate the loss of fear in human patients. Consistent with findings from the animal laboratory, patients receiving D-cycloserine benefited more from exposure-based psychotherapy than did placebo-treated controls. Although very preliminary, these data provide initial support for the use of cognitive enhancers in psychotherapy and demonstrate that preclinical studies in rodents can have direct benefits to humans.

Tests & Measures:

Clinical Global Improvement Scale


 

Title:

Alternatives to Debriefing and Modifications to Cognitive Behavior Therapy for Posttraumatic Stress Disorder.

Author(s):

Belaise, Carlotta, Laboratory of Experimental Psychotherapy, Department of Psychology, University of Bologna, Bologna, Italy
Fava, Giovanni A., Laboratory of Experimental Psychotherapy, Department of Psychology, University of Bologna, Bologna, Italy, giovanniandrea.fava@unibo.it
Marks, Isaac M., Department of Psychiatry, Imperial College School of Medicine, United Kingdom

Address:

Fava, Giovanni A., Dipartimento di Psicologia, Universita di Bologna, Viale Berti Pichat, 5, IT-40127, Bologna, Italy, giovanniandrea.fava@unibo.it

Source:

Psychotherapy and Psychosomatics, Vol 74(4), Jun 2005. pp. 212-217.

Publisher:

Switzerland: Karger

Abstract:

Background: Psychological debriefing uses brief unsystematic exposure, and is ineffective for posttraumatic stress symptoms and disorder. Systematic exposure alone and cognitive restructuring alone are each effective. Other approaches too may be useful. Methods: The treatment of 3 posttraumatic stress disorder (PTSD) patients is detailed in which there was no exposure to the main traumatic event. There was exposure to related cues in case 1, exposure to related and other cues followed by well-being therapy (WBT) in case 2 and WBT in case 3. Results: The 3 patients improved enduringly, confirming earlier findings that exposure to the main trauma is not essential for PTSD to improve. Conclusions: A study is needed of therapeutic mechanisms in PTSD and of the value of WBT in a randomized controlled trial.


 

Title:

Differential Time Courses and Specificity of Amygdala Activity in Posttraumatic Stress Disorder Subjects and Normal Control Subjects.

Author(s):

Protopopescu, Xenia, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Pan, Hong, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Tuescher, Oliver, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Cloitre, Marylene, New York University School of Medicine, New York, NY, US
Goldstein, Martin, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Engelien, Wolfgang, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Epstein, Jane, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Yang, Yihong, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Gorman, Jack, Mount Sinai School of Medicine, NY, US
LeDoux, Joseph, New York University, New York, NY, US
Silbersweig, David, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US
Stern, Emily, Functional Neuroimaging Laboratory, Weill Medical College, Cornell University, New York, NY, US, estern@med.cornell.edu

Address:

Stern, Emily, Functional Neuroimaging Laboratory, Department of Psychiatry, Weill Medical College, Cornell University, Box 140, Room 1302, 1300 York Avenue, New York, NY, US, estern@med.cornell.edu

Source:

Biological Psychiatry, Vol 57(5), Mar 2005. pp. 464-473.

Publisher:

Netherlands: Elsevier Science

Abstract:

Background: Previous neuroimaging studies have demonstrated exaggerated amygdala responses to negative stimuli in posttraumatic stress disorder (PTSD). The time course of this amygdala response is largely unstudied and is relevant to questions of habituation and sensitization in PTSD exposure therapy. Methods: We applied blood oxygen level dependent functional magnetic resonance imaging and statistical parametric mapping to study amygdala responses to trauma-related and nontrauma-related emotional words in sexual/physical abuse PTSD and normal control subjects. We examined the time course of this response by separate analysis of early and late epochs. Results: PTSD versus normal control subjects have a relatively increased initial amygdala response to trauma-related negative, but not nontrauma-related negative, versus neutral stimuli. Patients also fail to show the normal patterns of sensitization and habituation to different categories of negative stimuli. These findings correlate with measured PTSD symptom seventy, Conclusions: Our results demonstrate differential time courses and specificity of amygdala response to emotional and control stimuli in PTSD and normal control subjects. This has implications for path ophysiologic models of PTSD and treatment response. The results also extend previous neuroimaging studies demonstrating relatively increased amygdala response in PTSD and expand these results to a largely female patient population probed with emotionally valenced words.

Tests & Measures:

State Trait Anger Expression Inventory
PTSD Symptom Scale-Self Report
Anxiety Sensitivity Index
Adult Non-Interpersonal Violence scales
Clinician Administered PTSD Scale
Sexual Assault and Adult Interpersonal violence
Childhood Interpersonal Violence Before Age 18
Dissociative Experiences Scale
State Trait Anxiety Inventory
Structured Clinical Interview for DSM-IV Axis II Personality Disorders
Beck Depression Inventory
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Interoceptive Exposure Therapy Combined with Trauma-related Exposure Therapy for Post-traumatic Stress Disorder: A Case Report.

Author(s):

Wald, Jaye, University of British Columbia, Vancouver, BC, Canada, jwald@interchange.ubc.ca
Taylor, Steven, University of British Columbia, Vancouver, BC, Canada

Address:

Wald, Jaye, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T 2A1, jwald@interchange.ubc.ca

Source:

Cognitive Behaviour Therapy, Vol 34(1), Mar 2005. pp. 34-40.

Publisher:

United Kingdom: Taylor & Francis

Abstract:

Trauma-related exposure therapy is a useful but not universally effective treatment for post-traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post-traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma-related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician-Administered Post-traumatic Stress Disorder Scale, a self-report measure of post-traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post-traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1- and 3-month follow-up. Symptoms of anxiety sensitivity and post-traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post-traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma-related exposure therapy as a means of boosting treatment efficacy.

Tests & Measures:

PTSD Symptom Severity Scale
Anxiety Sensitivity Index
Beck Anxiety Index
State-Trait Anger Expression Inventory - Trait Form
Post-traumatic Cognitions Inventory
Reactions to Treatment Questionnaire
Beck Depression Inventory
Clinician-Administered PTSD Scale
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Traumaexposition in der körpertherapeutisch-energetischen Psychotherapie.

Translated Title:

Trauma exposure in body oriented, energetic psychotherapy.

Author(s):

Fuckert, Dorothea, Wilhelm-Reich-Institut für Interdisziplinäre Therapie u. Beratung, Waldbrunn, Germany, praxis@fuckert.de

Address:

Fuckert, Dorothea, Wilhelm-Reich-Institut fur Interdisziplinare Therapie u. Beratung, Im Braunlesrot 20, 69429, Waldbrunn, Germany, praxis@fuckert.de

Source:

PTT: Persönlichkeitsstörungen Theorie und Therapie, Vol 9(1), Mar 2005. pp. 36-40.

Publisher:

Germany: Schattauer

Abstract:

Is neurosis replaced by trauma-disorder? Does its alarm effect mean a chance for change? Specifically disturbed life energy functions in PTSD are described. Basics, therapy goals, typical errors and advantage of body oriented, energetic psychotherapy are discussed, as well as the use of an individually adapted, multimodal traumatherapy, and the evaluation of results, finally followed by a case-description.


 

Title:

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

Series Title:

Series in anxiety and related disorders

Author(s):

Batten, Sonja V., VA Maryland Health Care System, Baltimore, MD, US
Orsillo, Susan M., Suffolk University, Boston, MA, US
Walser, Robyn D., VA Palo Alto Health Care System, National Center for PTSD, Palo Alto, CA, US

Source:

Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment. Orsillo, Susan M. (Ed); Roemer, Lizabeth (Ed); pp. 241-269.
New York, NY, US: Springer Science + Business Media, 2005. xvii, 375 pp.

Abstract:

(from the chapter) Posttraumatic stress disorder (PTSD) is the only anxiety disorder for which a specific event is seen as responsible for the etiology of the symptoms. Because of its diagnostic categorization within the anxiety disorders, most of the treatments developed for PTSD have been based upon an understanding of posttraumatic symptoms as they relate to problems with fear and anxiety responses. Although this original conceptualization of PTSD as an anxiety disorder has led to several effective treatments (most notably exposure therapy), it has recently been argued that PTSD can be more thoroughly understood as a disorder of experiential avoidance. We believe that acceptance-based behavioral therapies that follow from this model of experiential avoidance have the potential to add significantly to the effectiveness and comprehensiveness of the current PTSD treatment armamentarium. The integration of acceptance-based approaches with traditional behavioral methods may be an important next step in the treatment of PTSD. Although preliminary findings are encouraging, more systematic evaluation of the potential efficacy and effectiveness of these approaches is clearly needed.


 

Title:

Beyond Exposure for Posttraumatic Stress Disorder (PTSD) Symptoms: Broad-Spectrum PTSD Treatment Strategies.

Author(s):

Lombardo, Thomas W., University of Mississippi, University, MS, US, pytwl@olemiss.edu
Gray, Matt J., Boston Veterans Health Care System, US

Address:

Lombardo, Thomas W., Psychology Department, University of Mississippi, P.O. Box 1848, University, MS, US, pytwl@olemiss.edu

Source:

Behavior Modification, Vol 29(1), Jan 2005. Special issue: Beyond Exposure for Posttraumatic Stress Disorder Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp. 3-9.

Publisher:

US: Sage Publications

Abstract:

Although cases of posttraumatic stress disorder (PTSD) with comorbid disorders are common, the first generation of PTSD treatment approaches, including exposure and cognitive-behavioral therapy, generally ignore symptoms beyond those specific to PTSD. Optimum PTSD treatment outcome requires more comprehensive strategies, and the development and empirical testing of broader approaches is the focus of the articles that follow in this special issue. After providing some background on PTSD and PTSD treatment, this paper gives an overview of these treatment and prevention papers, which represent second-generation strategies to help trauma-exposed individuals.


 

Title:

Exposure Therapy for Substance Abusers with PTSD: Translating Research to Practice.

Author(s):

Coffey, Scott F., Department of Psychiatry and Human Behavior, University of Missippi Medical Center, Jackson, MS, US, scoffey@psychiatry.umsmed.edu
Schumacher, Julie A., Department of Psychiatry and Human Behavior, University of Missippi Medical Center, Jackson, MS, US
Brimo, Marcella L., State University of New York, Buffalo, NY, US
Brady, Kathleen T., General Clinical Research Center, Medical University of South Carolina, Charleston, SC, US

Address:

Coffey, Scott F., Department of Psychiatry and Human Behavior, University of Missippi Medical Center, Clinical Sciences Building, 2500 North State Street, Jackson, MS, US, scoffey@psychiatry.umsmed.edu

Source:

Behavior Modification, Vol 29(1), Jan 2005. Special issue: Beyond Exposure for Posttraumatic Stress Disorder Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp. 10-38.

Publisher:

US: Sage Publications

Abstract:

Epidemiological research indicates that there is substantial cornorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Moreover, there is growing evidence that having a comorbid PTSD diagnosis is associated with greater substance use problem severity and poorer outcomes from SUD treatment. In an attempt to improve the treatment outcome for individuals with PTSD-SUD, recently developed treatments combine exposure therapy for PTSD with an empirically supported treatment for SUD. This article describes one of the treatments and discusses treatment modifications that have been incorporated when translating this research-based therapy to practice in an inner-city community mental health center.


 

Title:

Multicomponent Behavioral Treatment for Chronic Combat-Related Posttraumatic Stress Disorder: Trauma Management Therapy.

Author(s):

Turner, Samuel M., University of Maryland, College Park, MD, US, Turner@psyc.umd.edu
Beidel, Deborah C., University of Maryland, College Park, MD, US
Frueh, B. Christopher, Division of Public Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, US

Address:

Turner, Samuel M., Maryland Center for Anxiety Disorders, Department of Psychology, University of Maryland, College Park, MD, US, Turner@psyc.umd.edu

Source:

Behavior Modification, Vol 29(1), Jan 2005. Special issue: Beyond Exposure for Posttraumatic Stress Disorder Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp. 39-69.

Publisher:

US: Sage Publications

Abstract:

Posttraumatic stress disorder (PTSD) is a severe and chronic menial disorder that is highly prevalent within Veterans: Affairs (VA) Medical Centers. A severe psychiatric disorder, combat-related PTSD is typically accompanied by multiple comorbid psychiatric disorders, symptom chronicity, and extreme social maladjustment. Thus, PTSD is a complex psychiatric disorder resulting in considerable emotional distress and impaired social functioning and often constitutes a significant treatment challenge. Although a range of psychotherapeutic strategies for chronic PTSD have been advanced, behavioral treatments emphasizing various methods of exposure therapy have been the most carefully studied and show the most promise. However, chronic PTSD exposure alone does not appear to have a significant effect on the negative symptoms of PTSD (e.g., avoidance, interpersonal difficulties) or anger control. This may be because exposure is more focused on anxiety and fear reduction and does not address basic skill deficits, help reestablish impaired relationships, or teach anger control. Therefore, we developed a multicomponent treatment program to complement exposure by targeting those areas of the clinical syndrome (e.g., social skills) not found to be helped by exposure alone. This treatment program, trauma management therapy (TMT), has showed good preliminary results in an open trial. In this article, we describe the treatment program, including elements of education, individually administered exposure therapy, programmed practice (i.e., homework), and group-administered social and emotional skills training. The appendix includes a detailed description of how to implement the social and emotional skills training components on a session-by-session basis; the full TMT treatment manual is available on request.

Tests & Measures:

Clinical Global Impressions Scale
Spielberger Anger Expression Inventory
Social Phobia and Anxiety Inventory
Beck Depression Inventory
Clinician-Administered PTSD Scale
Hamilton Anxiety Rating Scale


 

Title:

Multiple Channel Exposure Therapy: Combining Cognitive-Behavioral Therapies for the Treatment of Posttraumatic Stress Disorder with Panic Attacks.

Author(s):

Falsetti, Sherry A., Family Health Center, Department of Family and Community Medicine, University of Illinois College of Medicine, Rockford, IL, US
Resnick, Heidi S., Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, US
Davis, Joanne, University of Tulsa, Tulsa, OK, US

Source:

Behavior Modification, Vol 29(1), Jan 2005. Special issue: Beyond Exposure for Posttraumatic Stress Disorder Symptoms: Broad-Spectrum PTSD Treatment Strategies. pp. 70-94.

Publisher:

US: Sage Publications

Abstract:

A large proportion of patients who present for treatment of posttraumatic stress disorder (PTSD) experience comorbid panic attacks, yet it is unclear to what extent currently available PTSD treatment programs address this problem. Here we describe a newly developed treatment, multiple-channel exposure therapy (M-CET), for comorbid PTSD and panic attacks. The treatment utilizes elements of cognitive processing therapy treatment for PTSD and elements of panic control treatment to target physiological, cognitive, and behavioral symptoms. Preliminary results suggest that M-CET may provide a promising treatment program for a subset of patients with PTSD who experience panic attacks. In addition, guidelines for conducting M-CET with clients who have been exposed to diverse traumatic events are provided. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


 

Title:

On 'Converting' Hand Pain Into Psychological Pain: Treating Hand Pain Vicariously Through Exposure-Based Therapy for PTSD.

Author(s):

Ciano-Federoff, Lynda M., Indiana University of Pennsylvania, Indiana, PA, US
Sperry, Jeannie A., Oasis Occupational Rehabilitation, US

Address:

Ciano-Federoff, Lynda M., Department of Psychology, Indiana University of Pennsylvania, Indiana, PA, US

Source:

Clinical Case Studies, Vol 4(1), Jan 2005. pp. 57-71.

Publisher:

US: Sage Publications

Abstract:

A 36-year-old woman with a history of teenage trauma presented to a pain clinic with unexplained hand pain and numbness. The patient was ultimately diagnosed with post-traumatic stress disorder with a conversion reaction. Because the trauma was taken to be significant in her symptomatology, she was referred for exposure-based therapy. Although psychological distress increased over treatment, her reported physical symptoms and an objectively measured index of symptoms both improved dramatically. Because many patients with unconventional presentations are overutilizers of medical resources, addressing the "cause" of the distress (e.g., trauma) can be advantageous for both patient and medical personnel.

Tests & Measures:

Fear of Pain Questionnaire-Ill
McGill Pain Questionnaire-short form
West Haven-Yale Multidimensional Pain Inventory
Pain Disability Index
Minnesota Multiphasic Personality Inventory-2
Beck Depression Inventory


 

Title:

Implications for Psychological Intervention.

Author(s):

Brewin, Chris R., Sub-Department of Clinical Health Psychology, University College London, London, United Kingdom

Source:

Neuropsychology of PTSD: Biological, cognitive, and clinical perspectives. Vasterling, Jennifer J. (Ed); Brewin, Chris R. (Ed); pp. 271-291.
New York, NY, US: Guilford Press, 2005. xiv, 337 pp.

Abstract:

(from the create) Posttraumatic stress disorder (PTSD) is a complex disorder involving a variety of quite distinct biological and psychological disturbances. Psychologically, changes can be observed in attention, memory, behavior, emotion, conscious appraisals, and sense of identity. It is important to note that it is not a disorder characterized exclusively, or even mainly, by fear. Models of PTSD based on the study of fear in animals, while of great interest, are unlikely on their own to provide a sufficiently comprehensive account of the disorder. Two separate processes are involved in recovery from traumatic experiences (Brewin, 2003). One is bringing under control the vivid reexperiencing of the trauma through flashbacks and nightmares, a reaction that seems to be mainly reported in the context of extreme fear, helplessness, or horror. The second is the conscious reappraisal of the event and its impact. Corresponding to these two processes are contrasting types of therapy for PTSD. One type, which includes prolonged exposure, focuses primarily on the relief of flashbacks and nightmares whereas the other type, which includes cognitive therapy, places greater emphasis on issues of belief, interpretation, and identity. This chapter examines the implications of neuropsychological and cognitive research on PTSD for understanding posttrauma reactions and the psychological treatment of PTSD.


 

Title:

Bringing home the psychological immediacy of the Iraqi battlefield.

Author(s):

Nathan, Peter E., Department of Psychology, University of Iowa, Iowa City, IA, US, peter-nathan@uiowa.edu

Address:

Nathan, Peter E., Department of Psychology, College of Liberal Arts and Sciences, University of Iowa, E119 Seashore Hall, Iowa City, IA, US, peter-nathan@uiowa.edu

Source:

Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005. pp. 1-3.

Publisher:

US: Rutgers University Libraries

Abstract:

The case report by J. A. Cigrang et al (see record 2006-04748-001) serves two functions. It describes serious combat-induced psychopathology in a sample of three veterans of the Iraq war, and it tests the efficacy of a method for preventing chronic PTSD that might be more efficient than current methods. Thus, exposure therapy in these three cases appears to have alleviated the intense early symptoms of PTSD, perhaps thereby heading off a chronic debilitating condition. While the Cigrang et al report does not constitute a definitive demonstration of the efficacy of exposure to abort chronic PTSD, it does convey with great immediacy the Iraq battlefield context as well as the demanding decisions front-line mental health professionals must make about combat-induced psychopathology. Of course, additional research is needed to establish the efficacy and effectiveness of this approach to psychopathology generated by battlefield conditions.


 

Title:

The scientist-practitioner on the front line: Development and formalization of evidenced-based interventions on the battlefield.

Author(s):

Peterson, Alan L., Wilford Hall Medical Center, San Antonio, TX, US, alan.peterson@lackland.af.mil
Cigrang, Jeffrey A., Wright-Patterson Medical Center, Dayton, OH, US
Schobitz, Richard P., Tripler Army Medical Center, Honolulu, HI, US

Address:

Peterson, Alan L., Department of Psychology, Wilford Hall Medical Center, 2200 Bergquist Drive, Suite 1, San Antonio, TX, US, alan.peterson@lackland.af.mil

Source:

Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005. pp. 1-5.

Publisher:

US: Rutgers University Libraries

Abstract:

P. E. Nathan (see record 2006-04748-002) and M. R. Petronko (see record 2006-04748-003) provide excellent commentaries on our three case studies (J. A. Cigrang, et al, see record 2006-04748-001) describing the use of prolonged imaginal exposure for the secondary prevention of Post-Traumatic Stress Disorder (PTSD). In this response, we note that future research should build upon the lessons and experiences of these cases and include larger sample sizes, additional measures (anxiety, depression, grief, quality of life, subjective units of distress ratings), the development of a flexible treatment manual, and formal measures of Acute Stress Disorder (ASD). Future research should also target process measures such as patient acceptability of the treatment and willingness to engage in the exposure sessions. Deployed military psychologists, in collaboration with civilian researchers, have the potential to further advance the scientific knowledge base on the assessment and treatment of combat-stress disorders through the use of innovative case studies. The potential importance of research and formalized treatments for individuals exposed to the significant psychological trauma related to terrorist attacks and bombings is highlighted.


 

Title:

Three american troops in Iraq: Evaluation of a brief exposure therapy treatment for the secondary prevention of combat-related PTSD.

Author(s):

Cigrang, Jeffrey A., Wright-Patterson Medical Center, Dayton, OH, US, jeff.cigrang@wpafb.af.mil
Peterson, Alan L., Wilford Hall Medical Center, San Antonio, TX, US
Schobitz, Richard P., Tripler Army Medical Center, Honolulu, HI, US

Address:

Cigrang, Jeffrey A., 88th Medical Operations Squadron/SGOH, 4881 Sugar Maple Drive, Wright-Patterson Air Force Base, OH, US, jeff.cigrang@wpafb.af.mil

Source:

Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005. pp. 1-25.

Publisher:

US: Rutgers University Libraries

Abstract:

Relatively little research has been devoted to developing empirically-supported interventions for the secondary prevention of chronic post-traumatic stress disorder (i.e., for individuals who have developed PTSD symptoms but not the full PTSD disorder). One-session psychological debriefing has been routinely used as a primary preventive intervention for individuals exposed to trauma, but the appropriateness of this practice has been questioned. The authors describe an alternative, secondary prevention model of brief exposure-based treatment using three cases of military members seeking help at a forward-deployed medical clinic in Iraq for PTSD symptoms following combat-related traumas. Treatment involved repeated imaginal exposure and in vivo exposure conducted in four therapy sessions over a five-week period. Baseline measures on the PTSD Checklist were at a level that is considered to be in the range of PTSD. The results indicated that after four treatment sessions, PTSD symptoms were reduced by an average of 56%, and the final PTSD Checklist scores were within normal limits. The results suggest that prolonged exposure therapy may be a rapid individual treatment for the secondary prevention of combat-related PTSD.


 

Title:

Towards formalizing a very promising treatment.

Author(s):

Petronko, Michael R., PTSD Clinic, Rutgers-State University of New Jersey, Piscataway, NJ, US, mpetronk@rci.rutgers.edu

Address:

Petronko, Michael R., PTSD Clinic, Rutgers University, Graduate School of Applied and Professional Psychology, 797 Hoes Lane West, Piscataway, NJ, US, mpetronk@rci.rutgers.edu

Source:

Pragmatic Case Studies in Psychotherapy, Vol 1(2), 2005. pp. 1-6.

Publisher:

US: Rutgers University Libraries

Abstract:

J. A. Cigrang et al (see record 2006-04748-001) present three case studies of a cognitive-behaviorally based approach to treat early symptoms of PTSD in American soldiers fighting in Iraq. Their clinical model is very promising in its capacity not only to address the needs of these soldiers in the combat theater, but also to proactively mitigate more pernicious symptom development subsequent to their return home. As one direction for extending their work, I suggest that they consider further formalizing and standardizing it so as to (a) facilitate groupbased research using a model that complements the case studies; (b) enhance its use in training; and (c) increase its capacity for dissemination. I further discuss the role of case studies in developing manualized therapy, together with the issue of degree of structure in manualization.


 

Title:

Tell Me Your Story: A Brief Exposure Treatment for Civilian War Victims.

Author(s):

Brown, Seth A.
Collins, Amanda L.

Source:

PsycCRITIQUES, Vol 50 (24), 2005. pp. No Pagination Specified.

Publisher:

US: American Psychological Assn

Reviewed Item:

Maggie Schauer, Frank Neuner, and Thomas Elbert (2005). Narrative Exposure Therapy: A Short-Term Intervention for Traumatic Stress Disorders After War, Terror, or Torture; Cambridge, MA: Hogrefe & Huber, 2005. 80 pp.

Abstract:

This article reviews Narrative Exposure Therapy: A Short-Term Intervention for Traumatic Stress Disorders After War, Terror, or Torture, by Maggie Schauer, Frank Neuner, and Thomas Elbert (see record 2005-02626-000). This book aims to provide one option for clinicians working in war-torn countries in need of brief and easily implemented therapeutic interventions for posttraumatic stress disorder (PTSD). In narrative exposure therapy (NET), the therapist and patient collaboratively develop a chronological narrative of the patient's life starting from birth with an emphasis on traumatic periods. Developing and continually revising an autobiographical narrative allows the patient to speak about and reexperience his or her buried traumatic experiences in a safe environment, which allows for a modification of his or her fear network, resulting in decreased symptoms. NET, being a newly developed treatment, has limited empirical support at this time. An additional concern is whether the narrative component of NET has incremental treatment value beyond the exposure component. This book makes a notable contribution toward fulfilling the treatment void for civilian war victims.


 

Title:

Associative Functional Analysis Model of Posttraumatic Stress Disorder.

Author(s):

Paunovic, Nenad, Department of Psychology, Stockholm University, Stockholm, Sweden

Source:

Trends in posttraumatic stress disorder research. Corales, Thomas A. (Ed); pp. 45-66.
Hauppauge, NY, US: Nova Science Publishers, Inc, 2005. xii, 291 pp.

Abstract:

(from the chapter) A revised associative functional analysis (AFA) model of posttraumatic stress disorder (PTSD) is outlined. In terms of the AFA model currently elicited respondent mechanisms, and dysfunctional cognitive and behavioral responses reciprocally influence each other, and interact with a representational memory network of corresponding factors in determining the development and maintenance of PTSD. The present AFA model combines cognitive, behavioral and network models into a unified framework. In the present AFA model a special emphasis is put on the influence of pleasurable and mastery respondent learning mechanisms incompatible to the respondent trauma-related learning. It is proposed that in order to achieve recovery the former should be elicited in the context of fully elicited trauma-related respondent mechanisms. Prolonged exposure counterconditioning (PEC), a new treatment for PTSD, aims at reinforcing an individuals incompatible respondent learning mechanisms and utilizing them in order to counter the numbing symptoms, increase the trauma exposure tolerance and weaken respondently learned trauma-related emotions. Important theoretical and methodological issues related to the PEC treatment are reviewed. In the discussion section additional issues related to the present AFA model and the PEC treatment for PTSD are outlined.


 

Title:

Posttraumatic Stress Disorder.

Author(s):

Wiederhold, Brenda K., Virtual Reality Medical Center, CA, US
Wiederhold, Mark D., Virtual Reality Medical Center, CA, US

Source:

Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. Wiederhold, Brenda K.; Wiederhold, Mark D.; pp. 117-124.
Washington, DC, US: American Psychological Association, 2005. viii, 225 pp.

Abstract:

(from the chapter) Posttraumatic stress disorder (PTSD) is a heterogeneous disorder that may occur following a traumatic event such as serious injury or threat of injury or death to self or others. Symptoms can include increased anxiety or arousal, dissociation, and flashbacks of the event. Duration of these symptoms must be at least once a month (American Psychiatric Association, 2000). Anxiety-reducing medications, antidepressants, support from friends and family, and cognitive-behavioral therapy (CBT; with some exposure involved) can help with recovery (Barlow, 1988). In treating those with PTSD following a motor vehicle accident, it is important to carefully assess whether the person is experiencing "accident phobia," which would be a specific phobia, or PTSD. Reports of treating accident phobias can be found as far back as 1962 (Wolpe) and have traditionally included some sort of exposure therapy. In the treatment of PTSD, exposure also seems to be included in most all treatment regimens. In fact, a panel of experts recently published a consensus opinion that exposure therapy is the most appropriate therapy for PTSD; the possibility of "retraumatizing" the individual was not considered cause for concern (Ballenger et al., 2001). Topics discussed in this chapter include the prevalence of and risk factors for PTSD; PTSD in Vietnam Veterans; PTSD in motor vehicle accident survivors; and virtual reality applications for these and other types of PTSD.


 

Title:

Fear of Driving.

Author(s):

Wiederhold, Brenda K., Virtual Reality Medical Center, CA, US
Wiederhold, Mark D., Virtual Reality Medical Center, CA, US

Source:

Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. Wiederhold, Brenda K.; Wiederhold, Mark D.; pp. 147-155.
Washington, DC, US: American Psychological Association, 2005. viii, 225 pp.

Abstract:

(from the chapter) Virtual driving systems have three main clinical applications in psychotherapy: (a) the treatment of posttraumatic stress disorder (PTSD) associated with individuals recovering from motor vehicle accidents who require, as part of treatment, exposure to driving scenarios; (b) the treatment of specific driving phobias; and (c) as part of a general treatment for agoraphobia, one manifestation of which is the inability to drive long distances from home. In the privacy of the therapist's office, driving exposure is achieved systematically and safely for both the patient and therapist. Tasks of increasing difficulty can be assigned to the patient, and the patient's reactions can be measured and observed. Another clinical application in the health psychology field is to provide treatment for individuals who have had a traumatic brain injury, stroke, or other physical trauma who need to relearn driving skills. Nonclinical applications are various and include training new drivers and assessing and retraining older drivers; this approach could also be used as a disciplinary treatment for drivers charged with road rage infractions. The research on clinical applications of virtual reality (VR) for the treatment of accident-related PTSD, specific driving phobias, and agoraphobia is not as well developed as research on many other specific phobias, but some studies indicate that virtual reality graded exposure therapy (VRGET) can be a successful therapeutic option. The importance of these studies derives from the observation that the physiological responses at work in driving anxiety are similar to those in other phobias that respond positively to VRGET. The breadth of these studies provides a sense of the potential for this application of VR treatment.


 

Title:

Claustrophobia.

Author(s):

Wiederhold, Brenda K., Virtual Reality Medical Center, CA, US
Wiederhold, Mark D., Virtual Reality Medical Center, CA, US

Source:

Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. Wiederhold, Brenda K.; Wiederhold, Mark D.; pp. 165-171.
Washington, DC, US: American Psychological Association, 2005. viii, 225 pp.

Abstract:

(from the chapter) Whereas agoraphobia is usually associated with the fear of being trapped alone in an open space, claustrophobia is the fear of being trapped in an enclosed place. There is often a strong association between the two phobias; many of those who are fearful of large, open spaces also seem frightened of small, enclosed spaces. One hypothesis posits that both phobias are vestiges of primitive fears--the danger of being attacked was great while in either a large, unsheltered place or in a small, enclosed space. About 10% of the population have a mild to marked form of claustrophobia, and about 2% have severe claustrophobia. In about 33% of individuals with claustrophobia, the fear begins in childhood; more women appear to experience this disorder than men (Rachman, 1978). Claustrophobia can be a concomitant of agoraphobia, aviophobia, or posttraumatic stress disorder (PTSD). One of the most common manifestations of claustrophobia is a refusal to ride in an enclosed elevator. Other common precipitators of claustrophobia include closets, tunnels, airplanes, and certain medical testing machinery and procedures, such as magnetic resonance imaging, hyperbaric oxygen treatment, and computed tomography (CT) scan (Beck, Emery, & Greenberg, 1985; Botella, Quero, et al., 1998). This chapter explores the use of virtual reality therapy in claustrophobia studies, particularly virtual reality graded exposure therapy.


 

Title:

Interview with Albert ('Skip') Rizzo.

Author(s):

Thies, Yvonne, International University Bremen, Bremen, Germany, y.thies@iu-bremen.de

Source:

Zeitschrift für Medienpsychologie, Vol 17(4), 2005. pp. 168-170.

Publisher:

Germany: Hogrefe & Huber

Abstract:

Presents an interview with Albert Rizzo on Virtual Reality. Albert "Skip" Rizzo is a clinical psychologist and professor at the University of Southern California's Integrated Media Systems Center and School of Gerontology. His current clinical and research interests involve neuropsychological assessment, cognitive rehabilitation, and the use of advanced computer interface technology (i. e., Virtual Reality) for mental health treatment. Here he conducts research on the design, development and evaluation of virtual reality systems targeting the assessment and training/rehabilitation of spatial abilities, attention, memory, executive function and motor abilities. His research also includes virtual reality applications that use 360° panoramic video for exposure therapy and he is developing a graphics-based VR environment for treating PTSD in returning military personnel from the Iraq War.


 

Title:

Narrative exposure therapy: A short-term intervention for traumatic stress disorders after war, terror, or torture.

Author(s):

Schauer, Maggie
Neuner, Frank
Elbert, Thomas

Source:

Ashland, OH, US: Hogrefe & Huber Publishers, 2005. viii, 68 pp.

Abstract:

(from the jacket) This book is the first practical manual describing a new and successful short-term treatment for traumatic stress and PTSD called Narrative Exposure Therapy (NET). The manual provides both experienced clinicians and trainees with all the knowledge and skills needed to treat trauma survivors using this approach, which is especially useful in crisis regions where longer- term interventions are not possible. NET has been field tested in postwar societies such as Kosovo, Sri Lanka, Uganda, and Somalia. Its effectiveness was demonstrated in controlled trials in Uganda and Germany. Single case studies have also been reported for adults and children. Three to six sessions can be sufficient to afford considerable relief. Part I of this manual describes the theoretical background. Part II covers the therapeutic approach in detail, with practical advice and tools. Part III then focuses on special issues such as dealing with challenging moments during therapy, defense mechanisms for the therapist, and ethical issues.


Record: 47

Title:

Imagery vividness and perceived anxious arousal in prolonged exposure treatment for PTSD.

Author(s):

Rauch, Sheila A. M., University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, US, srauch@mail.med.upenn.edu.
Foa, Edna B., University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, US
Furr, Jami M., Temple University, Department of Psychology, Philadelphia, PA, US
Filip, Jennifer C., University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, Philadelphia, PA, US

Address:

Rauch, Sheila A. M., Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market Street, Suite 600N, Philadelphia, PA, US, srauch@mail.med.upenn.edu.

Source:

Journal of Traumatic Stress, Vol 17(6), Dec 2004. pp. 461-465.
Journal URL: http://www.wkap.nl/journalhome.htm/0894-9867

Publisher:

US: John Wiley & Sons
Publisher URL: http://www.wiley.com/WileyCDA/

ISSN:

0894-9867 (Print)
1573-6598 (Electronic)

Digital Object Identifier:

10.1007/s10960-004-5794-8

Language:

English

Keywords:

imagery vividness; prolonged exposure treatment; perceived anxious arousal; subjective distress; female survivors; chronic PTSD; sexual assault; nonsexual assault; cognitive restructuring

Abstract:

The present paper examines imagery vividness and anxiety during Prolonged Exposure (PE) for chronic PTSD among 69 female survivors of sexual or nonsexual assault. All participants received between 9 and 12 individual sessions of either PE alone or in combination with cognitive restructuring. As hypothesized, vividness and anxiety ratings from early imaginal exposure sessions were moderately to highly correlated, but these correlations decreased in later sessions. Both subjective distress and vividness decreased significantly with exposure. Greater reductions in subjective distress between the first and last exposure session were related to better outcome. However, contrary to hypothesis, vividness was not related to outcome. Theoretical implications of the results are discussed. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)

Tests & Measures:

PTSD Symptom Scale - Interview (PSS-I)
Subjective Units of Distress Ratings


Record: 48

Title:

Bridging the Gap Between Posttraumatic Stress Disorder Research and Clinical Practice: The Example of Exposure Therapy.

Author(s):

Cook, Joan M., Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US, cook_j@mail.trc.upenn.edu
Schnurr, Paula P., Executive Division, VA National Center for PTSD, White River Junction, VT, US
Foa, Edna B., Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US

Address:

Cook, Joan M., University of Pennsylvania, Treatment Research Center, 3900 Chestnut Street, Philadelphia, PA, US, cook_j@mail.trc.upenn.edu

Source:

Psychotherapy: Theory, Research, Practice, Training, Vol 41(4), Win 2004. Special issue: The Psychological Impact of Trauma: Theory, Research, Assessment, and Intervention. pp. 374-387.

Publisher:

US: Educational Publishing Foundation
Publisher URL: http://www.apa.org

ISSN:

0033-3204 (Print)

Digital Object Identifier:

10.1037/0033-3204.41.4.374

Language:

English

Keywords:

exposure therapy; posttraumatic stress disorder; research; clinical practice; empirically supported psychosocial treatments

Abstract:

There are notable challenges in translating empirically supported psychosocial treatments (ESTs) into general routine clinical practice. However, there may be additional unique dissemination and implementation obstacles for ESTs for trauma-related disorders. For example, despite considerable evidence from randomized clinical trials that attests to the efficacy of exposure therapy for posttraumatic stress disorder, front-line clinicians in real-world settings rarely use this treatment. Perceived and actual barriers that interfere with adoption include clinician misconceptions about what exposure entails and complex cases to which ESTs may not be readily applicable. Specific suggestions for bridging the science-into-service gap in trauma ESTs (in general) and in exposure therapy (in particular) are proposed. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


Record: 49

Title:

The experience of mental death: The core feature of complex posttraumatic stress disorder.

Author(s):

Ebert, Angela, School of Psychology, Curtin University of Technology, Perth, WAU, Australia, a.ebert@exchange.curtin.edu.au
Dyck, Murray J., School of Psychology, Curtin University of Technology, Perth, WAU, Australia

Address:

Ebert, Angela, School of Psychology, Curtin University of Technology, GPO Box U1987, Perth, WAU, Australia, 6845, a.ebert@exchange.curtin.edu.au

Source:

Clinical Psychology Review, Vol 24(6), Oct 2004. pp. 617-635.
Journal URL: http://www.elsevier.com/wps/find/journaldescription.cws_home/652/description#description

Publisher:

Netherlands: Elsevier Science
Publisher URL: http://elsevier.com

ISSN:

0272-7358 (Print)

Digital Object Identifier:

10.1016/j.cpr.2004.06.002

Language:

English

Keywords:

mental death; posttraumatic stress disorder; interpersonal stress; torture; cognitive mechanisms

Abstract:

Exposure to extreme interpersonal stress, exemplified by the experience of torture, represents a threat to the psychological integrity of the victim. The experience is likely to result in mental death, in the loss of the victim's pretrauma identity. Mental death is characterized by loss of core beliefs and values, distrust, and alienation from others, shame and guilt, and a sense of being permanently damaged. Mental death is a primary feature of a distinct posttrauma syndrome, complex posttraumatic stress disorder (PTSD), which is refractory to standard exposure therapies. We identify cognitive mechanisms that mediate the symptoms of complex PTSD, and suggest how current treatments need to be modified to obtain enhanced treatment outcomes. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


Record: 50

Title:

Hjelper terapi for traumatiserte mennesker?

Translated Title:

Does trauma therapy help?

Author(s):

Dyregrov, Atle, Senter for Krisepsykologi, Bergen, Norway, atle@uib.no

Address:

Dyregrov, Atle, Senter for Krisepsykologi, Fabrikkgt. 5, 5059, Bergen, Norway, atle@uib.no

Source:

Tidsskrift for Norsk Psykologforening, Vol 41(10), Oct 2004. pp. 787-793.

Publisher:

Norway: Norsk Psykologforening
Publisher URL: http://www.psykol.no/

ISSN:

0332-6470 (Print)

Language:

Norwegian

Keywords:

trauma therapy; therapeutic interventions; posttraumatic stress disorder; psychological consequences; physical consequences

Abstract:

This article describes the psychological and physical consequences of trauma. It then reviews different therapeutic interventions for Posttraumatic Stress Disorder (PTSD). Methods based on behavioural and cognitive strategies seem most effective in the treatment of trauma. Studies have shown that a large majority of persons with an existing PTSD diagnosis do not have PTSD after termination of treatment. Furthermore, positive treatment outcome is clearly demonstrated long after treatment closure. Effective methods of treatment include exposure therapy, cognitive therapy, Eye Movement Desensitisation and Reprocessing (EMDR), and cognitive behavioural therapy. New treatment methods will no doubt broaden the number of ways in which PTSD may be treated, allowing for programmes better suited to the needs of each particular patient. (PsycINFO Database Record (c) 2006 APA, all rights reserved)(journal abstract)

 

 

Title:

A Comparison of Narrative Exposure Therapy, Supportive Counseling, and Psychoeducation for Treating Posttraumatic Stress Disorder in an African Refugee Settlement.

Author(s):

Neuner, Frank, Department of Clinical Psychology, University of Konstanz, Konstanz, Germany, frank.neuner@uni-konstanz.de
Schauer, Margarete, Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
Klaschik, Christine, Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
Karunakara, Unni, Johns Hopkins University School of Public Health and Vivo, Baltimore, MD, US
Elbert, Thomas, Department of Clinical Psychology, University of Konstanz, Konstanz, Germany

Address:

Neuner, Frank, Department of Clinical Psychology, University of Konstanz, D-78457, Konstanz, Germany, frank.neuner@uni-konstanz.de

Source:

Journal of Consulting and Clinical Psychology, Vol 72(4), Aug 2004. pp. 579-587.
Journal URL: http://www.apa.org/journals/ccp.html

Publisher:

US: American Psychological Assn
Publisher URL: http://www.apa.org

ISSN:

0022-006X (Print)

Digital Object Identifier:

10.1037/0022-006X.72.4.579

Language:

English

Keywords:

narrative exposure therapy; supportive counseling; psychoeducation; posttraumatic stress disorder; African refugee settlement; emotional trauma; refugees

Abstract:

Little is known about the usefulness of psychotherapeutic approaches for traumatized refugees who continue to live in dangerous conditions. Narrative exposure therapy (NET) is a short-term approach based on cognitive-behavioral therapy and testimony therapy. The efficacy of narrative exposure therapy was evaluated in a randomized controlled trial. Sudanese refugees living in a Ugandan refugee settlement (N = 43) who were diagnosed as suffering from posttraumatic stress disorder (PTSD) either received 4 sessions of NET, 4 sessions of supportive counseling (SC), or psychoeducation (PE) completed in 1 session. One year after treatment, only 29% of the NET participants but 79% of the SC group and 80% of the PE group still fulfilled PTSD criteria. These results indicate that NET is a promising approach for the treatment of PTSD for refugees living in unsafe conditions. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)

Tests & Measures:

Composite International Diagnostic Interview
Demography of Forced Migration Questionnaire


 

Title:

Brief Exposure Therapy for the Relief of Posttraumatic Stress Disorder: A Single Case Experimental Design.

Author(s):

Sharp, John, University of Glasgow, Glasgow, Scotland
Espie, Colin A., University of Glasgow, Glasgow, Scotland, c.espie@clinmed.gla.ac.uk

Address:

Espie, Colin A., Psychological Medicine, Division of Community Based Sciences, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, Scotland, G12 0XH, c.espie@clinmed.gla.ac.uk

Source:

Behavioural and Cognitive Psychotherapy, Vol 32(3), Jul 2004. pp. 365-369.

Publisher:

US: Cambridge Univ Press

Abstract:

The present study tested the effectiveness of Vaughan and Tarrier's (1992) Image Habituation Training (IHT) in the treatment of posttraumatic stress disorder (PTSD) using a single case experimental design. The intervention was a brief exposure treatment involving one therapist-led training session and 12 self-directed homework sessions. Assessment measures were taken at pre-treatment, post-treatment, and 3-month follow-up. Decreases demonstrated in direct standardized measures of PTSD, anxiety, and depression were consistent with previous research. The mechanisms underlying the treatment effect were also investigated. Measures of image intensity, image-related anxiety, and belief in a dysfunctional cognition were taken at session-start, mid-session, and session-end. Decreases in between and within homework sessions using these three measures suggested that the processes responsible for change are complex and interactive. The findings from this study demonstrate the effectiveness of IHT as a brief exposure therapy for PTSD and highlight the need for further research aimed at eliciting the mechanisms of change.

Tests & Measures:

PTSD Diagnostic Scale
Revised Impact of Events Scale
Beck Anxiety Inventory
Beck Depression Inventory


 

Title:

The Nakivale Camp Mental Health Project: Building local competency for psychological assistance to traumatised refugees.

Author(s):

Onyut, Lamaro P., Vivo, Mbarara, Uganda, Patience.Onyut@vivo.org
Neuner, Frank, Vivo, Mbarara, Uganda
Schauer, Elisabeth, Vivo, Mbarara, Uganda
Ertl, Verena, University of Konstanz, Germany
Odenwald, Michael, Vivo, Mbarara, Uganda
Schauer, Maggie, Vivo, Mbarara, Uganda
Elbert, Thomas, Vivo, Mbarara, Uganda

Address:

Onyut, Lamaro P., Patience.Onyut@vivo.org

Source:

Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict, Vol 2(2), Jun 2004. pp. 90-107.

Publisher:

Netherlands: War Trauma Foundation

Abstract:

Little is known about the usefulness of psychiatric concepts and psychotherapeutic approaches for refugees who have experienced severe traumatic events and continue to live in stressful and potentially dangerous conditions in refugee settlements. The central goal of the Nakivale Camp Mental Health Project is to establish the usefulness of short-term treatment approaches when applied by local paramedical personnel in a disaster region. In a randomized controlled clinical trial, the efficacy of Narrative Exposure Therapy (NET) vis-à-vis Supportive Counselling has been tested, when applied by trained paramedical personnel from within the same refugee community. Here we demonstrate the feasibility of such an approach and detail the methods and strategy for it. The project also included an epidemiological survey to ascertain the prevalence of PTSD among refugee adolescents and adults alike. Consistent with other investigations, the demographic survey revealed a high prevalence of chronic PTSD ranging from 31.1% in the Rwandan to 47% in the Somali population; even though traumatic events had on average taken place more than 9 and 11 years earlier in each case respectively. Diagnostic validity was assured using expert clinical interviews. The significant social and work-related dysfunction, a disabling consequence of PTSD, does not only impact on the life of the affected individual. Communities where a significant percentage of members, are psychologically affected by past human rights violations, atrocities and war, are held back in their recovery process at many levels. Therefore mental health programmes with workable guidelines on how to treat posttraumatic symptoms, based on solid scientific research with proven effectiveness and feasibility, in particular cultural settings, must become a humanitarian priority.

Tests & Measures:

Posttraumatic Diagnostic Survey
Composite International Diagnostic Interview
Hopkins Symptom Checklist 25


 

Title:

Therapeutic Alliance, Negative Mood Regulation, and Treatment Outcome in Child Abuse-Related Posttraumatic Stress Disorder.

Author(s):

Cloitre, Marylene, Institute for Trauma and Stress, New York University, New York, NY, US, marylene.cloitre@med.nyu.edu
Chase Stovall-McClough, K., Institute for Trauma and Stress, New York University, New York, NY, US
Miranda, Regina, School of Medicine, New York University, New York, NY, US
Chemtob, Claude M., Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, US

Address:

Cloitre, Marylene, Institute for Trauma and Stress, Child Study Center, New York University, 215 Lexington Avenue, 16th Floor, New York, NY, US, marylene.cloitre@med.nyu.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 72(3), Jun 2004. pp. 411-416.

Publisher:

US: American Psychological Assn

Abstract:

This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic memories. Hierarchical regression analyses indicated the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants' improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome.

Tests & Measures:

Working Alliance Inventory
General Expectancy for Negative Mood Regulation scale
Modified PTSD Symptom Scale-Self Report (MPSS-SR)


 

Title:

Sequential Treatment for Child Abuse-Related Posttraumatic Stress Disorder: Methodological Comment on Cloitre, Koenen, Cohen, and Han (2002).

Author(s):

Cahill, Shawn P., Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, US, scahill@mail.med.upenn.edu
Zoellner, Lori A., Department of Psychology, University of Washington, Seattle, WA, US
Feeny, Norah C., Department of Psychiatry, Case Western Reserve University, Cleveland, OH, US
Riggs, David S., Center for the Treatment and Study of Anxiety, University of Pennsylvania, Philadelphia, PA, US

Address:

Cahill, Shawn P., Center for the Treatment and Study of Anxiety, University of Pennsylvania, 3535 Market Street, 6th Floor, Philadelphia, PA, US, scahill@mail.med.upenn.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 72(3), Jun 2004. pp. 543-548.

Publisher:

US: American Psychological Assn

Abstract:

M. Cloitre, K. Koenen, L. R. Cohen, and H. Han (2002; see record 2002-18226-001) presented results of a randomized trial that clearly demonstrate the safety and efficacy of a treatment program delivering skills training in affective and interpersonal regulation (STAIR) prior to conducting imaginal exposure (IE) to trauma memories for adults with posttraumatic stress disorder (PTSD) related to childhood abuse. In this comment the authors review the results presented by Cloitre et al and specifically compare the impact of the STAIR and IE phases of the treatment on affect regulation and psychopathology measures. Evidence for adverse events associated with exposure therapy is reviewed. The authors emphasize that the present study should not be interpreted as evidence that pretreatment with STAIR is additively helpful or necessary prior to IE for PTSD associated with child abuse and that a between-groups comparison is necessary before such conclusions can be drawn.


 

Title:

Treating Life-Impairing Problems Beyond PTSD: Reply to Cahill, Zoellner, Feeny, and Riggs (2004).

Author(s):

Cloitre, Marylene, Child Study Center, New York University School of Medicine, New York, NY, US, marylene.cloitre@med.nyu.edu
Stovall-McClough, K. Chase, Child Study Center, New York University School of Medicine, New York, NY, US
Levitt, Jill T., Child Study Center, New York University School of Medicine, New York, NY, US

Address:

Cloitre, Marylene, Institute for Trauma and Stress, New York University Child Study Center, 215 Lexington Avenue, 16th Floor, New York, NY, US, marylene.cloitre@med.nyu.edu

Source:

Journal of Consulting and Clinical Psychology, Vol 72(3), Jun 2004. pp. 549-551.

Publisher:

US: American Psychological Assn

Abstract:

This reply to the comment by Cahill, Riggs, Zoellner, and Feeny (2004; see record 2004-95166-018) on the article by Cloitre, Koenen, Cohen, and Han (2002; see record 2002-18226-001) reiterates that an important goal of treatment research among chronically traumatized populations is to address problems that impair life functioning, including not only posttraumatic stress disorder but also emotion regulation difficulties and interpersonal problems. The need for further research on symptom exacerbation and drop-out rates in exposure-based treatment for child abuse survivors is discussed. An ongoing follow-up study is described, which is designed to assess the relative utility of STAIR and modified PE individually versus their combination in meeting "good outcome" standards as defined above. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


 

Title:

VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Author(s):

Rosen, Craig S., National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, US, crosen@stanford.edu
Chow, Helen C., VA VISN 21 Mental Illness Research, Education, and Clinical Center, Palo Alto, CA, US
Finney, John F., VA VISN 21 Mental Illness Research, Education, and Clinical Center, Palo Alto, CA, US
Greenbaum, Mark A., VA VISN 21 Mental Illness Research, Education, and Clinical Center, Palo Alto, CA, US
Moos, Rudolf H., VA VISN 21 Mental Illness Research, Education, and Clinical Center, Palo Alto, CA, US
Sheikh, Javaid I., National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, US
Yesavage, Jerome A., VA VISN 21 Mental Illness Research, Education, and Clinical Center, Palo Alto, CA, US

Address:

Rosen, Craig S., National Center for PTSD, (152-MPD), 795 Willow Road, Menlo Park, CA, US, crosen@stanford.edu

Source:

Journal of Traumatic Stress, Vol 17(3), Jun 2004. pp. 213-222.

Publisher:

US: John Wiley & Sons

Abstract:

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.


 

Title:

Fallacies and Deflections in Debating the Empirical Support for EMDR in the Treatment of PTSD: A Reply to Maxfield, Lake, & Hyer.

Author(s):

Rubin, Allen, University of Texas, School of Social Work, Austin, TX, US, arubin@mail.utexas.edu

Address:

Rubin, Allen, University of Texas, School of Social Work, Austin, TX, US, arubin@mail.utexas.edu

Source:

Traumatology, Vol 10(2), Jun 2004. pp. 91-105.

Publisher:

US: Academy of Traumatology

Abstract:

The Maxfield, Lake, and Hyer acerbic attack (see record 2005-01404-002) on my review (2003) is filled with fallacies and inaccurate and unwarranted accusations that deflect attention away from the main issue pertaining to the insufficient evidence base for current claims that EMDR is more effective than exposure therapies and is an empirically-supported treatment for children, combat PTSD, and multiple trauma PTSD. More research is needed before such claims can be called evidence-based. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


 

Title:

Posttraumatic Stress Disorder: Acquisition, Recognition, Course, and Treatment.

Author(s):

Davidson, Jonathan R. T., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, US, tolme@acpub.duke.edu
Stein, Dan J.
Shalev, Arieh Y.
Yehuda, Rachel

Address:

Davidson, Jonathan R. T., Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, US, tolme@acpub.duke.edu

Source:

Journal of Neuropsychiatry & Clinical Neurosciences, Vol 16(2), May 2004. pp. 135-147.

Publisher:

US: American Psychiatric Assn

Abstract:

Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.


 

Title:

A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD.

Author(s):

Becker, Carolyn Black, Department of Psychology, Trinity University, San Antonio, TX, US, carolyn.becker@trinity.edu
Zayfert, Claudia, Dartmouth Medical School, Lebanon, NH, US
Anderson, Emily, Department of Psychology, Trinity University, San Antonio, TX, US

Address:

Becker, Carolyn Black, Department of Psychology, Trinity University, 715 Stadium Drive, San Antonio, TX, US, carolyn.becker@trinity.edu

Source:

Behaviour Research and Therapy, Vol 42(3), Mar 2004. pp. 277-292.

Publisher:

Netherlands: Elsevier Science

Abstract:

Although research supports the efficacy of exposure therapy for PTSD, some evidence suggests that exposure is under-utilized in general clinical practice. The purpose of this study was to assess licensed psychologists' use of imaginal exposure for PTSD and to investigate perceived barriers to its implementation. A total of 852 psychologists from three states were randomly selected and surveyed. An additional 50 members of a trauma special interest group of a national behavior therapy organization were also surveyed. The main survey results indicate that a large majority of licensed doctoral level psychologists do not report use of exposure therapy to treat patients with PTSD. Although approximately half of the main study sample reported that they were at least somewhat familiar with exposure for PTSD, only a small minority used it to treat PTSD in their clinical practice. Even among psychologists with strong interest and training in behavioral treatment for PTSD, exposure therapy is not completely accepted or widely used. Clinicians also appear to perceive a significant number of barriers to implementing exposure.


 

Title:

Combat-related PTSD and logotherapy.

Author(s):

Gilmartin, Robin M., PTSD Residential Rehabilitation Program, CT Veterans Hospital, Newington, CT, US
Southwick, Steven, Yale University Medical School, New Haven, CT, US

Address:

Gilmartin, Robin M., VA Connecticut Healthcare, 555 Willard Ave., Newington, CT, US

Source:

International Forum for Logotherapy, Vol 27(1), Spr 2004. pp. 34-38.

Publisher:

US: Viktor Frankl Inst of Logotherapy

Abstract:

In accordance with DSM-IV, Posttraumatic Stress Disorder (PTSD) follows from traumatic events that have been experienced, witnessed, or confronted and which involve actual or threatened death or serious injury, or threat to the physical integrity of self or others. Chronic combat-related PTSD is difficult to treat. In this report we describe the use of logotherapy for the treatment of a combat veteran suffering with chronic PTSD. Jim, a 54-year-old Vietnam veteran who served as a medic in the Marines, struggled with chronic war-related PTSD. He joined a weekly meaning-focused Community Service (CS) group after completing a combination of treatments for PTSD - cognitive behavioral therapy (CBT), pharmacotherapy, skills training, followed by exposure therapy. These treatments were moderately effective in reducing some symptoms while improving Jim's coping with other, persistent symptoms. We have identified four core existential issues that veterans with combatrelated PTSD often face and which conventional therapies alone do not adequately address. These include a severely skewed external locus of control, a foreshortened sense of future, guilt and survivor guilt, and loss of meaning.


 

Title:

Efficacy and Outcome Predictors for Three PTSD Treatments: Exposure Therapy, EMDR, and Relaxation Training.

Author(s):

Taylor, Steven, University of British Columbia, Vancouver, BC, Canada

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 13-37.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) In recent years there has been a rapidly growing amount of research on the treatment of post traumatic stress disorder (PTSD). Our recent metaanalysis suggested that exposure therapy and eye movement desensitization and reprocessing (EMDR) are among the most effective treatments for PTSD. In this chapter we take the opportunity to summarize our previously reported findings and to present some hitherto unpublished results. Compared to EMDR and relaxation training: (1) exposure therapy tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment, as assessed by structured interview, (2) EMDR and relaxation did not differ from one another on any outcome variable, (3) exposure produced significantly larger reductions in avoidance and reexperiencing symptoms, as assessed before and after treatment via structured interview, and (4) exposure was faster at reducing avoidance, as assessed by a questionnaire administered at the beginning of each session. Our findings suggest that exposure is a first-line psychosocial treatment for PTSD.

Tests & Measures:

Anxiety Sensitivity Index
Reactions to Treatment Questionnaire
Beck Depression Inventory
Clinician-Administered PTSD Scale
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Multiple Channel Exposure Therapy of PTSD: Impact of Treatment on Functioning and Resources.

Author(s):

Falsetti, Sherry A., Department of Family Health and Community Medicine, University Family Health Center, College of Medicine at Rockford, University of Illinois at Chicago, Rockford, IL, US
Erwin, Brigette A., Medical University of South Carolina, National Crime Victims Research and Treatment Center, Charleston, SC, US
Resnick, Heidi S., Medical University of South Carolina, National Crime Victims Research and Treatment Center, Charleston, SC, US
Davis, Joanne, Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, US
Combs-Lane, Amy M., Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, WV, US

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 39-56.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) The present study examined whether female patients diagnosed with PTSD and comorbid panic attacks evidenced improvement in functioning following treatment with Multiple Channel Exposure Therapy (MCET). Based on several reviews, Sheehan and colleagues (1996) argue that, at minimum, three domains of functioning should be included when assessing disability: work impairment, social impairment, and family life/home responsibilities. Thus, participants treated with MCET and control participants were compared on measures of satisfaction with, resources for and quality of work, social life and, family at baseline and at 12 weeks (posttreatment for, the treatment condition). In addition, the treatment group was followed and assessed at 3 months and 6 months to examine further changes in functioning. It was expected that the treatment group would exhibit greater improvement in social functioning and material and emotional resources than control participants. It was also expected that the treatment group would evidence continued improvement in these areas at follow-up assessments. The treatment and control conditions evidenced improvement in work, marital, economic, and overall adjustment from pretreatment to posttreatment, and did not differ. In addition, the treatment group evidenced continued improvement in work, marital, economic, and overall adjustment from pretreatment to 3-month follow-up and from pretreatment to 6-month follow-up. The treatment group evidenced the most consistent amount of change on parental functioning, evidencing improvement among all assessment points. The treatment and control conditions reported having fewer overall family resources than did a normative sample; however, there was a trend for the treatment group to evidence improvement in time for self between the pretreatment and the 6-month follow-up assessment. Otherwise, neither group reported change in basic needs, money, time for self, time for family, or overall family resources at any assessment point.

Tests & Measures:

Anxiety Disorders Interview Schedule for DSM-IV-Lifetime
tructured Clinical Interview for DSM-IV Nonpatient Version
Family Resource Scale
Clinician-Administered PTSD Scale
Social Adjustment Scale


 

Title:

Anxiety Sensitivity and its Implications for Understanding and Treating PTSD.

Author(s):

Taylor, Steven, University of British Columbia, Vancouver, BC, Canada

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 57-65.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) Empirically supported psychosocial treatments for posttraumatic stress disorder (PTSD) all entail some form of trauma-related exposure therapy (TRE). Although TRE tends to be effective, it is not effective for all PTSD sufferers. New developments in trauma treatment are needed to address this problem. This is especially important given that PTSD is a severe, prevalent, and often chronic disorder. In this book there are a number of important suggestions for improving treatment outcome, such as reducing trauma-related anger, augmenting treatment with virtual reality interventions, and improving social support. In this chapter I would like to suggest another approach, derived largely from anxiety sensitivity theory. This approach emphasizes some interventions (TRE and interoceptive exposure) and deliberately omits others (cognitive restructuring and breathing retraining). In the following sections I will briefly review TRE, followed by a discussion of the theoretical and empirical reasons why anxiety sensitivity should be explicitly considered in understanding and treating PTSD.


 

Title:

Virtual Reality Exposure Therapy of Combat-Related PTSD: A Case Study Using Psychophysiological Indicators of Outcome.

Author(s):

Rothbaum, Barbara Olasov, Trauma and Anxiety Recovery Program, Emory University School of Medicine, Atlanta, GA, US
Ruef, Anna Marie, Boston Department of Veterans Affairs Medical Center, Boston, MA, US
Litz, Brett T., Boston Department of Veterans Affairs Medical Center, Boston, MA, US
Han, Hyemee, Boston Department of Veterans Affairs Medical Center, Boston, MA, US
Hodges, Larry, College of Computing, Georgia Institute of Technology, Atlanta, GA, US

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 93-112.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) This chapter describes the treatment of a Vietnam veteran for posttraumatic stress disorder (PTSD) related to his war experiences by virtual reality exposure therapy. Psychophysiological monitoring occurred throughout the treatment as well as at pre- and posttreatment. Although the treatment was considered successful, that would not be clearly evident by the usual standards. His scores on standardized measures of PTSD and related symptoms decreased, but in many cases not until 6 months after the termination of therapy. Much of his distress was triggered by acts committed by him or with his participation in Vietnam and he responded with guilt and anger. In many ways, the most important aspects of his therapy occurred in each session after the exposure therapy when the material was discussed in a more cognitive therapy type of discussion. We have found this processing of the traumatic material that comes up in exposure therapy not just useful, but mandatory, for effective emotional processing. Regarding his physiological responding to the virtual Vietnam stimuli, there were clear signs of significant emotional engagement, although, more often than not, the participant maintained a high level of physiological activity at the end of the session. Consistent with this finding, we have found in conducting exposure therapy with sexual assault survivors with PTSD that the between-session habituation is more important than the within-session habituation. It is also interesting that his physiological reactivity did not always match his self-report of distress. Despite these difficulties and inconsistencies, the patient did well in therapy. We chose this case to highlight some of the interesting aspects of exposure therapy, virtual reality exposure therapy, and psychophysiological monitoring.

Tests & Measures:

Mississippi Scale
Combat Exposure Scale
Boston Life Satisfaction Inventory
Beck Depression Inventory
Brief Symptom Inventory
Clinician-Administered PTSD Scale
PTSD Checklist
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Combining Cognitive Restructuring and Exposure Therapy: Toward an Optimal Integration.

Author(s):

Moore, Sally A., Department of Psychology, University of Washington, Seattle, WA, US
Zoellner, Lori A., Department of Psychology, University of Washington, Seattle, WA, US
Bittinger, Joyce N., Department of Psychology, University of Washington, Seattle, WA, US

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 129-149.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) Both cognitive and exposure therapies are highly effective for the treatment of chronic posttraumatic stress disorder (PTSD). In clinical practice, the integration of these therapies for treatment of this disorder is often quite common. However, in light of recent treatment outcome research indicating that their combination may not increase the efficacy of comprehensive exposure or cognitive monotherapies, clinicians are left wondering how to proceed. First, this chapter reviews theory and research on cognitive features common to PTSD. Second, this chapter reviews treatment outcome research that explores our ability to enhance patient response by combining cognitive and exposure approaches. Third, this chapter discusses advantages and disadvantages of combining these approaches. Finally, this chapter suggests some practical methods aimed at obtaining an "optimal integration" of exposure and cognitive interventions. While no simple answers are forthcoming regarding such optimal integration, clinicians are urged to use the information and recommendations that follow to guide their decision making about appropriate PTSD treatment.


 

Title:

Effect of Cognitive-Behavioral Treatments for PTSD on Anger.

Author(s):

Cahill, Shawn P., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Rauch, Sheila A., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Hembree, Elizabeth A., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Foa, Edna B., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 175-196.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) Several studies have documented a relationship between anger and posttraumatic stress disorder (PTSD) in veterans and civilian populations. The results of the current study suggest that (a) the effects of prolonged exposure (PE), stress inoculation training (SIT), and their combination implemented for PTSD on anger are genuine; (b) the effects hold for both clinically angry and non-clinically angry participants; (c) anger reduction for is both statistically and clinically meaningful; and (d) high levels of anger did not impede the effectiveness of treatments for PTSD and associated psychopathology. These results challenge clinical lore that exposure therapy, the best-validated treatment for PTSD, should not be implemented with highly angry individuals.

Tests & Measures:

Structured Clinical Interview for DSM-III-R Disorders
PTSD Symptoms Scale-Interview
State-Trait Anger Expression Inventory
State Trait Anxiety Inventory
Beck Depression Inventory


 

Title:

PTSD, Dissociation, and Treatment.

Author(s):

Feeny, Norah C., Department of Psychiatry, Case Western Reserve University, Cleveland, OH, US
Danielson, Carla Kmett, Medical University of South Carolina, Charleston, SC, US

Source:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives. Taylor, Steven (Ed); pp. 223-241.
New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the chapter) Dissociative symptoms, such as subjective sense of numbing or detachment, reduced awareness of one's surroundings, derealization, depersonalization, and dissociative amnesia, are often considered cardinal features of posttraumatic stress disorder (PTSD). This chapter discusses background information on PTSD, definitional issues of dissociation, and the relationship between dissociation and chronic PTSD. In addition, it discusses the potential impact of dissociative symptoms on treatment for PTSD and discuss how to manage these symptoms in the course of exposure treatment. Ultimately, being aware of the likely multidimensional nature of dissociation and its impact on PTSD may help clinicians and researchers better understand how to most effectively implement treatment for trauma survivors.


 

Title:

Effects of emotional engagement and habituation on exposure therapy for PTSD.

Author(s):

Rubenstein, Amy, Yeshiva U., US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 65(1-B), 2004. pp. 451.

Publisher:

US: Univ Microfilms International

Abstract:

Exposure therapy is now considered the first line of treatment for Post Traumatic Stress Disorder (Foa, Davidson, & Frances, 1999). Over the past decade, many studies have illustrated its effectiveness in treating patients with PTSD (Boudewyns & Hyer, 1990; Cooper & Clum, 1989; Foa et al., 1999; Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; Tarrier et al., 1999). More recently, trauma theorists have explored uncovering how and why exposure therapy is so effective. Compelling arguments have been made that two process variables, emotional engagement and habituation, mediate successful outcome of exposure therapy (Jaycox, Foa, & Morral, 1998; van Minnen & Hagenaars, 2002). However, to date, there have been few studies that explore this. The present investigation will examine the effects of emotional engagement and habituation on exposure therapy for PTSD in a sample of trauma patients. It was hypothesized that (1) emotional engagement at the beginning of exposure therapy will predict a decrease in PTSD symptoms over the course of treatment, and (2) habituation across sessions will predict a decrease in PTSD symptoms over the course of treatment. Eighteen adults diagnosed with PTSD received cognitive-behavioral that involved reliving their trauma, and rated their distress at 5-minute intervals (SUDS). Significant improvement on all PTSD measures was found at the end of treatment. The results suggest that emotional engagement and habituation during exposure therapy is important for treatment success. Consistent relationships between SUDS levels and measures for PTSD and depression outcome scores exist for all types of sessions (first session, mean across 4 sessions, and final session). SUDS levels during the first exposure session appear to the most predictive based on Cohens medium effect size (.3 or better). The higher the level of emotional engagement and habituation in the first session, the lower the symptom levels at outcome.


 

Title:

A meta-analysis of group treatments for post-traumatic stress disorder: How treatment modality affects symptoms.

Author(s):

Bornstein, Hallie Alyssa, U Wyoming, US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 64(10-B), 2004. pp. 5207.

Publisher:

US: Univ Microfilms International

Abstract:

This meta-analysis synthesized the results from controlled clinical group treatments for posttraumatic stress disorder (PTSD). The treatment interventions included cognitive restructuring, psycho-education, exposure, supportive, and process group therapy. Participants in the studies included combat veterans, survivors of sexual abuse or assault, and severe bereavement sufferers. Analyses showed that overall, all therapy seemed to have a positive effect on the measurement of trauma symptoms. When a multiple regression was performed exposure therapy improved depression symptoms while psycho-education improved social functioning immediately after treatment. Within six months of treatment, psycho-education continued to produce improvements in social functioning but process therapy negatively influenced depression and overall PTSD symptoms. Cognitive restructuring was found to improve overall PTSD symptoms more than six months after treatment termination. Considering all therapy modalities together seemed to make a rather significant difference in terms of the outcome. Overall, although PTSD symptoms were significantly influenced in a positive direction by a therapeutic intervention at post-treatment, due to the state of the current literature no definitive relationships between the type of intervention and symptom amelioration were found. In addition, no one symptom consistently responded to any one type of therapy across all time periods. However, a therapeutic intervention that uses cognitive restructuring, exposure, and psycho-education in a group setting would likely be quite effective in reducing trauma symptoms. In summary, this meta-analysis found that most investigations use more than one type of intervention modality and that there is a great deal of overlap between intervention type. Due to this overlap, many of the therapy modalities that are used within the studies are not "pure" therapies. Additional analyses were conducted on mediating variables. These analyses found no difference in the reported improvement in symptoms typically assessed in trauma treatment by combat and noncombat trauma survivors. Also, an analysis of all interventions found a relationship between the length of treatment and symptom improvement for three of the target symptoms (avoidance, social functioning, and overall effect size). The recommendations for future research were discussed.


 

Title:

Cognitive-behavioral treatment for PTSD among people with severe mental illness: A proposed treatment model.

Author(s):

Frueh, B. Christopher, Medical University of South Carolina, Charleston, SC, US
Buckley, Todd C., National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, US
Cusack, Karen J., South Carolina Department of Mental Health, SC, US
Kimble, Matthew O., National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, US
Grubaugh, Anouk L., Medical University of South Carolina, Charleston, SC, US
Turner, Samuel M., University of Maryland, College Park, MD, US
Keane, Terence M., National Center for PTSD, Veterans Affairs Boston Healthcare System, Boston, MA, US

Address:

Frueh, B. Christopher, Mental Health Service (116), Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC, US

Source:

Journal of Psychiatric Practice, Vol 10(1), Jan 2004. pp. 26-38.

Publisher:

US: Lippincott Williams & Wilkins

Abstract:

The lifetime prevalence of posttraumatic stress disorder (PTSD) is about 8%-14% in the general population, and trauma victimization (51%-98%) and PTSD (up to 42%) are even more prevalent among persons treated within public-sector mental health clinics. Despite this, individuals with PTSD and severe mental illness (SMI) who are treated within the public sector tend to receive inadequate mental health services. In addition, treatments for PTSD for this population remain undeveloped, with virtually no available empirical treatment outcome data to guide clinicians. We propose a model for a comprehensive, multicomponent cognitive-behavioral treatment program for this target population that includes elements of consumer education, anxiety management training, social skills training, exposure therapy, "homework" assignments, and long-term follow-up care. Special considerations for public-sector consumers with PTSD and SMI are addressed, as are directions for future research.


 

Title:

Brief Behavior Therapy.

Series Title:

Core competencies in psychotherapy

Author(s):

Hembree, Elizabeth A., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Roth, Deborah, Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US
Bux, Donald A. Jr., National Center on Addiction and Substance Abuse, Columbia University, New York, NY, US
Foa, Edna B., Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, US

Source:

The Art and Science of Brief Psychotherapies: A Practitioner's Guide. Dewan, Mantosh J. (Ed; Steenbarger, Brett N. (Ed); Greenberg, Roger P. (Ed); pp. 51-83.
Washington, DC, US: American Psychiatric Publishing, Inc., 2004. xv, 307 pp.

Abstract:

(from the chapter) In this chapter, we describe an approach to psychotherapy that has produced a vast body of literature in recent years. We begin with a general description of the behavioral approach to psychotherapy. Next, because thorough assessment is a crucial first step in behavioral interventions, we briefly review some of the evaluation techniques commonly used by behavior therapists. We describe two types of behavior therapy that have received much empirical support, particularly for their efficacy in the treatment of pathological anxiety: a commonly used form of anxiety management training called stress inoculation training (SIT) and exposure therapy. After introducing these techniques, we present detailed descriptions of two exposure-based treatment programs that have been developed and extensively studied at the Center for the Treatment and Study of Anxiety (CTSA) at the University of Pennsylvania in Philadelphia. These are the Exposure and Ritual Prevention (EX/RP) program for the treatment of obsessive-compulsive disorder (OCD) and the Prolonged Exposure (PE) Therapy program for the treatment of chronic posttraumatic stress disorder (PTSD). Each type of treatment is illustrated by a detailed case example. In addition, the chapter contains many other clinical examples of the interventions we describe.


 

Title:

Advances in the treatment of posttraumatic stress disorder: Cognitive-behavioral perspectives.

Author(s):

Taylor, Steven, (Ed), University of British Columbia, Vancouver, BC, Canada

Source:

New York, NY, US: Springer Publishing Co, 2004. xv, 326 pp.

Abstract:

(from the preface) Over the past two decades there have been many important advances in treating posttraumatic stress disorder (PTSD). Psychosocial treatments, particularly behavioral and cognitive-behavioral therapy, are among the most effective interventions. Although these treatments are useful, they are not universally efficacious. Some PTSD patients find these treatments to be too distressing to tolerate. Some endure treatment but fail to benefit, and some show only a partial or incomplete response. Thus, it is important to discover ways of improving treatment tolerability and outcome. Another important issue concerns the breadth of treatment effects. Are behavioral and cognitive-behavioral therapies sufficiently broad in their effects on trauma-related psychopathology and related factors? PTSD is commonly comorbid with various clinical problems, including co-occurring mental disorders and such psychosocial problems as poor quality of life. Therefore it is important to consider whether our treatments are addressing all the important trauma-related problems in people suffering from PTSD. This book strives to address these issues.


 

Title:

Beyond the manual: The insider's guide to prolonged exposure therapy for PTSD.

Author(s):

Hembree, Elizabeth A., University of Pennsylvania, Philadelphia, PA, US, hembree@mail.med.upenn.edu
Rauch, Sheila A. M., University of Pennsylvania, Philadelphia, PA, US
Foa, Edna B., University of Pennsylvania, Philadelphia, PA, US

Address:

Hembree, Elizabeth A., Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 6th Floor, Philadelphia, PA, US, hembree@mail.med.upenn.edu

Source:

Cognitive and Behavioral Practice, Vol 10(1), Win 2003. pp. 22-30.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Prolonged Exposure therapy (PE; Foa & Rothbaum, 1998) has strong empirical support for its efficacy in reducing trauma-related psychopathology in individuals with chronic PTSD (Rothbaum, Meadows, Resick, & Foy, 2000). In the process of providing PE to many clients and in training therapists in a variety of settings in its use, we at the Center for the Treatment and Study of Anxiety have amassed extensive experience with this therapy. This article extends the treatment guidelines provided in the PE treatment manual by sharing the knowledge and wisdom that years of experience have brought us. We emphasize the importance of forging a strong therapeutic alliance and providing a thorough rationale for treatment, discuss ways to implement in-vivo and imaginal exposure so as to promote effective emotional engagement with traumatic memories, and conclude with some recommendations for how therapists who conduct PE for PTSD can take care of themselves while delivering a therapy that is very rewarding and, at times, emotionally challenging.


 

Title:

Myths regarding exposure therapy for PTSD.

Author(s):

Feeny, Norah C., Case Western Reserve University, Cleveland, OH, US, ncf2@po.cwru.edu
Hembree, Elizabeth A., University of Pennsylvania, Philadelphia, PA, US
Zoellner, Lori A., University of Washington, Seattle, WA, US

Address:

Feeny, Norah C., Case Western Reserve University, Department of Psychiatry, 11100 Euclid Ave., Hanna Pavilion, Cleveland, OH, US, ncf2@po.cwru.edu

Source:

Cognitive and Behavioral Practice, Vol 10(1), Win 2003. pp. 85-90.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Considerable evidence exists for the efficacy and tolerability of exposure therapy for PTSD (cf. Foa & Rothbaum, 1998, Rothbaum, Meadows, Resick, & Foy, 2000). However, the use of exposure therapy in real-world settings has lagged behind such findings. It is our belief that this gap between science and practice is partly due to several clinical myths regarding the use of exposure therapy. In this article, we outline four such myths, discuss relevant empirical findings, and argue that exposure therapy is indeed applicable for the treatment of a variety of patients with PTSD by clinicians in a variety of real-world settings. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract)


 

Title:

Do patients drop out prematurely from exposure therapy for PTSD?

Author(s):

Hembree, Elizabeth A., School of Medicine, University of Pennsylvania, Philadelphia, PA, US, hembree@mail.med.upenn.edu
Foa, Edna B., School of Medicine, University of Pennsylvania, Philadelphia, PA, US
Dorfan, Nicole M., School of Medicine, University of Pennsylvania, Philadelphia, PA, US
Street, Gordon P., Center for New Beginnings, Littleton, NH, US
Kowalski, Jeanne, Division of Oncology Biostatistics, Johns Hopkins University, Baltimore, MD, US
Tu, Xin, School of Medicine, University of Pennsylvania, Philadelphia, PA, US

Address:

Hembree, Elizabeth A., Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 6th Floor, Philadelphia, PA, US, hembree@mail.med.upenn.edu

Source:

Journal of Traumatic Stress, Vol 16(6), Dec 2003. pp. 555-562.

Publisher:

US: John Wiley & Sons

Abstract:

Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic posttraumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR). These findings are consistent with previous research about the tolerability of exposure therapy.


 

Title:

Comment on Hembree and Foa (2003) and EMDR.

Author(s):

Lipke, Howard, DVAMC, Wheeling, IL, US, hlipke@aol.com

Address:

Lipke, Howard, DVAMC, North Chicago, 361 Rustic, Wheeling, IL, US, hlipke@aol.com

Source:

Journal of Traumatic Stress, Vol 16(6), Dec 2003. pp. 573-574.

Publisher:

US: John Wiley & Sons

Abstract:

Comments on "Intervention for trauma-related emotional disturbances in adult trauma victims," by E.A. Hembree and E. Foa (see record 2003-05170-009). Hembree and Foa consider the literature on the importance of eye movement and other sensory/motor activity in Eye Movement Desensitization and Reprocessing (EMDR). They cite several specific studies on the subject and then uncritically report the Lohr, Tolin, and Lilienfeld literature review conclusion that eye movement and/or other sensory motor activity are not active ingredients in the therapy. In that review, Lohr et al. erroneously described several studies as having shown no positive effects for eye movement when, in fact, these studies reported clear positive effects for eye movement. Later, after referring to another literature review (Cahill, Carrigan, & Freuh) they conclude that "Taken together, the empirical studies on EMDR to date suggest that this treatment is effective for chronic posttraumatic stress disorder (PTSD)." The uncritical interpretation of eye movement or other sensory/motor activity in EMDR by Hembree and Foa poses the danger of unjustly steering scientists and clinicians away from consideration of EMDR as a distinct method of treatment, and of attempting to better understand its mechanism of effect.


 

Title:

Contextualizing Trauma: Using Evidence-Based Treatments in a Multicultural Community After 9/11.

Author(s):

Marshall, Randall D., New York State Psychiatric Institute, New York, NY, US, randall@nypsi.cpmc.columbia.edu
Suh, Eun Jung, Columbia University College of Physicians and Surgeons, New York, NY, US

Address:

Marshall, Randall D., New York State Psychiatric Institute Unit 69, 1051 Riverside Drive, New York, NY, US, randall@nypsi.cpmc.columbia.edu

Source:

Psychiatric Quarterly, Vol 74(4), Win 2003. Special issue: The Fifteenth Annual New York State Office of Mental Health Research Conference. pp. 401-420.

Publisher:

Germany: Springer

Abstract:

The mental health community was caught unaware after 9/11 with respect to treatment of survivors of terrorist attacks. Because this form of trauma was quite rare in the U.S., few trauma specialists had extensive experience, or taught regularly on this subject. Since the primary objective of terrorism is the creation of demoralization, fear, and uncertainty in the general population, a focus on mental health from therapeutic and public health perspectives is critically important to successful resolution of the crisis. Surveys after 9/11 showed unequivocally that symptomatology related to the attacks were found in hundreds of thousands of people, most of whom were not escapees or the families of the deceased. Soon after 9/11, our center formed a collaboration with other academic sites in Manhattan to rapidly increase capacity for providing state-of-the-art training and treatment for trauma-related psychiatric problems. Our experience suggests that evidence-based treatments such as Prolonged Exposure Therapy have proven successful in treating 9/11-related PTSD. However, special clinical issues have arisen, such as the influence of culture on clinical presentation and treatment expectations in a multiethnic community...


 

Title:

When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD.

Author(s):

Grunert, Brad K., Medical College of Wisconsin, US
Smucker, Mervin R., Medical College of Wisconsin, US
Weis, Jo M., Medical College of Wisconsin, US
Rusch, Mark D., Medical College of Wisconsin, US

Address:

Grunert, Brad K., Hand Rehabilitation Center, Froedtert Memorial Lutheran Hospital, 9200 West Wisconsin Ave., Milwaukee, WI, US

Source:

Cognitive and Behavioral Practice, Vol 10(4), Fal 2003. pp. 333-346.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Presents a detailed cognitive-behavioral analysis of two industrial victims suffering from PTSD who failed to benefit from PE alone, but who subsequently made a quick and lasting recovery when an imagery-based, cognitive restructuring component was added to their exposure treatment. A comparative analysis is presented of the theoretical underpinnings and treatment components of the behavioral and cognitive treatments used with the subjects in this study--PE and imagery rescripting and reprocessing therapy (IRRT). PE is a behavioral treatment based upon theories of classical conditioning that relies on exposure, habituation, desensitization, and extinction to facilitate emotional processing of fear. By contrast, IRRT is cognitive therapy applied in the context of imagery modification. In IRRT, exposure is employed not for habituation, but for activating the trauma memory so that the distressing cognitions can be identified, challenged, modified, and processed.

Tests & Measures:

State Trait Anxiety Inventory


 

Title:

Selected Annotated Journal Resources.

Author(s):

Doty, Kelly
Rohde, Carlyanne

Source:

International Journal of Emergency Mental Health, Vol 5(4), Fal 2003. pp. 221-229.

Publisher:

US: Chevron Publishing

Abstract:

This annotated, selective bibliography of empirical studies (published in 2003) of traumatic stress (1) directed forgetting following mood induction in chronic posttraumatic stress disorder (PTSD) patients, (2) trauma and PTSD in people with schizophrenia, (3) cumulative adversity and PTSD in a diverse community sample of young adults, (4) structured group therapy for PTSD in incarcerated male juveniles, (5) a diathesis-stress model of PTSD, and (6) imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of PTSD.


 

Title:

Treatment choice for PTSD.

Author(s):

Zoellner, Lori A., University of Washington, Department of Psychology, Seattle, WA, US, zoellner@u.washington.edu
Feeny, Norah C., Case Western Reserve University, Cleveland, OH, US
Cochran, Bryan, University of Washington, Department of Psychology, Seattle, WA, US
Pruitt, Larry, University of Washington, Department of Psychology, Seattle, WA, US

Address:

Zoellner, Lori A., University of Washington, Department of Psychology, Box 351525, Seattle, WA, US, zoellner@u.washington.edu

Source:

Behaviour Research and Therapy, Vol 41(8), Aug 2003. pp. 879-886.

Publisher:

Netherlands: Elsevier Science

Abstract:

The impetus for seeking help for assault-related difficulties often rests upon the victims themselves. Yet, we know very little about what factors influence a woman's decision to seek a particular kind of help after an assault. To learn more about these factors, data from 273 women with varying degrees of trauma history and subsequent PTSD symptoms were collected. All participants read a standard, "if this happened to you, what would you do" scenario describing a traumatic event and subsequent trauma-related psychiatric symptoms. Participants were given the same trauma scenario (i.e., sexual assault) and three treatment options to choose from: sertraline (SER), prolonged exposure (PE), or no treatment. Ratings of treatment credibility, personal reactions to treatment options, and treatment choice were examined. Women were more likely to choose PE than SER for the treatment of chronic PTSD. Perceived credibility of the treatment and personal reactions coincided with women's choices. By better understanding who would choose which treatments for PTSD and why, we will improve our ability to tailor how we approach discussing treatment options with these women.

Tests & Measures:

Posttraumatic Stress Diagnostic Scale
State Trait Anxiety Inventory
Beck Depression Inventory


 

Title:

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

Author(s):

Bryant, Richard A., U New South Wales, School of Psychology, Sydney, NSW, Australia, r.bryant@unsw.edu.au
Moulds, Michelle L., U New South Wales, School of Psychology, Sydney, NSW, Australia
Guthrie, Rachel M., U New South Wales, School of Psychology, Sydney, NSW, Australia
Dang, Suzanne T., U New South Wales, School of Psychology, Sydney, NSW, Australia
Nixon, Reginald D. V., U New South Wales, School of Psychology, Sydney, NSW, Australia

Address:

Bryant, Richard A., School of Psychology, U New South Wales, Sydney, NSW, Australia, 2052, r.bryant@unsw.edu.au

Source:

Journal of Consulting and Clinical Psychology, Vol 71(4), Aug 2003. pp. 706-712.

Publisher:

US: American Psychological Assn

Abstract:

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.

Tests & Measures:

Beck Depression Inventory--II
State Trait Anxiety Inventory


 

Title:

Effect of Cognitive-Behavioral Treatments for PTSD on Anger.

Author(s):

Cahill, Shawn P., U Pennsylvania, Philadelphia, PA, US, scahill@mail.med.upenn.edu
Rauch, Sheila A., U Pennsylvania, Philadelphia, PA, US
Hembree, Elizabeth A., U Pennsylvania, Philadelphia, PA, US
Foa, Edna B., U Pennsylvania, Philadelphia, PA, US

Address:

Cahill, Shawn P., Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, US, scahill@mail.med.upenn.edu

Source:

Journal of Cognitive Psychotherapy, Vol 17(2), Sum 2003. Special issue: Special Issue on Posttraumatic Stress Disorder. pp. 113-131.

Publisher:

US: Springer Publishing

Abstract:

We investigated three questions related to anger and the treatment of chronic posttraumatic stress disorder (PTSD), utilizing data from a previously published study of cognitive behavioral therapies (CBTs) with female assault victims (Foa, Dancu, Hembree, Jaycox, Meadows, & Street, 1999). The questions were: (1) Do CBTs targeted at PTSD result in a concomitant reduction in anger?, (2) If so, how do these treatments compare with one another?, And (3) Do high levels of pretreatment anger predict poorer outcome on measures of PTSD symptom severity, depression, and general anxiety? Data from the State-Trait Anger Expression Inventory at pretreatment and posttreatment assessments were available for 67 participants randomly assigned to receive prolonged exposure (PE:n=19), stress inoculation training (SIT:n=18), combined treatment (PE/SIT;n=17), or waitlist control (WL:n=13). Compared to WL, treatments significantly lowered levels of state-anger. Comparisons among active treatments indicated significantly lower state-anger for SIT compared to PE/SIT, but PE did not differ from SIT or PE/SIT. Treatment gains were maintained at follow-up. Pretreatment state-anger was correlated with posttreatment PTSD symptom severity and depression, but multiple regression analyses revealed that...

Tests & Measures:

State Trait Anxiety Inventory
Beck Depression Inventory


 

Title:

Multiple Channel Exposure Therapy of PTSD: Impact of Treatment on Functioning and Resources.

Author(s):

Falsetti, Sherry A., U Illinois, Coll of Medicine, Chicago, IL, US, falsetti@uic.edu
Erwin, Brigette A., Medical U of South Carolina, Charleston, SC, US
Resnick, Heidi S., Medical U of South Carolina, Charleston, SC, US
Davis, Joanne, University of Tulsa ,, OK, US
Combs-Lane, Amy M., West Virginia University School of Medicine, Morgantown, WV, US

Address:

Falsetti, Sherry A., University of Illinois College of Medicine at Rockford, University Family Health Center, 1221 East State St., Rockford, IL, US, falsetti@uic.edu

Source:

Journal of Cognitive Psychotherapy, Vol 17(2), Sum 2003. Special issue: Special Issue on Posttraumatic Stress Disorder. pp. 133-147.

Publisher:

US: Springer Publishing

Abstract:

Posttraumatic stress disorder (PTSD) is associated with significant impairment in functioning. Although improvement in PTSD symptoms following cognitive-behavioral treatment of PTSD has been demonstrated in numerous studies, improvement in functioning has yet to be fully explored. In addition to measures of PTSD, measures of functioning may help to identify more reliably broad-based change following cognitive- behavioral treatment of PTSD. A few studies have demonstrated short-term improvement in functioning following pharmacotherapy of PTSD. The current study is the first investigation to examine short- and long-term changes in adjustment and resources following cognitive-behavioral treatment of PTSD. 24 of 47 women with anxiety and related symptoms subsequent to exposure to at least one traumatic event were randomly assigned to 12 weekly group sessions (90 min each) of Multiple Channel Exposure Therapy (MCET). Ss' ethnicity was noted. Findings suggest that, immediately following, female trauma victims with PTSD and comorbid panic attacks reported improvement in work, marital, economic, and overall adjustment. In addition, 3 and 6 months following MCET, patients continued to experience improvement in work, marital, economic, parental, and overall adjustment.

Tests & Measures:

Clinician-Administered PTSD Scale
Social Adjustment Scale


 

Title:

Outcome Predictors for Three PTSD Treatments: Exposure Therapy, EMDR, and Relaxation Training.

Author(s):

Taylor, Steven, U British Columbia, Vancouver, BC, Canada

Address:

Taylor, Steven, University of British Columbia, Vancouver, BC, Canada

Source:

Journal of Cognitive Psychotherapy, Vol 17(2), Sum 2003. Special issue: Special Issue on Posttraumatic Stress Disorder. pp. 149-161.

Publisher:

US: Springer Publishing

Abstract:

Several psychosocial treatments appear to be effective in treating posttraumatic stress disorder (PTSD). However, little is known about the predictors of treatment outcome. It is possible that some variables predict poor outcome for some treatments but not for other treatments. To investigate this issue, outcome predictors were investigated for three eight-session treatments: exposure therapy (entailing prolonged imaginal and in vivo exposure), relaxation training, and eye movement desensitization and reprocessing (EMDR). Sixty people with PTSD entered and 45 completed treatment. Treatments did not differ in attrition or perceived credibility. Exposure tended to be most effective, and EMDR and relaxation did not differ in efficacy. A number of clinical and cognitive variables were examined to identify predictors of treatment dropout as well as predictors of the likelihood that patients would be remitted from PTSD after treatment. These analyses were conducted by controlling for treatment condition. Low patient ratings of treatment credibility (assessed in session 2) predicted treatment dropout, regardless of treatment type. Severe reexperiencing symptoms (assessed prior to treatment) predicted poor outcome for relaxation training but not for the other therapies...

Tests & Measures:

Beck Depression Inventory
Clinician-Administered PTSD Scale
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Virtual Reality Exposure Therapy of Combat-Related PTSD: A Case Study Using Psychophysiological Indicators of Outcome.

Author(s):

Rothbaum, Barbara Olasov, Emory U of Medicine, Atlanta, GA, US
Ruef, Anna Marie, Boston U, School of Medicine, Boston, MA, US
Litz, Brett T., Boston U, School of Medicine, Boston, MA, US
Han, Hyemee, Boston U, School of Medicine, Boston, MA, US
Hodges, Larry, Georgia Inst of Technology, Atlanta, GA, US

Address:

Rothbaum, Barbara Olasov, Emory University of Medicine, Atlanta, GA, US

Source:

Journal of Cognitive Psychotherapy, Vol 17(2), Sum 2003. Special issue: Special Issue on Posttraumatic Stress Disorder. pp. 163-177.

Publisher:

US: Springer Publishing

Abstract:

This article describes the treatment by exposure therapy of a Vietnam veteran for PTSD related to his war experiences. There are several unique features of this particular treatment and case report. One, the exposure treatment was delivered in conjunction with virtual reality. The patient was exposed to two virtual Vietnam environments, a virtual Huey helicopter and a virtual landing zone, while engaging in exposure to his most traumatic Vietnam memories. Two, the nature of several of these traumatic memories included guilt over acts that the patient committed in Vietnam, which is often times not considered a good candidate for exposure therapy. Three, psychophysiological monitoring occurred throughout the treatment as well as at pretreatment and posttreatment. His responses to treatment, in terms of guilt, anger, and anxiety, standardized symptom measures at pretreatment and posttreatment and follow-ups of 3 months and 6 months, and psychophysiological treatment responding, are discussed.

Tests & Measures:

Beck Depression Inventory
Brief Symptom Inventory
Clinician-Administered PTSD Scale
PTSD Checklist
Structured Clinical Interview for DSM-IV Axis I Disorders


 

Title:

Anxiety Sensitivity and Its Implications for Understanding and Treating PTSD.

Author(s):

Taylor, Steven, University of British Columbia, Vancouver, BC, Canada, taylor@interchange.ubc.ca

Address:

Taylor, Steven, Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T 2A1, taylor@interchange.ubc.ca

Source:

Journal of Cognitive Psychotherapy, Vol 17(2), Sum 2003. Special issue: Special Issue on Posttraumatic Stress Disorder. pp. 179-186.

Publisher:

US: Springer Publishing

Abstract:

Empirically supported psychosocial treatments for posttraumatic stress disorder (PTSD) all entail some form of trauma-related exposure therapy. Although these treatments are often useful, none are effective for all patients. Even those who respond are often left with residual symptoms. A better understanding of the causes of PTSD may lead to more effective treatments. The present article reviews the nascent but steadily growing research on the role of anxiety sensitivity (fear of arousal-related sensations) in PTSD. Available research suggests that anxiety sensitivity may play an important role and that treatments that directly target anxiety sensitivity (such as interoceptive exposure) may improve outcome, particularly if these treatments are implemented before commencing trauma-related exposure therapy.


 

Title:

Cognitive-behavioral therapy in the treatment of posttraumatic stress disorder.

Author(s):

Falsetti, Sherry A., Department of Family and Community Medicine, University of Illinois Family Health Center, Rockford, IL, US, falsetti@uic.edu

Address:

Falsetti, Sherry A., Family Health Center, 1221 East State St, Rockford, IL, US, falsetti@uic.edu

Source:

Primary Psychiatry, Vol 10(5), May 2003. pp. 78-83.
Journal URL: http://www.primarypsychiatry.com/index.php3

Publisher:

US: MBL Communications, Inc
Publisher URL: http://mblcommunications.com

ISSN:

1082-6319 (Print)

Language:

English

Keywords:

cognitive behavior therapy; posttraumatic disorder; cognitive processing therapy; stress inoculation training; exposure therapy; psychoeducation; cognitive restructuring; relapse prevention

Abstract:

Posttraumatic stress disorder (PTSD) is a common disorder that often occurs comorbid with depression and/or panic attacks. This article reviews the cognitive-behavioral treatment options for patients suffering from PTSD, including cognitive-processing therapy, stress inoculation training, prolonged exposure, and multiple-channel exposure therapy. A decision-making model for choosing treatment components that best meet each patients needs is presented. Phases of treatment, including psychoeducation, copings skills, cognitive restructuring, behavioral task scheduling, relapse prevention, and evaluation, are discussed.


 

Title:

A brief behavioural treatment of chronic post-traumatic stress disorder in earthquake survivors: Results from an open clinical trial.

Author(s):

Basoglu, Metin, Inst of Psychaitry, Section of Trauma Studies, London, England
Livanou, M.
Salcioglu, E.
Kalender, D.

Address:

Basoglu, Metin, Section of Trauma Studies, Inst of Psychiatry, 38 Carver Road, London, England, SE24 9LT

Source:

Psychological Medicine, Vol 33(4), May 2003. pp. 647-654.

Publisher:

US: Cambridge Univ Press

Abstract:

Given the extent of the mental health problem following earthquakes, brief, effective and cost-effective treatment interventions are needed. This study examined whether cognitive-behavioural treatment could be shortened to a minimum number of sessions without undermining its effectiveness in post-traumatic stress disorder (PTSD). The study participants (N=231) were consecutive referrals to 5 project sites in the earthquake region in Turkey a mean of 13 mo after the disaster. A modified behavioural treatment (BT) was used, which involved self-exposure instructions based on an enhancement of "sense of control" rather than a habituation rationale and minimal cognitive interventions. The duration of treatment was variable, involving as many sessions as required for clinical improvement. Survival analysis explored the minimum number of sessions required for clinical improvement, and multiple regression analysis to examine the predictors of outcome. Survivors received a mean of 4.3 sessions. Significant treatment effects and clinically meaningful effect sizes were noted on all measures. Treatment improved all PTSD and depression symptoms. The cumulative proportion of improved cases was 76% after one session and 88% after two sessions. No baseline variable predicted treatment outcome.


 

Title:

The illusion of presence in immersive virtual reality during an fMRI brain scan.

Author(s):

HOFFMAN, HUNTER G., Human Interface Technology Laboratory, University of Washington, Seattle, WA, US, hunter@hitL.washington.edu
RICHARDS, TODD, Department of Radiology, University of Washington School of Medicine, Seattle, WA, US
CODA, BARBARA, Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA, US
RICHARDS, ANNE, Department of Radiology, University of Washington School of Medicine, Seattle, WA, US
SHARAR, SAM R., Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA, US

Address:

HOFFMAN, HUNTER G., Human Interface Technology Laboratory, University of Washington, Seattle, WA, US, hunter@hitL.washington.edu

Source:

CyberPsychology & Behavior, Vol 6(2), Apr 2003. pp. 127-131.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

The essence of immersive virtual reality (VR) is the illusion it gives users that they are inside the computer-generated virtual environment. This unusually strong illusion is theorized to contribute to the successful pain reduction observed in burn patients who go into VR during woundcare (www.vrpain.com) and to successful VR exposure therapy for phobias and post-traumatic stress disorder (PTSD). The present study demonstrated for the first time that subjects could experience a strong illusion of presence during an fMRI despite the constraints of the fMRI magnet bore (i.e., immobilized head and loud ambient noise).


 

Title:

Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training.

Author(s):

Taylor, Steven, U British Columbia, Dept of Psychiatry, Vancouver, BC, Canada, taylor@unixg.ubc.ca
Thordarson, Dana S., U British Columbia, Dept of Psychiatry, Vancouver, BC, Canada
Maxfield, Louise, Lakehead U, Dept of Psychology, Thunder Bay, ON, Canada
Fedoroff, Ingrid C., St Paul's Hosp, Vancouver, BC, Canada
Lovell, Karina, U Manchester, School of Nursing, Midwifery, & Health Visiting, Manchester, England
Ogrodniczuk, John, U British Columbia, Dept of Psychiatry, Vancouver, BC, Canada

Address:

Taylor, Steven, U British Columbia, Dept of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T 2A1, taylor@unixg.ubc.ca

Source:

Journal of Consulting and Clinical Psychology, Vol 71(2), Apr 2003. pp. 330-338.

Publisher:

US: American Psychological Assn

Abstract:

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N=60). Treatments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.

Conference:

World Congress of Behavioral and Cognitive Therapies, Jul, 2001, Vancouver, BC, Canada

Conference Notes:

A preliminary report of this study was presented at the aforementioned congress.


 

Title:

Interventions for trauma-related emotional disturbances in adult victims of crime.

Author(s):

Hembree, Elizabeth A., U Pennsylvania School of Medicine, Pittsburgh, PA, US, hembree@mail.med.upenn.edu
Foa, Edna B., U Pennsylvania School of Medicine, Pittsburgh, PA, US

Address:

Hembree, Elizabeth A., Dept of Psychiatry, U Pennsylvania, 3535 Market Street, 6th Floor, Pittsburgh, PA, US, hembree@mail.med.upenn.edu

Source:

Journal of Traumatic Stress, Vol 16(2), Apr 2003. pp. 187-199.

Publisher:

US: John Wiley & Sons

Abstract:

This paper provides an overview of several treatment interventions for trauma-related disturbances in adult victims of crime. Following a brief discussion of mental health service utilization among crime victims, we describe interventions for acute and chronic reactions to trauma. We present some controlled studies of psychosocial treatments for posttraumatic stress disorder (PTSD) that have gained empirical support and are recommended as first line interventions by expert consensus (E. B. Foa, J. R. T. Davidson, and A. Francis, 1999) including exposure therapy, cognitive therapy, and stress inoculation training, followed by a brief summary of selected studies examining the efficacy of pharmacological treatment for PTSD. Finally, we discuss multicultural issues, factors associated with treatment outcome, and challenges we have encountered in treating crime victims. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Brief Treatments for the Traumatized: A Project of the Green Cross Foundation.

Author(s):

Langsley, Donald G.

Source:

American Journal of Psychotherapy, Vol 57(2), 2003. pp. 284-285.

Publisher:

US: Assn for the Advancement of Psychotherapy

Reviewed Item:

Charles R. Figley (Ed.) (2002). Brief Treatments for the Traumatized: A Project of the Green Cross Foundation; Greenwood Press, Westport, CT, 2002, 337 pp.,

Abstract:

Psychologists have made many contributions to the literature about PTSD. In this book, edited by Charles R. Figley (see record 2003-04267-000), psychologists write all but one of the chapters. In a Medline search for articles about PTSD published during the past two years more than a thousand papers are listed, most of them about the psychotherapy of this condition under the categories of cognitive therapy, exposure therapy, play therapy, psycho education and anxiety management. However there are also many advances in the use of the newer antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), nefazadone and venlafaxine. Yet there is no discussion of the use of medication in this book. Nevertheless, it will be a very useful resource for the professional treating the victims of trauma. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Trauma-focused psychotherapy after a trial of medication for chronic PTSD: Pilot observations.

Author(s):

Marshall, Randall D., Columbia University College of Physicians and Surgeons, New York, NY, US
Cárcamo, Jaime H., New York State Psychiatric Institute, New York, NY, US
Blanco, Carlos, Columbia University College of Physicians and Surgeons, New York, NY, US
Liebowitz, Michael, Columbia University College of Physicians and Surgeons, New York, NY, US

Address:

Marshall, Randall D., Anxiety Disorders Clinic, New York State Psychiatric Institute, Unit 69, 1051 Riverside Drive, New York, NY, US

Source:

American Journal of Psychotherapy, Vol 57(3), 2003. pp. 374-383.

Publisher:

US: Assn for the Advancement of Psychotherapy

Abstract:

Background: To date, all clinical trials using a single therapeutic modality (psychotherapy or pharmacotherapy) have found that even the best validated treatments for adults with chronic Posttraumatic Stress Disorder (PTSD) leave a substantial proportion of patients with disabling residual symptoms. Method: We reviewed the treatment course of three research patients with PTSD who received trauma-focused psychotherapy after experiencing a partial response to medication. Structured diagnostic interviews, validated symptom measures, and standardized treatment approaches were used to assess treatment response. Results: All patients partially benefited from medication treatment, and the degree of benefit varied substantially. Also, all patients experienced an additional reduction in PTSD symptoms after a time-limited course of prolonged exposure therapy (PE). This finding differs from anecdotal observations among U.S. War veterans and has never been documented systematically among civilian adults with chronic PTSD. Conclusion: Maximizing treatment outcome in adults with chronic PTSD may require additional psychotherapy after a partial medication response, and further study is warranted.


 

Title:

Emotional arousal during therapy for posttraumatic stress disorder with childhood sexual abuse survivors.

Author(s):

Gleiser, Kari A., Boston U., US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 64(3-B), 2003. pp. 1491.

Publisher:

US: Univ Microfilms International

Abstract:

This process-outcome psychotherapy study examined the influence of emotional arousal and habituation on symptom reduction in two brief therapies for adult female survivors of childhood sexual abuse (CSA) with Posttraumatic Stress Disorder (PTSD). Although affect regulation and emotional processing have been long regarded as essential markers of therapeutic progress in healing from trauma, there is a paucity of rigorous empirical investigation of affective process variables contributing to good therapeutic outcome. This study explored the relationship of observer-rated emotional arousal and habituation to PTSD symptom reduction in 46 adult female survivors of CSA: 21 in a 14-session cognitive-behavioral exposure therapy (CBT), and 25 in a 14-session supportive present-centered therapy (PCT). Researchers rated from videotapes clients' peak and modal negative affective arousal, and the presence/absence of eight categorical emotions (e.g. fear, sadness, anger, shame) across an early and late session. Six hypotheses investigated whether extremes of overly restricted or unmodulated emotional arousal and reduced rates of between-session habituation were significantly related to poorer treatment outcome, and whether this relationship changed depending on the type of treatment. Participants who experienced more habituation of negative affect arousal (expressions of distress manifest in facial expressions, voice intonation, and body language) exhibited more PTSD symptom (e.g. nightmares, intrusive memories, avoidance of triggers) improvement. Higher peak arousal and lower modal arousal at the beginning of therapy were related to more symptom reduction. Although overall negative affect arousal was higher among CBT clients than PCT clients, this interaction did not relate to improvement on PTSD symptomatology. The data did not show support for any correlations between observer-rated negative affect arousal and clients' subjective report of distress, or for any relationship between expression of categorical emotions and symptom improvement. Finally, no association was found for the therapy group by habituation interaction in predicting PTSD symptom reduction. These findings provide support for the centrality of emotional engagement and habituation in treating PTSD, and highlight the need to develop more empirically supported ways of assessing constructs related to emotional processing and regulation. For clinicians, monitoring and helping regulate clients' emotional arousal in PTSD therapies is crucial for achieving good outcome.


 

Title:

Survivors' beliefs, level of control, intensity of symptoms, and decision to use hypnotherapy: A correlational study of northern New York consumers.

Author(s):

Davis, Toby Kevin, Walden U., US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 64(4-B), 2003. pp. 1897.

Publisher:

US: Univ Microfilms International

Abstract:

This study examined the relationship between symptoms, control, and beliefs, and the decision to engage in hypnosis. While hypnosis has been considered an important adjunct to exposure therapy to reduce extant symptomatology associated with persons diagnosed with posttraumatic stress disorder (PTSD), interventions using hypnosis appear less frequently than anticipated, though psychotherapists at many clinics and agencies are trained in hypnotherapy. Anecdotal evidence, as well as research literature, suggests persons with a trauma history may be reluctant to engage in hypnotherapy due to issues surrounding symptom intensity, control, and/or a belief system that inhibits the use of hypnosis. Thirty Northern New York residents provided background information and participated in psychological testing. The Traumatic Stress Institute-Belief Scale, Defense Mechanism Inventory, and Personality Assessment Inventory were employed to measure variables associated with beliefs, control, and symptom intensity, and these data were compared to a forced choice response regarding the decision to choose or not choose hypnosis. Eighty percent of the participants indicated they would choose hypnosis to reduce symptomatology. With the exception of trauma-related obsessive-compulsive behaviors, no relationship existed among hypnosis, beliefs, control, and symptom intensity. This research suggests that other variables exist for the curtailed application of hypnotherapy to reduce PTSD symptomatology.


 

Translated Title:

From Eye Movement Desensitization and Reprocessing to Exposure Therapy: A Review of the Evidence for Shared Mechanisms.

Author(s):

Spates, C. Richard, Western Michigan University, Kalamazoo, MI, US
Koch, Ellen I., University of Michigan Health System, MI, US

Source:

Japanese Journal of Behavior Analysis, Vol 18(2), 2003. pp. 62-76.

Publisher:

Japan: Japanese Association for Behavior Analysis

Abstract:

Posttraumatic stress disorder (PTSD) is a condition that affects people in all cultures and throughout the lifespan. Since the introduction of posttraumatic stress disorder into diagnostic practice, a great deal of research has addressed its epidemiology, pathophysiology, and psychological and physiological mechanisms, as well as its treatment. A behavioral formulation of the disorder has prevailed among leading researchers in the field, and has proved heuristic in leading to efficacious treatments, e.g., exposure therapy. Eye movement desensitization and reprocessing (EMD/R), a recently developed intervention that claims to be a departure from this formulation, has received empirical support for its efficacy. The present article reviews the evidence supporting a behavioral formulation of eye movement desensitization and reprocessing, and suggests that it shares common mechanisms of action with exposure therapy. Greater research attention should be given to examining ways of rendering exposure-based therapies for posttraumatic stress disorder more tolerant and acceptable to clients and practitioners.


 

Title:

Prolonged exposure counterconditioning as a treatment for chronic posttraumatic stress disorder.

Author(s):

Paunovic, Nenad, Department of Psychology, Stockholm University, Stockholm, Sweden, sonepaunovic@hotmail.com

Address:

Paunovic, Nenad, Traumacenter (House 27), Danderyds Hospital, 182 88, Danderyd, Sweden, sonepaunovic@hotmail.com

Source:

Journal of Anxiety Disorders, Vol 17(5), 2003. pp. 479-499.

Publisher:

Netherlands: Elsevier Science

Abstract:

A counterconditioning model is presented from which the behavioral treatment prolonged exposure counterconditioning (PEC) was developed. The first part of a PEC session is intended to increase trauma exposure tolerance and counter numbing symptoms, the second to elicit trauma responses fully, and the third to weaken trauma responses. The first client with chronic posttraumatic stress disorder (PTSD) who was treated with PEC is presented. A statistical technique for analyzing single-case subject designs was used to evaluate the treatment. PEC effectively decreased the client's PTSD and associated psychopathology. Crucial differences between PEC and other behavioral treatments are discussed. An associative functional model is presented as a potentially useful conceptualization of PTSD, depression, and other anxiety disorders.

Tests & Measures:

Beck Anxiety Inventory
Beck Depression Inventory
Clinician-Administered PTSD Scale


 

Title:

Augmenting exposure therapy with other CBT procedures.

Author(s):

Foa, Edna B., U Pennsylvania, Dept of Psychiatry, Philadelphia, PA, US
Rothbaum, Barbara O., Emory U School of Medicine, Atlanta, GA, US
Furr, Jami M., U Pennsylvania, Philadelphia, PA, US

Address:

Foa, Edna B., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment of Anxiety, 3535 Market St, 6th floor, Philadelphia, PA, US

Source:

Psychiatric Annals, Vol 33(1), Jan 2003. pp. 47-53.

Publisher:

US: SLACK

Abstract:

Most studies on treatment outcome for posttraumatic stress disorder (PTSD) have used cognitive behavioral therapy (CBR) programs, which include variants of exposure therapy, anxiety management, and cognitive therapy. Combinations of these interventions have also been investigated. More recently, eye movement desensitization and reprocessing (EMDR) has been employed for the treatment of PTSD, and a number of studies have explored its efficacy. In the treatment guidelines developed under the auspices of the International Society for Traumatic Stress Studies, exposure therapy has emerged as the most empirically supported intervention for PTSD. In this article the authors focus on reviewing well-controlled studies that compared the efficacy of exposure therapy to that of other interventions. In comparing outcome across studies, the focus is on percent change from baseline on the main PTSD measure calculated on completers whenever possible. Result suggest that exposure therapy is highly effective; treatment effects appear to be diminished by diluting exposure therapy when attempting to augment it with other treatments.


 

Title:

Exposure-based, trauma-focused therapy for comorbid posttraumatic stress disorder-substance use disorder.

Author(s):

Coffey, Scott F., State U of New York, Dept of Psychiatry, Buffalo, NY, US
Dansky, Bonnie S., CB Technologies, Inc., Exton, PA, US
Brady, Kathleen T., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, Charleston, SC, US

Source:

Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. Ouimette, Paige (Ed); Brown, Pamela J. (Ed); pp. 127-146.
Washington, DC, US: American Psychological Association, 2003. xiii, 315 pp.

Abstract:

(from the create) This chapter reviews exposure-based, trauma-focused therapy for comorbid posttraumatic stress disorder-substance use disorder (PTSD-SUD). The authors present a brief review and description of exposure-based treatments of PTSD, addressing two of the more common techniques: (a) exposure through imagery and (b) in vivo exposure. The authors also present two example of exposure-based treatments for PTSD and SUDs, substance dependence PTSD therapy and concurrent treatment of PTSD and cocaine dependence. Clinical guidelines for using exposure-based therapies are discussed.

 

Exposure Therapy and PTSD II

 

Title:

Posttraumatic stress disorder in female victims of assault: Theory and treatment.

Author(s):

Foa, Edna B., Allegheny U of the Health Sciences, US
Zoellner, Lori A.

Source:

Behavior and cognitive therapy today: Essays in honor of Hans J. Eysenck. Sanavio, E. (Ed); pp. 87-101.
Oxford, England: Elsevier Science Ltd, 1998. xv, 339 pp.

Abstract:

(from the chapter) Discusses theory and treatment of posttraumatic stress disorder (PTSD) in female victims of assault. Diagnostic features of PTSD, prevalence of PTSD, factors involved in the natural recovery from a trauma, cognitive structures underlying PTSD, cognitive-behavioral treatment, and processes underlying cognitive-behavioral therapy are described.
The authors discuss three psychological factors that seem to underlie the processing of a traumatic event: emotional engagement with traumatic memories, organization and articulation of the trauma narrative, and changes in basic schemas about the world and about oneself. All three actors were found to influence both natural recovery from a recent trauma and the amelioration of posttrauma psychopathology via exposure therapy. Clearly many other psychological factors are implicated in natural recovery from a trauma and in treatment of PTSD. Their identification is awaiting further research.

Conference:

Congress of the European Association for Behavioral and Cognitive Therapies, 27th, Sep, 1997, Venice, Italy


 

Title:

Cognitive-behavioral treatment of war-zone-related posttraumatic stress disorder: A flexible, hierarchical approach.

Author(s):

Flack, William F. Jr., Indiana U of Pennsylvania, Dept of Psychology, Indiana, PA, US
Litz, Brett T.
Keane, Terence M.

Source:

Cognitive-behavioral therapies for trauma. Follette, Victoria M. (Ed); Ruzek, Josef I. (Ed); Abueg, Francis R. (Ed); pp. 77-99.
New York, NY, US: Guilford Press, 1998. xii, 431 pp.

Abstract:

(from the chapter) In this chapter, the authors explicate a cognitive-behavioral approach to the treatment of posttraumatic reactions to the experience of warfare. They begin by describing briefly the prototypical combat veteran who has posttraumatic stress disorder (PTSD), focusing on his military and postmilitary experiences, and tying these experiences to the sorts of posttraumatic reactions most frequently seen in the clinics and hospitals of the Department of Veterans Affairs. The authors summarize a cognitive-behavioral perspective on the origins and sequelae of posttraumatic reactions. Following a section on assessment, the authors discuss their flexible, hierarchical approach to the treatment of combat-related PTSD. Their model of treatment offers a range of clinical options that address the level of patients' functioning, their personal resources, and both their immediate and long-term needs. Exposure-based treatment is at the center of this cognitive-behavioral model. Thus, the authors discuss in some detail the boundary conditions of, and clinical guidelines for, this procedure. The chapter ends with a case example, illustrating the principles and practices described.


 

Title:

Intrusion, arousal, and avoidance: Sexual trauma survivors.

Author(s):

Meadows, Elizabeth A., Central Michigan U, Dept of Psychology, Mt Pleasant, MI, US
Foa, Edna B.

Source:

Cognitive-behavioral therapies for trauma. Follette, Victoria M. (Ed); Ruzek, Josef I. (Ed); Abueg, Francis R. (Ed); pp. 100-123.
New York, NY, US: Guilford Press, 1998. xii, 431 pp.

Abstract:

(from the chapter) In this chapter, the authors review cognitive-behavioral treatments that have been used for rape-related posttraumatic stress disorder (PTSD). These include exposure therapy, cognitive therapy, stress innoculation training, and cognitive processing therapy. In discussing each of these treatments, they review their theoretical underpinnings as well as the literature regarding their efficacy. They then describe in some detail implementation of one such treatment: prolonged exposure. Decision making regarding type of treatment is also discussed, with clinical examples to illustrate implementation of adjunctive treatments or modifications to exposure.


 

Title:

Sexual revictimization: Risk factors and prevention.

Author(s):

Cloitre, Marylene, New York Hosp-Cornell Medical Ctr, Payne Whitney Clinic, New York, NY, US

Source:

Cognitive-behavioral therapies for trauma. Follette, Victoria M. (Ed); Ruzek, Josef I. (Ed); Abueg, Francis R. (Ed); pp. 278-304.
New York, NY, US: Guilford Press, 1998. xii, 431 pp.

Abstract:

(from the chapter) Research data indicate that retraumatized women make up the largest subgroup of sexually assaulted women. Given this, sexual assault research should have as a priority the identification of the psychological characteristics of women with a history of childhood sexual abuse that put them "at risk" for adult sexual assault. It is also important to begin developing prevention programs for at-risk women and adolescent girls that target and reduce these risk factors. This chapter reviews the available data on the potential assault risk factors among women with a history of childhood abuse. It also presents a developing model of retraumatization and a cognitive-behavioral intervention designed to reduce risk for repeated sexual assaults. Topics discussed include theoretical orientation: a social-developmental perspective; affect regulation; interpersonal relatedness; posttraumatic stress disorder (PTSD) as a risk factor for retraumatization; a proposed treatment model: skills training in affect and interpersonal relatedness regulation/prolonged exposure; assessment; guidelines for selection; and clinical application.


 

Title:

Cognitive-behavioral treatment of posttraumatic stress disorder.

Author(s):

Astin, Millie C., Emory Clinic, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US
Resick, Patricia A.

Source:

International handbook of cognitive and behavioural treatments for psychological disorders. Caballo, Vicente E. (Ed); pp. 161-196.
Oxford, England: Pergamon/Elsevier Science Ltd, 1998. xiv, 698 pp.

Abstract:

(from the chapter) Discusses the cognitive-behavioral treatment of posttraumatic stress disorder (PTSD). Most behavioral and cognitive-behavioral treatments of PTSD are grounded in behavioral learning theory, including anxiety management techniques and stress inoculation training. While learning theory accounts for much of the development and maintenance of PTSD, it does not really explain intrusion symptoms and fear. According to emotional processing theory, repetitive exposure to the traumatic memory in a safe environment will result in habituation of the fear and subsequent change in the fear structure. Behavioral techniques based on both learning theory and emotional processing theory include exposure techniques. Other PTSD treatments, such as cognitive processing therapy, are based on information processing theory. This therapy was developed to facilitate the expression of affect and the appropriate accommodation of the traumatic event with more general cognitive schemas regarding one's self and the world. A more recent technique applied to PTSD is eye movement desensitization and reprocessing therapy, a cognitive-behavioral treatment aimed at facilitating information processing of traumatic events and cognitive restructuring of negative trauma-related cognitions.


 

Title:

Psychosocial treatments for posttraumatic stress disorder.

Series Title:

Review of psychiatry series

Author(s):

Foa, Edna B., Allegheny U of the Health Sciences, Dept of Psychiatry, Ctr for Treatment & Study of Anxiety, Philadelphia, PA, US
Meadows, Elizabeth A.

Source:

Psychological trauma. Yehuda, Rachel (Ed); pp. 179-204.
Washington, DC, US: American Psychiatric Association, 1998. xv, 218 pp.

Abstract:

(from the chapter) In this chapter we first discuss factors implicated in the development of posttraumatic stress disorder (PTSD). We then review the treatments that have been designed to ameliorate PTSD symptoms and discuss both their theoretical underpinnings and the literature evaluating their efficacy. Finally, we describe in more detail prolonged exposure therapy, a treatment that has been studied extensively.


 

Title:

A comparison study of EMDR and exposure on Posttraumatic Stress Disorder: A single subject design.

Author(s):

Simon, Melinda J., Central Michigan U, US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 58(5-B), Nov 1997. pp. 2700.

Publisher:

US: Univ Microfilms International

Abstract:

Exposure has been shown to be efficacious in the treatment of Posttraumatic Stress Disorder. Recent claims have been made regarding the comparative and perhaps even superior efficacy of EMDR in the treatment of PTSD. The comparative effectiveness was tested using two subjects, a multiple baseline design, targeting two distinct trauma-related images per subject. Standardized and objective assessment measures of diagnostic criteria were administered at baseline, post-treatment, and at follow-up. Order of treatment was reversed for the second subject. Results of the study showed that EMDR and Exposure were comparable treatments of PTSD. EMDR demonstrated more rapid overall symptom reduction than Exposure. Both Exposure and EMDR generalized across traumas.


 

Title:

Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression.

Author(s):

Echeburúa, Enrique, U del País Vasco, Facultad de Psicología, San Sebastián, Spain
de Corral, Paz
Zubizarreta, Irene
Sarasua, Belén

Source:

Behavior Modification, Vol 21(4), Oct 1997. pp. 433-456.

Publisher:

US: Sage Publications

Abstract:

Compared the effectiveness of 2 therapeutic modalities in the treatment of chronic posttraumatic stress disorder (PTSD) in victims of sexual aggression: (1) self-exposure and cognitive restructuring and (2) progressive relaxation training. The sample consisted of 20 patients (victims of rape in adulthood or adult victims of childhood sexual abuse) selected according to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria. A multigroup experimental design with repeated measures (pretreatment, posttreatment, and 1-, 3-, 6-, and 12-mo follow-up) was used. Most treated patients improved, but the success rate was higher in all measures in the exposure and cognitive restructuring group immediately on posttreatment and at follow-up.


 

Title:

Work-related post-traumatic stress disorder: Use of exposure therapy in work-simulation activities.

Author(s):

Phillips, Mary Ellen, Rehabilitation Inst, Ctr for Pain Studies, Chicago, IL, US
Bruehl, Stephen
Harden, R. Norman

Source:

American Journal of Occupational Therapy, Vol 51(8), Sep 1997. pp. 696-700.

Publisher:

US: American Occupational Therapy Assn

Abstract:

Documents the interdisciplinary use of exposure techniques during work simulation activities to facilitate return to work in a 34-yr-old man with work-related chronic back pain and posttraumatic stress disorder (PTSD). Physical therapy focused on improving sacroiliac alignment and increasing abdominal strength as lower-extremity strength and flexibility. Psychological treatment initially focused on cognitive therapy for depression and improving pain coping skills. When symptoms of PTSD were diagnosed, co-treatment between occupational therapy and psychology during work-simulation activities was proposed to help the client to achieve his return-to-work goals. Treatment consisted of 5 sessions, with work simulation activities graded to include increasing demands on the proprioceptive, visual, and auditory systems. Co-treatment using exposure therapy resulted in a positive treatment outcome, and the client was able to return to work.


 

Title:

Client compliance with exposure treatments for posttraumatic stress disorder.

Author(s):

Scott, Michael J., U Manchester, Dept of Psychology, Manchester, England
Stradling, Stephen G.

Source:

Journal of Traumatic Stress, Vol 10(3), Jul 1997. pp. 523-526.
 

Publisher:

US: John Wiley & Sons

Abstract:

Examined the acceptability of 2 exposure-based treatments in routine clinical practice with clients with posttraumatic stress disorder (PTSD). In Study 1, only 1 of 14 clients completed the image habituation procedure for homework in the manner described by its authors. In Study 2, only 21 of the 37 clients complied with an audiotape exposure treatment, and compliance was related to initial symptom severity and to severity of comorbid depression. Exposure-based treatments are not a treatment of choice for some clients.


 

Title:

Systematic desensitization as an alternative exposure strategy for PTSD.

Author(s):

Frueh, B. Christopher
de Arellano, Michael A.
Turner, Samuel M.

Source:

American Journal of Psychiatry, Vol 154(2), Feb 1997. pp. 287-288.

Publisher:

US: American Psychiatric Assn

Abstract:

Argues that systematic desensitization may offer a reasonable alternative strategy for engineering therapeutic exposure to traumatic stimulus cues in individuals with posttraumatic stress disorder (PTSD). The case study of a 34-yr-old recently divorced Black man with a 10-yr history of PTSD, major depression, panic attacks, guilt, and dissociative symptoms that resulted from a military training accident in which he was severely injured and a soldier under his command was killed, is presented for illustrative purposes. The S's psychiatric symptoms led to marital problems, divorce, estrangement from his 2 children, and a 12-mo layoff from his job. After 4 sessions of progressive muscle relaxation training and 1 session that was devoted to developing a fear hierarchy of trauma cues, 15 weekly 50-min sessions of systematic desensitization were conducted. After 4 mo, the S reported substantial decreases in intrusive symptoms, physiological reactivity, panic attacks, and depressed mood. It is believed that systematic desensitization may be an effective alternative to intensive exposure therapy for some cases of chronic PTSD.


 

Title:

The decision-making process of choosing a treatment for patients with civilian trauma-related PTSD.

Author(s):

Falsetti, Sherry A., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Ctr, Charleston, SC, US

Source:

Cognitive and Behavioral Practice, Vol 4(1), 1997. pp. 99-121.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Reviews the assessment and treatment of patients with civilian trauma-related posttraumatic stress disorder (PTSD) and presents a decision-making process for choosing treatment components that best meet each patient's needs based on the problem-solving model of C. M. Nezu and A. M. Nezu (1995). Areas of importance for assessment include thorough trauma history, PTSD symptomatology, level of behavioral avoidance, comorbid disorders, coping skills, and distorted cognitions. Instruments available for assessment of these areas are reviewed including the Trauma Assessment for Adults--Self Report and the PTSD Symptom Scale. Three cognitive behavioral treatments for PTSD are presented: stress inoculation training, prolonged exposure, and cognitive processing therapy. Multiple channel exposure therapy, a treatment that combines PTSD and panic control treatment, is also briefly presented. As there are currently very few empirical studies that have investigated matching clients' problems to treatments, particularly with regard to treatment of PTSD, the decision-making process of choosing treatment components is discussed. A brief case example of a 35-yr-old female with a history of sexual abuse is included.


 

Title:

Heart rate during group flooding therapy for PTSD.

Author(s):

Woodward, Steven H., VA Palo Alto Health Care System, National Ctr for PTSD, Sleep Laboratory, Palo Alto, CA, US
Drescher, Kent D.
Murphy, Ronald T.
Ruzek, Joseph I.
et al.

Source:

Integrative Physiological & Behavioral Science, Vol 32(1), Jan-Mar 1997. pp. 19-30, 75-83.

Publisher:

US: Transaction Publishers

Abstract:

Examined, via heart rate (HR), the arousal levels of participants in group trauma re-exposure therapy (GTRT) for posttraumatic stress disorder (PTSD) to gain insight into this type of therapy, with an emphasis on extinction. Six Vietnam combat-related PTSD inpatients participated biweekly in GTRT during which their electrocardiograms were recorded. Findings show HRs of Ss not directly engaged in imaginal re-exposure to their personal combat traumas (PCT) consistently exhibited mild linear declines from the beginnings to the ends of the 2.5 hour sessions. Ss actively engaged in PCT re-exposure exhibited higher whole-session HRs. Most also exhibited more specific elevation extending over the later portions of sessions during which intensive re-exposure usually occurred. No Ss exhibited focal increases in HR concurrent with periods of most intensive traumatic incident review. GTRT may not provide an opportunity for "vicarious" flooding in nonengaged Ss.


 

Title:

Trauma and women: Course, predictors, and treatment.

Author(s):

Foa, Edna B., Allegheny U of Health Sciences, Dept of Psychiatry, Ctr for Treatment & Study of Anxiety, Philadelphia, PA, US

Source:

Journal of Clinical Psychiatry, Vol 58(Suppl 9), 1997. pp. 25-28.

Publisher:

US: Physicians Postgraduate Press

Abstract:

According to retrospective studies, posttraumatic stress disorder (PTSD) resulting from aggravated assault, rape, or noncrime trauma affects over 4 million women in the US. Prospective studies reviewed here found that 3 mo postassault the prevalence of PTSD was 48% in rape victims and 25% in nonsexual crime victims. Prolonged exposure treatment and stress inoculation training are both effective psychotherapeutic treatments for PTSD. Prolonged exposure involves having the patient relive the traumatic memory and recount the event in detail. This description is audiotaped and the patient is asked to listen to it as part of assigned homework. In vivo exposure to feared objects or situations is also assigned as homework. Stress inoculation training consists of teaching patients a variety of techniques for managing anxiety, including controlled breathing, deep muscle relaxation, thought-stopping, cognitive restructuring, preparation for stressors, covert modeling, and role-play. Both treatments have been proven to be effective alone and in combination in ameliorating chronic PTSD in women after traumatic sexual or nonsexual assault. This efficacy was maintained for 3 mo of followup.


 

Title:

Exposure therapy for post-traumatic stress disorder: Its relative efficacy, limitations, and optimal application.

Author(s):

Paunovic, Nenad, Stockholm U, Dept of Psychology, Stockholm, Sweden

Source:

Scandinavian Journal of Behaviour Therapy, Vol 26(2), 1997. pp. 54-69.

Publisher:

United Kingdom: Taylor & Francis

Abstract:

Post-traumatic stress disorder (PTSD) is a very debilitating psychological disturbance that follows the experience of traumatic events. Exposure therapy has shown good treatment efficacy in earlier treatment outcome studies on PTSD. Only a few other behavioral treatments have shown equal effectiveness, and exposure is usually a necessary treatment component in the others. This paper presents a short review of controlled treatment outcome studies on PTSD. The relative efficacy of exposure therapy compared to other treatments is discussed and factors that can hinder and enhance its effectiveness are reviewed. In the discussion section some methodological pitfalls in the treatment outcome studies are discussed.


 

Title:

A cognitive-behavioral approach.

Series Title:

New directions in therapeutic interventions; Vol. 2

Author(s):

Mueser, Kim T., Dartmouth Medical School, Dept of Psychiatry, Hanover, NH, US
Taylor, Kathryn L.

Source:

Sexual abuse in the lives of women diagnosed with serious mental illness. Harris, Maxine (Ed); Landis, Christine L. (Ed); pp. 67-90.
Amsterdam, Netherlands: Harwood Academic Publishers, 1997. xix, 391 pp.

Abstract:

(from the chapter) In this chapter we present a cognitive-behavioral approach to treating the aftermath of sexual abuse in women. As a background to the method we provide an overview of one common syndrome resulting from sexual trauma, posttraumatic stress disorder (PTSD). Next, we describe the principles of cognitive-behavioral treatment. This is followed by a detailed case presentation of a 32-yr-old woman in exposure-based cognitive-behavioral treatment for PTSD resulting from a history of sexual and physical abuse. We conclude with a discussion of the need for multi-faceted treatment approaches to address the diverse needs of sexual abused mentally ill women.


 

Title:

Cognitive processing therapy for chronic PTSD from childhood sexual abuse: A case study.

Author(s):

Hall, Cindy Ann, South Central Community Mental Health Ctrs, Inc., Bloomington, IN, US
Henderson, Constance M.

Source:

Counselling Psychology Quarterly, Vol 9(4), Dec 1996. pp. 359-371.

Publisher:

United Kingdom: Taylor & Francis

Abstract:

Describes the treatment of a woman with chronic posttraumatic stress disorder (PTSD) using cognitive processing therapy, a manualized cognitive therapy program that combines exposure therapy and cognitive restructuring/skill development. The client had a long history of childhood sexual abuse, as well as repeated sexual victimization as an adult, and addiction issues. She presented with significant avoidance symptoms, including a highly restricted range of affect and distinct feelings of detachment from others. These symptoms were greatly reduced by the end of the 17-wk therapy, including both individual and group modalities. The authors elaborate on theoretical issues, the Cognitive Processing Therapy model (P. A. Resick and M. Schnicke, 1993) as it was adapted for use with survivors of childhood sexual abuse, the various phases of the therapeutic process, and specific examples of therapeutic change with this particularly complicated case.


 

Title:

Trauma Management Therapy: A preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD.

Author(s):

Frueh, B. Christopher, Ralph H. Johnson Veterans Affairs Medical Ctr, Charleston, SC, US
Turner, Samuel M.
Beidel, Deborah C.
Mirabella, Robert F.
et al.

Source:

Behaviour Research and Therapy, Vol 34(7), Jul 1996. pp. 533-543.

Publisher:

Netherlands: Elsevier Science

Abstract:

Describes the development and initial evaluation of a comprehensive and multicomponent behavioral treatment (Trauma Management Therapy, or TMT) for chronic combat-related posttraumatic stress disorder (PTSD). The program uses elements of intensive exposure therapy, programed practice, and structured social and emotional skills training to target the multiple aspects of chronic combat-related PTSD. The treatment was found to be effective in alleviating a broad spectrum of difficulties in 15 male Vietnam combat veterans with chronic PTSD, most of whom had co-occurring Axis I and/or Axis II disorders. The results are discussed with respect to the implementation of TMT and the general need for a comprehensive approach to treating combat-related PTSD.


 

Title:

Cognitive-behavioral therapy for posttraumatic stress disorder.

Author(s):

Rothbaum, Barbara Olasov, Emory U, School of Medicine, Atlanta, GA, US
Foa, Edna B.

Source:

Traumatic stress: The effects of overwhelming experience on mind, body, and society. van der Kolk, Bessel A. (Ed); McFarlane, Alexander C. (Ed); Weisaeth, Lars (Ed); pp. 491-509.
New York, NY, US: Guilford Press, 1996. xxv, 596 pp.

Abstract:

(from the preface) of the various proposed therapies, the effects of cognitive-behavioral treatments have been most thoroughly examined / there is a growing body of systematic research demonstrating the ability of such treatments to assist in alleviating the broad range of posttraumatic stress disorder (PTSD) symptoms / because uncontrolled exposure may have negative consequences, and since traumatized people with very high levels of avoidance are often most reluctant to expose themselves to their traumatic memories, there remain important questions about the necessary technical skills and timing for these forms of treatment
(from the chapter) theoretical considerations / definition of treatment modalities / exposure therapy / anxiety management training / exposure therapy and AMT [anxiety management training]


 

Title:

Self-administered exposure therapy by a Vietnam veteran with PTSD.

Author(s):

Frueh, B. Christopher

Source:

American Journal of Psychiatry, Vol 152(12), Dec 1995. pp. 1831-1832.

Publisher:

US: American Psychiatric Assn

Abstract:

Presents the case of a 48-yr-old Vietnam veteran with posttraumatic stress disorder (PTSD) who self administered exposure therapy. Psychiatric diagnoses were based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) (SCID) and SCID-II, the Hamilton anxiety scale, the MMPI-II and a PTSD checklist. The S engineered daily exposure sessions by watching Vietnam war movies, reading, and talking about the war, sitting near a helicopter pad, and "meditating" on his traumatic combat experiences. Symptom reduction was substantiated by reduced scores on the PTSD checklist and the Hamilton anxiety scale.


 

Title:

Psychological reactions of victims of violent crime.

Author(s):

Bisson, Jonathan I., U Wales, Coll of Medicine, Dept of Psychological Medicine, Cardiff, Wales
Shepherd, Jonathan P.

Source:

British Journal of Psychiatry, Vol 167(6), Dec 1995. pp. 718-720.

Publisher:

United Kingdom: Royal College of Psychiatrists

Abstract:

Discusses the prevalence, prevention, and treatment of, and factors associated with psychological sequelae (PS) in victims of violent crime, through a research review. Initial acute PS to violent crime may gradually lead to post-traumatic stress, anxiety, depressive disorders and substance-abuse/dependence. Studies on the prevalence of psychological effects show that most victims develop one or more of these psychiatric disorders. Factors associated with intense PS include sex, severity of the stressor, family psychiatric history, and lack of social support. Interventions involve preventive and treatment strategies. Prevention aims at reducing the acute PS through early interventions, such as psychological debriefing and emotional support. Treatment is essential when reactions are pathological, and specific treatments should be aimed at distinct clinical disorders. Exposure therapy and medication have proven useful in posttraumatic stress disorder (PTSD) sufferers.


 

Title:

Change in rape narratives during exposure therapy for posttraumatic stress disorder.

Author(s):

Foa, Edna B., Medical Coll of Pennsylvania, Eastern Pennsylvania Psychiatric Inst, Philadelphia, US
Molnar, Chris
Cashman, Laurie

Source:

Journal of Traumatic Stress, Vol 8(4), Oct 1995. Special issue: Research on traumatic memory. pp. 675-690.

Publisher:

US: John Wiley & Sons

Abstract:

Examined changes in narratives of rape during therapy for posttraumatic stress disorder (PTSD) involving repeated reliving and recounting of the trauma with 14 women who had experienced sexual assault, using a narrative coding system. Relationships between narrative categories hypothesized to be affected by the treatment and treatment outcome were also examined. Ss completed the State-Trait Anxiety Inventory, Rape Aftermath Symptom Test, Beck Depression Inventory, and PTSD Symptom Scale. Narrative length increased from pre- to post-treatment, percentage of actions and dialogue decreased, and percentage of thoughts and feelings increased, particularly thoughts reflecting attempts to organize the trauma memory. Increase in organized thoughts was correlated negatively with depression. While indices of fragmentation did not significantly decrease during therapy, a correlation between decrease in fragmentation and reduction in trauma-related symptoms was detected.


 

Title:

An open trial of exposure therapy based on deconditioning for post-traumatic stress disorder.

Author(s):

Thompson, J. A., Traumatic Stress Clinic, Camden, England
Charlton, P. F. C.
Kerry, R.
Lee, D.

Source:

British Journal of Clinical Psychology, Vol 34(3), Sep 1995. pp. 407-416.

Publisher:

United Kingdom: British Psychological Society

Abstract:

Conducted a debriefing session followed by 8 weekly sessions of imaginal exposure and in vivo exposure with 23 patients who had experienced a major stressful event. Ss recounted their traumatic experiences aloud, using the first person and the present tense, and included as much detail as possible. This account was audiotaped and Ss were asked to listen to the tape between treatment sessions. There were reductions of 42% on an impact of events scale, of 61% on the General Health Questionnaire (GHQ), of 38% on the SCL-90, and of 35% on a clinician administered post-traumatic stress scale, all of which were significant. The number of Ss who satisfied the diagnostic criteria for posttraumatic stress disorder (PTSD) was halved.


 

Title:

No longer a victim: A treatment outcome study for crime victims with post-traumatic stress disorder.

Author(s):

Bisbey, Lori Beth, California School of Professional Psychology - San Diego, US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 56(3-B), Sep 1995. pp. 1692.

Publisher:

US: Univ Microfilms International

Abstract:

Crime victims diagnosed with PTSD (N = 57), were blocked for relationship status (in a committed relationship: married/living with or no relationship: single, no relationship, divorced) and then randomly assigned to one of three conditions: direct therapeutic exposure (DTE), traumatic incident reduction (TIR), or a waiting list control. The DTE condition involved teaching subjects progressive muscle relaxation (PMR) and then conducting sessions which began with PMR, then contained an imaginal flooding script and ended with PMR. The TIR condition involved a series of questions that asked subjects to repetitively review the trauma from beginning to end silently and then tell the therapist what happened until a point of closure was reached. Additional questions asked the subject to examine the cognitive content in the incident and to make connections to earlier associated incidents (if there were any). Treatment was done bi-weekly by one of four therapists, in approximately 2 hour sessions for a period of about 5 weeks (maximum of 20 hours). Measures of PTSD-related symptoms, relationship satisfaction, job satisfaction, and general psychological symptoms were administered pre-test and post-test (two weeks following termination of treatment). Both treatment groups significantly improved on all PTSD-related measures while the control group did not. The TIR group improved significantly more than the DTE group on all PTSD-related measures. None of the groups improved on the relationship satisfaction and job satisfaction measures. Both treatment groups significantly improved on the depression, obsessive-compulsive and psychoticism subscales while the control group did not. The TIR group improved significantly more on the obsessive-compulsive subscale than the DTE group. The TIR group significantly improved on the paranoid ideation subscale while the DTE and control groups did not. The outcome of this study supports the notion that treatment involving repeated exposure to therapy.


 

Title:

Exposure therapy and antidepressant medication for treatment of chronic PTSD.

Author(s):

Mirabella, Robert F.
Frueh, B. Christopher
Fossey, Mark D.

Source:

American Journal of Psychiatry, Vol 152(6), Jun 1995. pp. 955-956.

Publisher:

US: American Psychiatric Assn

Abstract:

Presents a case of a 46-yr-old man who was treated with exposure therapy for a history of posttraumatic stress disorder (PTSD) and depression. The S was also treated with antidepression medication and social skills training to reduce his fear response to traumatic stimulus cues. The authors argue that antidepressant medication allowed the S respite from acute symptoms so that he was able to endure the involuntary symptoms associated with reliving trauma.


 

Title:

Tratamiento psicológico del trastorno de estrés postraumático crónico en víctimas de agresiones sexuales: un estudio experimental.

Translated Title:

Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression: An experimental study.

Author(s):

Corral Gargallo, Paz del, U del País Vasco, Facultad de Psicología, Bilbao, Facultad de Psicología, Bilbao, Spain
Echeburúa Odriozola, Enrique
Zubizarreta Anguera, Irene
Sarasua Sanz, Belén

Source:

Análisis y Modificación de Conducta, Vol 21(78), 1995. pp. 455-482.

Publisher:

Spain: Editorial Promolibro

Abstract:

Studied the efficacy of exposure therapy and cognitive reevaluation compared to progressive relaxation training for the treatment of posttraumatic stress disorder in sexual assault victims. Human Ss: 20 female Spanish adolescents and adults (aged 15-41 yrs) (sexual assault victims). Information on the characteristics associated with sexual assault, psychological symptoms, and treatment response was obtained by semistructured interview. Exposure therapy consisted of gradual recovery of social activities, exposure to erotic or violent stimuli, imagination of traumatic dreams or thoughts, and training in sexual abilities. Cognitive reevaluation included explanation of normal reactions to sexual assault, modification of negative thought processes associated with violation, and development of coping mechanisms. Progressive relaxation training following the method proposed by D. A. Berustein and T. D. Borkovec, 1973 was practiced twice daily. A multigroup experimental design with repeated measures (pretreatment, posttreatment and at 1, 3, and 6 mo follow up) was used to evaluate changes in depressive, anxiety, adaptation, and other psychological symptoms. Tests used: The Beck Depression Inventory, the State-Trait Anxiety Inventory, the Adaptation Scale (Echeburúa and Corral, 1987), the Modified Fears Questionnaire (L. J. Veronen and D. G. Kilpatrick, 1980), and the Severity of Posttraumatic Stress Syndrome Symptoms Scale (Echeburúa et al, 1994). Statistical tests were used. (English abstract)


 

Title:

Exposure therapy for combat-related PTSD: A critical review.

Author(s):

Frueh, B. Christopher, Ralph H. Johnson Veterans Affairs Medical Ctr, Psychology Service, Charleston, SC, US
Turner, Samuel M.
Beidel, Deborah C.

Source:

Clinical Psychology Review, Vol 15(8), 1995. pp. 799-817.

Publisher:

Netherlands: Elsevier Science

Abstract:

Reviews the treatment outcome literature on exposure therapy for combat-related posttraumatic stress disorder (PTSD). Although current literature is quite underdeveloped, available data suggest that exposure is superior to wait-list controls and "standard treatment." In particular, exposure treatment results in decreased symptoms of intrusive images, cognitions, and physiological arousal. Treatment gains are maintained for as long as 6 mo. Limitations of current studies, important procedural variables, patient characteristics, and issues of measurement are highlighted. Efficacy of exposure alone as a treatment for PTSD and the need for addition of other behavioral treatment strategies to exposure are discussed.


 

Title:

Cognitive-behavioral therapy of post-traumatic stress disorder.

Author(s):

Foa, Edna B., Medical Coll of Pennsylvania, Dept of Psychiatry, Philadelphia, PA, US
Rothbaum, Barbara Olasov
Molnar, Chris

Source:

Neurobiological and clinical consequences of stress: From normal adaptation to post-traumatic stress disorder. Friedman, Matthew J. (Ed); Charney, Dennis S. (Ed; Deutch, Ariel Y. (Ed); pp. 483-494.
Philadelphia, PA, US: Lippincott Williams & Wilkins Publishers, 1995. xxi, 551 pp.

Abstract:

(from the chapter) offers a review of studies examining cognitive-behavioral interventions [with posttraumatic stress disorder (PTSD)] / special focus [is] on those employed with female assault survivors / begin . . . with a general description of cognitive-behavioral procedures [including exposure therapy, systematic desensitization, imaginal and in vivo exposure, eye movement desensitization reprocessing, anxiety management training, stress inoculation training and biofeedback] / examine literature regarding the efficacy of these procedures with PTSD symptoms / propose mechanisms to explain the success that cognitive-behavioral procedures have had in alleviating PTSD symptoms


 

Title:

Accidental injury: Approaches to assessment and treatment.

Series Title:

Plenum series on stress and coping

Author(s):

Best, Connie L., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Ctr, Charleston, SC, US
Ribbe, David P.

Source:

Traumatic stress: From theory to practice. Freedy, John R. (Ed); Hobfoll, Stevan E. (Ed); pp. 315-337.
New York, NY, US: Plenum Press, 1995. xvii, 402 pp.

Abstract:

(from the chapter) focus on the assessment and treatment of accident-related psychological trauma / begins with 2 case examples [of a 23-yr-old male in a motor vehicle accident and a male burn victim in his late 40s] that [the authors] believe typify accidental injury victims and illustrate some of the specific concerns that these patient victims may have / provide a description of a variety of measures and interview schedules that have been found to be helpful when assessing psychological aspects of accident-related trauma / outline an approach to treatment for accident-related trauma / the majority of the treatment interventions presented do address posttraumatic stress disorder (PTSD) or PTSD-like symptoms, since these symptoms may be the most problematic for patients
embracing a tripartite model of anxiety that posits that a person may experience anxiety in the physical, cognitive, or behavioral channels, [the authors] utilize a cognitive-behavioral framework for treatment interventions / this chapter is primarily intended for use of clinicians who provide direct psychological services or for those professionals who provide consultation for multidisciplinary treatment teams that treat accidental injury patients
assessment [telling their story; Potential Stressful Events Interview; Trauma Assessment for Adults; NIMH [National Institute of Health] Diagnostic Interview Schedule, Version III; Clinician Administered PTSD Scale; Impact of Event Scale; Symptoms Checklist-90-Revised; Beck Depression Inventory]
physical treatment techniques [deep muscle relaxation, cue-controlled breathing, pleasant imagery] / cognitive treatment techniques [rational emotive therapy, cognitve restructuring, stress innoculation training, thought stopping] / behavioral treatment techniques [role playing, exposure therapy]


 

Title:

Post-traumatic stress disorder: Evaluation of a behavioral treatment program.

Author(s):

Richards, David A., U London Inst of Psychiatry, England
Lovell, Karina
Marks, Isaac M.

Source:

Journal of Traumatic Stress, Vol 7(4), Oct 1994. pp. 669-680.
 

Publisher:

US: John Wiley & Sons

Abstract:

Tested the relative values of imaginal and real-life exposure exercises by randomizing 14 patients (aged 15-50 yrs) with posttraumatic stress disorder (PTSD) at least 6 mo after the initiating trauma to 1 of 2 groups. The 7 Ss in Group 1 had 4 weekly, hour-long sessions of imaginal exposure followed by 4 weekly, hour-long sessions of live exposure. The 7 Ss in Group 2 had the reverse order of 4 live exposure sessions followed by 4 imaginal exposure sessions. Both groups (13 completers) improved significantly on both PTSD-specific measures and measures of general health posttreatment, and significantly further on 7 out of 12 measures at follow-up 12 mo posttreatment. There was a 65-80% reduction in target symptoms. On 1 measure only (Problem 2, phobic avoidance), live exposure yielded more improvement than imaginal exposure whether given first or second.


 

Title:

Iatrogenic post-traumatic stress disorder: A case study.

Author(s):

DelMonte, M. M., St Patrick's Hosp, Dublin, Ireland

Source:

Australian Journal of Clinical Hypnotherapy and Hypnosis, Vol 14(1), Mar 1993. pp. 1-5.

Publisher:

Australia: Australian Academic Press

Abstract:

Reports the case of a 32-yr-old woman with a history of personal trauma, who was inadvertently given iv adrenaline while under anesthesia. Ventricular fibrillation ensued and she almost died. Following the mishap she went through various severe symptoms of posttraumatic stress disorder (PTSD), including psychic numbing, depression, weeping, anxiety, irritability, and anger. The S developed a strong hospital phobia and a deep fear of pregnancy. Her relationship with her husband and children markedly deteriorated. Several styles of intervention (i.e., hypnotic regression, exposure therapy, cognitive-analytical therapy, and family therapy to restore the family unit to normal functioning) were used to restore the family unit to premorbid normal functioning.


 

Title:

Stress theory and therapeutic practice.

Author(s):

Thompson, James, U London University Coll & Middlesex Hosp School of Medicine, Middlesex Hosp, England

Source:

Stress Medicine, Vol 8(3), Jul 1992. pp. 147-150.

Publisher:

US: John Wiley & Sons

Abstract:

Notes that few theories of stress have led to detailed treatment techniques. These simplistic theories are based on the notion of a passive structure bearing a heavy weight. There is a need for active models that measure a person's capacity to cope with the demands of the environment. Conditioning models have explanatory power, but they cannot always account for some features of stress reactions. Nonetheless, conditioning provides a rationale for a treatment approach that has shown a good record of success. Developments in the treatment of posttraumatic stress disorder (PTSD), such as graded exposure therapies in which patients are directly exposed to the feared stimulus, show promising results. Evidence suggests that therapy based on habituation and extinction of a CR is the treatment of choice for posttrauma reactions.

Conference Notes:

3rd International Society for the Investigation of Stress Conference: What is stress? (1990, Padua, Italy).


 

Title:

Exposure therapy for PTSD.

Author(s):

Baggaley, M. R.

Source:

British Journal of Psychiatry, Vol 159, Nov 1991. pp. 732-733.

Publisher:

United Kingdom: Royal College of Psychiatrists

Abstract:

Comments on D. A. Richards and J. S. Rose (see record 1991-34038-001) article which describes a treatment program for posttraumatic stress disorder (PTSD), but uses outcome measures for depression, phobic anxiety and social adjustment. The author suggests that, before worrying whether in vivo or imaginal exposure is more effective, future research should use more appropriate outcome measures for PTSD, and carefully define what combination of disorder is present initially.


 

Title:

Exposure therapy for post-traumatic stress disorder: Four case studies.

Author(s):

Richards, David A., U London, Inst of Psychiatry, England
Rose, John S.

Source:

British Journal of Psychiatry, Vol 158, Jun 1991. pp. 836-840.

Publisher:

United Kingdom: Royal College of Psychiatrists

Abstract:

Describes the cases and treatment of 4 Ss (aged 29-47 yrs) with posttraumatic stress disorder (PTSD) using 2 behavioral approaches. Ss' symptoms responded differently to the different approaches. In vivo exposure was effective for phobic anxiety, while imaginal exposure improved dysphoria and some phobic symptoms. Audiotaped imaginal exposure may be important as part of the treatment of PTSD.


 

Title:

Treatment of post-traumatic phobias and PTSD after car accidents.

Author(s):

Kuch, Klaus, U Toronto, Assistant Professor, Toronto, ON, Canada

Source:

Innovations in clinical practice: A source book, Vol. 8. Keller, Peter A. (Ed); Heyman, Steven R. (Ed); pp. 263-270.
Sarasota, FL, England: Professional Resource Exchange, Inc, 1989. x, 468 pp.

Abstract:

(from the chapter) diagnosis / epidemiology / etiology and natural history / clinical presentation / observation and measurement of post-traumatic phobic behavior / exposure therapy / complications


 

Title:

Nightmares.

Author(s):

Marks, Isaac M., U London, Inst of Psychiatry, England

Source:

Integrative Psychiatry, Vol 5(2), Jun 1987. pp. 71-73.

Publisher:

US: International Universities Press, Inc.

Abstract:

Contends that nightmares are common in the general population but rarely present for psychiatric treatment except in posttraumatic stress disorder (PTSD). They resemble phobias in being unpleasant stimuli that Ss avoid thinking or talking about in detail. Case reports are described suggesting that exposure therapy, which helps phobias, also eases nightmares when applied as rehearsal relief. Other forms of exposure therapy used include desensitization, implosion, rehearsal relief, and fantasy flooding. Suggestions given for further research include studying whether rehearsal relief is actually necessary for success and whether rehearsing traumatic experiences not actually present in the nightmare could be equally therapeutic.


 

Title:

'Nightmares': Commentary.

Author(s):

Geer, James H., Louisiana State U, Baton Rouge, US

Source:

Integrative Psychiatry, Vol 5(2), Jun 1987. pp. 79-80.

Publisher:

US: International Universities Press, Inc.

Abstract:

Commends I. Marks (see record 1988-30431-001) for providing a comprehensive review of the literature surrounding recurrent nightmares but questions Marks's suggestions that rehearsal relief is an effective treatment and his linking of recurrent nightmares with posttraumatic stress disorder (PTSD). (0 ref)

 

 

Title:

The influence of distraction during exposure and researcher allegiance during outcome trials.

Author(s):

Devilly, Grant J., U Melbourne, Melbourne, Australia

Source:

Behavior Therapist, Vol 24(1), Jan 2001. pp. 18-21.

Publisher:

US: Assn for Advancement of Behavior Therapy

Abstract:

The utility of distraction during exposure is a hotly debated topic, and research into its utility for the treatment of posttraumatic stress disorder (PTSD) has been unyielding. This paper aims to briefly present an explanation for a trend that has become apparent in the outcome data of some studies investigating Eye Movement Desensitization and Reprocessing and generalizing from this example, a caution against the use of distraction during other exposure based treatments.


 

Title:

Do cognitive and exposure treatments improve various PTSD symptoms differently? A randomized controlled trial.

Author(s):

Lovell, Karina, U Manchester, School of Nursing, Midwifery &amp, Health Visiting, Manchester, England
Marks, Isaac M.
Noshirvani, Homa
Thrasher, Sian
Livanou, Maria

Source:

Behavioural and Cognitive Psychotherapy, Vol 29(1), Jan 2001. pp. 107-112.

Publisher:

US: Cambridge Univ Press

Abstract:

This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher, & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. 77 PTSD outpatients were randomly allocated to one of four treatments: (1) exposure alone; (2) cognitive restructuring alone; (3) combined exposure and cognitive restructuring; or (4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitive restructuring improved almost all individual symptoms similarly.


 

Title:

Indirect ego-strengthening in treating PTSD in immigrants from Central America.

Author(s):

Gafner, George, CISM, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, US
Benson, Sonja

Address:

Gafner, George, 1025 W. Los Altos Road, Tucson, AZ, US

Source:

Contemporary Hypnosis, Vol 18(3), 2001. pp. 135-144.

Publisher:

United Kingdom: Whurr Publishers Ltd.

Abstract:

Describes the use of 2 indirect, hypnotic ego-strengthening techniques in the treatment of post-traumatic stress disorder (PTSD) among refugees from civil war in El Salvador and Guatemala. Many of these refugees, who fled to the US during the 1980s, experienced torture and other abuse, with current adaptation complicated by PTSD. The scope of the problem is examined along with cultural factors in mental health treatment and the limitations of conventional exposure therapy. The types of ego-strengthening techniques are metaphorical ego-strengthening, which involves a story that may be the therapy portion of hypnosis; the other technique is described as "short-burst" ego-strengthening, which relies on a short confusional statement (non sequitur) followed by a suggestion. These techniques are seen as useful and successful techniques for treating PTSD in refugees.


 

Title:

Women and traumatic events.

Author(s):

Foa, Edna B., U Pennsylvania, Dept of Psychiatry, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US, foa@mail.med.upenn.edu
Street, Gordon P.

Source:

Journal of Clinical Psychiatry, Vol 62(Suppl17), 2001. Special issue: Understanding posttraumatic stress disorder. pp. 29-34.

Publisher:

US: Physicians Postgraduate Press

Abstract:

Posttraumatic stress disorder (PTSD) gained the status of a psychiatric disorder in 1980, although the syndrome had already been recognized widely for many years. PTSD is distinguished by alternations between reexperiencing of the traumatic event that triggered the PTSD in the first place and avoidance and numbing. Increased arousal (e.g., exaggerated startle reaction) also forms part of the diagnosis. Although the majority of trauma victims recover spontaneously, more than 30% develop persistent PTSD symptoms, with women being twice as likely as men to suffer PTSD. To date, the most studied psychosocial treatments for PTSD are the cognitive-behavioral interventions. Exposure therapy (systematic exposure to the traumatic memory in a safe environment) has been demonstrated to be quite effective with adult women who were sexually or nonsexually assaulted in adulthood as well as with women who were sexually abused in childhood. Supportive counseling does not appear as effective as exposure therapy, but is better than no therapy.

Conference:

Understanding Posttraumatic Stress Disorder, Mar, 1999, Cannes, France


 

Title:

How to end the EMDR controversy.

Author(s):

McNally, Richard J., Harvard U, Cambridge, MA, US, rjm@wjh.harvard.edu

Address:

McNally, Richard J., Harvard U, Dept of Psychology, 33 Kirkland Street, Cambridge, MA, US, rjm@wjh.harvard.edu

Source:

Psicoterapia Cognitiva e Comportamentale, Vol 7(2), 2001. pp. 153-154.

Publisher:

Italy: Tipografia PIME Editrice Srl

Abstract:

Discusses how the controversy concerning eye movement desensitization and reprocessing (EMDR; F. Shapiro, 1995) can be resolved. It is proposed that EMDR advocates must document the efficacy of EMDR with posttraumatic stress disorder (PTSD) patients and must replicate these findings at least once. It is suggested that EMDR theorists should provide a psychologically plausible explanation of the role of eye movements in enhancing the efficacy of exposure therapy.


 

Title:

Cognitive-behavioral approaches to PTSD.

Author(s):

Zoellner, Lori A., U Washington, Dept of Psychology, Seattle, WA, US
Fitzgibbons, Lee A.
Foa, Edna B.

Source:

Treating psychological trauma and PTSD. Wilson, John P. (Ed); Friedman, Matthew J. (Ed); Lindy, Jacob D. (Ed); pp. 159-182.
New York, NY, US: Guilford Press, 2001. xii, 467 pp.

Abstract:

(from the chapter) This chapter argues that several cognitive-behavioral treatments are effective in reducing posttraumatic stress disorder (PTSD) and related symptoms and that prolonged exposure may have some advantage over other programs. In an attempt to explain natural recovery and treatment efficacy, the authors focus on 3 psychological factors that are involved in the successful processing of a traumatic event: emotional engagement with the trauma memory, organization and articulation of the trauma narrative, and modification of basic core beliefs about the world and about oneself. To illustrate the process of exposure therapy and the mechanisms involved in its success, they present 2 case examples, one describing recovery and the other failure to benefit from treatment. These cases also demonstrate the complexity and intricacy inherent in delivering this seemingly straightforward treatment program.


 

Title:

Treatment of concurrent PTSD and OCD: A commentary on the case of Howard.

Author(s):

Riggs, David S., Boston VA Medical Ctr, Boston, MA, US

Source:

Cognitive and Behavioral Practice, Vol 7(1), Win 2000. pp. 130-132.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

The complexity inherent in treating patients diagnosed with multiple disorders often leaves clinicians feeling unsure of how best to encourage change, or even where to begin. The present commentary discusses the interplay between the symptoms of posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder in the case of a 51-yr-old male Vietnam veteran originally reported by M. O. Kimble (see record 2001-16628-011). Focusing on the need to assess the interplay of the 2 symptom clusters, the paper presents a model for understanding the etiological and functional relations that could link the symptoms of PTSD and obsessive-compulsive disorder (OCD). Further, the paper discusses ways in which a clinician might approach such complex cases (e.g., exposure-based treatments) to address all of the client's needs in an effective and efficient manner.


 

Title:

Implementation of empirically supported treatment for PTSD: Obstacles and innovations.

Author(s):

Zayfert, Claudia, Dartmouth Medical School, Dept of Psychiatry, Lebanon, NH, US, Claudia.Zayfert@Dartmouth.EDU
Black, Carolyn

Address:

Zayfert, Claudia, Dartmouth Medical School, Dept of Psychiatry, Lebanon, NH, US, Claudia.Zayfert@Dartmouth.EDU

Source:

Behavior Therapist, Vol 23(8), Sep 2000. pp. 161-168.

Publisher:

US: Assn for Advancement of Behavior Therapy

Abstract:

Reports preliminary data on the results of exposure therapy (ET) to the range of individuals presenting to the authors' clinic and summarizes strategies that have been developed to facilitate ET. In doing so, the authors hope to begin a discussion focused on making ET work for both clinicians and patients in real-world clinics, as well as to illustrate a model for blending empirically supported treatments to meet patient needs. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Conference:

Annual Meeting of the Association for the Advancement of Behavior Therapy, 33rd, Nov, 1999, Toronto, ON, Canada

Conference Notes:

Portions of this research were presented at the aforementioned conference.


 

Title:

A comparison between EMDR and exposure for treating PTSD: A single-subject analysis.

Author(s):

Simon, Melinda J., Central Michigan U, MI, US

Source:

Behavior Therapist, Vol 23(8), Sep 2000. pp. 172-175.

Publisher:

US: Assn for Advancement of Behavior Therapy

Abstract:

Used a single-subject analysis to compare the efficacy of eye movement eesensitization and reprocessing (EMDR) to imaginal exposure for the treatment of posttraumatic stress disorder (PTSD). More specifically, this study compared exposure and EMDR for treating symptoms associated with the traumatic memories reported by 2 female Ss (aged 30-35 yrs) diagnosed with PTSD. Standardized assessments were used to measure severity of trauma-related intrusive thoughts and sleep disturbances, whereas levels of symptoms were tracked throughout treatment and at 3-mo follow-up. Ss were asked to identify 2 relatively distinct traumatic memories. Exposure and EMDR treatments differed in the following ways: First, exposure instructed the S to remain focused on the original trauma while EMDR instructed the S to let the image shift and change; second, the standard saccadic eye movements were included with EMDR whereas exposure Ss were instructed to maintain a fixed gaze. Both EMDR and exposure were effective for treating traumatic memories related to PTSD. Moreover, Ss responded with reduced symptomatology in approximately the same length of time to each treatment. The results must be interpreted with caution due to the very small sample being analyzed.


 

Title:

Treatment of post-traumatic stress disorder in an eleven-year-old boy using imaginal and in vivo exposure.

Author(s):

Abrahams, Sharon, Inst of Psychiatry, Dept of Psychology, London, England
Udwin, Orlee

Source:

Clinical Child Psychology and Psychiatry, Vol 5(3), Jul 2000. pp. 387-401.

Publisher:

Germany: Springer

Abstract:

Evaluates the use of cognitive-behavior therapy with an 11-yr-old boy who developed posttraumatic stress disorder (PTSD) after witnessing a violent incident which culminated in the death of a relative. Treatment involved a combination of imaginal exposure to scenes from the traumatic incident and in vivo exposure to associated feared situations. The intervention resulted in considerable improvement in the 3 key features of PTSD: re-experiencing the event (intrusive thoughts, nightmares and flashbacks), avoidance of associated stimuli, and levels of arousal.


 

Title:

Treatment of posttraumatic stress reactions to traffic accidents.

Author(s):

Fecteau, Gary William, U New Brunswick, Canada

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 61(1-B), Jul 2000. pp. 527.

Publisher:

US: Univ Microfilms International

Abstract:

Post traumatic stress disorder and other reactions including driving phobias and depression have in recent years been clearly identified as common accident sequelae. These disorders affect a sizeable minority of those involved in traffic accidents of sufficient severity to necessitate medical attention. This minority can be conservatively estimated at 20 to 25% of accident victims after one year. Their psychological symptoms and distress can be persistent over years, and disabling. Unfortunately, no treatment outcome data exist beyond case study reports and only one pilot investigation has been published upon which to base clinical practice. For post traumatic stress disorder (PTSD) in general, and for non-combat related trauma, in particular, controlled therapy outcome research is sparse. The present research was a randomized control clinical therapy outcome study for PTSD in motor vehicle accident victims. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Participants completed assessments including a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. They were then randomly assigned to eight to ten hours of individual cognitive-behavioural therapy (n = 10) or to a wait list control group (n = 10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. The assessments were conducted both prior to and upon completion of therapy or equivalent time for wait-list controls. A mail follow-up of symptom questionnaires was also completed three months and six months after the end of therapy. Results demonstrated statistically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Analysis of clinical significance also supported the efficacy of treatment. Treatment gains were maintained over the six month follow-up period. The vast majority of participants also experienced chronic pain often with concurrent depression. These depressive symptoms, which were not targeted by treatment, were resistant to change. In addition to efficacy of treatment, potential predictors of initial PTSD symptom levels were explored by multiple regression. Avoidant coping style, fear level experienced during the trauma, and, crisis support were found to be significant variables related to PTSD symptoms. The present research is the first controlled therapy trial with this treatment population and the findings are discussed in terms of the therapeutic needs of this group and PTSD outcome research.


 

Title:

Eye movement desentitization and reprocessing in the treatment of post-traumatic stress disorder: A review of an emerging therapy.

Author(s):

Shepherd, Jonathan, U Southampton, Wessex Inst for Health Research & Development, Southampton, England
Stein, K.
Milne, R.

Source:

Psychological Medicine, Vol 30(4), Jul 2000. pp. 863-871.

Publisher:

US: Cambridge Univ Press

Abstract:

Examined Eye Movement Desensitization and Reprocessing (EMDR) as psychotherapy for posttraumatic stress disorder (PTSD). A wide range of electronic databases and reference lists of articles obtained were searched and relevant experts were consulted. Studies were critically appraised according to established criteria. The authors found 16 published randomized controlled trials comparing EMDR with alternative psychotherapy treatments, variants of EMDR and with delayed treatment groups. Studies generally had a mean average of 35 patients and were of variable methodological quality, with only 5 reporting blinding of outcome assessors to treatment allocation, and in some cases with high loss to follow-up. In most cases EMDR was shown to be effective at reducing symptoms up to 3 mo after treatment. In 1 case benefit was maintained up to 9 mo and in another (uncontrolled) follow-up treatment effect was present at 15 mo. Two studies suggest that EMDR is as effective as exposure therapies, 3 claim greater effectiveness in comparison to relaxation training, and 3 claim superiority over delayed treatment groups. Of the studies examining specific treatment components, 2 found that treatment with eyes moving was more effective than eyes fixed, while 3 studies found the 2 procedures to be of equal effectiveness.


 

Title:

Imaginal exposure or cognitive therapy in the treatment of post-traumatic stress disorder.

Author(s):

Fahy, T. J., National U of Ireland, Clinical Science Inst, Galway, Ireland

Source:

British Journal of Psychiatry, Vol 176, Jun 2000. pp. 597.

Publisher:

United Kingdom: Royal College of Psychiatrists

Abstract:

Comments on the article by N. Tarrier et al (see record 2000-13686-013), which reported no significant difference in outcome for patients with posttraumatic stress disorder (PTSD) who received either imaginal exposure or cognitive therapy. They concluded that clinical benefits were maintained for both treatments. Fahy suggests that, in the absence of a control group, such a conclusion is not warranted, and that their findings are open to a number of interpretations.


 

Title:

Alexithymia in survivors of sexual assault: Predicting treatment outcome.

Author(s):

Kimball, Leslie Alison, U Missouri - Saint Louis, US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 60(11-B), Jun 2000. pp. 5777.

Publisher:

US: Univ Microfilms International

Abstract:

Alexithymia refers to difficulties in identifying and describing feelings, distinguishing feelings from bodily sensations, symbolic thinking, and imaginative thinking, and has been described as the single most common cause of poor outcome in psychoanalysis and other forms of psychotherapy. In recent years, alexithymia has been increasingly observed in survivors of traumatic events. Two widely-used treatments for PTSD secondary to sexual assault, cognitive processing therapy and prolonged exposure, were investigated for their relative efficacy in treating alexithymia. One hundred thirteen female rape victims who entered the study at least three months post-rape were given the Toronto Alexithymia Scale (TAS), the Clinician-Administered PTSD Scale (CAPS), a Standardized Trauma Interview, and the Sexual Assault Response Questionnaire (SARQ) at pre- and post-treatment. As expected, there was a significant reduction in alexithymia scores from pre- to post-treatment, and there was a significant relationship between PTSD and alexithymia at post-treatment. However, there was no difference in alexithymia scores between clients receiving CPT or PE, and the presence of alexithymia at pre-treatment did not interfere with the successful treatment of PTSD. Possible methodological and clinical reasons for these findings are discussed.


 

Title:

Cognitive behavioral treatment for PTSD with comorbid panic attacks.

Author(s):

Falsetti, Sherry A., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Ctr, Charleston, SC, US
Resnick, Heidi S.

Source:

Journal of Contemporary Psychotherapy, Vol 30(2), Sum 2000. Special issue: Treatments of anxiety disorders. pp. 163-179.

Publisher:

Germany: Springer

Keywords:

multiple channel exposure therapy for treatment of PTSD & comorbid panic attacks

Abstract:

Many individuals that experience traumatic events such as sexual and physical assault develop posttraumatic stress disorder (PTSD). More recently, research has indicated that a significant proportion of PTSD sufferers may also have comorbid panic attacks. Although there are several effective treatments that focus on alleviating PTSD symptoms, until now there were no treatments that focused on also treating comorbid panic attacks. Multiple channel exposure therapy (M-CET) is the first treatment developed to specifically treat comorbid PTSD and panic attacks. It is also unique in that it has been used to treat women who have multiple trauma histories as well as a wide range of different types of traumatic event-exposure in a group format. This treatment is described in a session by session format and special considerations in implementing the treatment are discussed.


 

Title:

Subjective improvement in PTSD patients with treatment by imaginal exposure or cognitive therapy: Session by session changes.

Author(s):

Tarrier, Nicholas, Withington Hosp, Dept of Clinical Psychology, Manchester, England
Humphreys, Lloyd

Source:

British Journal of Clinical Psychology, Vol 39(1), Mar 2000. pp. 27-34.

Publisher:

United Kingdom: British Psychological Society

Abstract:

A self rating scale, the Subjective Symptom Checklist (SSC), was developed to assess posttraumatic stress disorder (PTSD) patients' perceptions of their symptoms between treatment sessions. Reliability and validity of the scale were acceptable. The scale was used in a treatment trial comparing the efficacy of cognitive therapy vs imaginal exposure. 62 patients (mean age 38.6 yrs) completed treatment and post-treatment assessment. Conventional pre-post treatment comparisons using standardized assessments showed no differences between the two treatments. However, when patients who failed to respond to treatment were excluded, group treatment effects became apparent. Patients who received imaginal exposure showed a significantly greater reduction in subjective ratings of their symptoms than did those who received cognitive therapy. It was cautiously concluded that although some PTSD patients could not tolerate exposure, those who could may receive greater subjective benefit than those who received cognitive therapy.


 

Title:

Posttraumatic stress disorder.

Author(s):

Keane, Terence M., V.A. Boston Healthcare System, National Ctr for Posttraumatic Stress Disorder, Boston, MA, US
Street, Amy E.
Orcutt, Holly K.

Source:

Effective brief therapies: A clinician's guide. Hersen, Michel (Ed; Biaggio, Maryka (Ed); pp. 139-155.
San Diego, CA, US: Academic Press, Inc, 2000. xv, 458 pp.

Abstract:

(from the chapter) Presents a multi-phase treatment for posttraumatic stress disorder (PTSD) in a 58-yr-old male. After a comprehensive assessment, treatment proceeded with a major psychoeducational intervention. Imaginal techniques were used for the exposure phase of the treatment. A return trip to the site of victimization was the most trying phase of treatment for the S.


 

Title:

Cognitive-behavioral therapy.

Author(s):

Rothbaum, Barbara Olasov, Emory U, School of Medicine, Dept of Psychiatry, Atlanta, GA, US
Meadows, Elizabeth A.
Resick, Patricia
Foy, David W.

Source:

Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. Foa, Edna B. (Ed; Keane, Terence M. (Ed); Friedman, Matthew J. (Ed); pp. 60-83.
New York, NY, US: Guilford Press, 2000. xii, 388 pp.

Abstract:

(from the chapter) Focuses on a review of the extant literature on cognitive-behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). The authors review 8 different CBTs for PTSD, along with several additional studies of treatment programs that combine 1 or more of these 8 treatments. These include: exposure therapy (EX), systematic desensitization, stress innoculation training (SIT), cognitive processing therapy, cognitive therapy (CT), assertiveness training, biofeedback, relaxation training (Relax), combined SIT/EX, combined EX/Relax/CT, and combined CT/EX. Treatment outcome studies have been conducted on the efficacy of each of these treatments for PTSD, and the authors review several published or in-press reports. Comparing the numbers and types of studies supporting each type of treatment, EX has the most studies and the greatest number of well-controlled studies to support its use. The limitations for each of the reviewed treatments are described.


 

Title:

Cognitive-behavioral therapy.

Author(s):

Rothbaum, Barbara Olasov, Emory U, School of Medicine, Dept of Psychiatry, Atlanta, GA, US
Meadows, Elizabeth A.
Resick, Patricia
Foy, David W.

Source:

Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. Foa, Edna B. (Ed); Keane, Terence M. (Ed); Friedman, Matthew J. (Ed); pp. 320-325.
New York, NY, US: Guilford Press, 2000. xii, 388 pp.

Abstract:

(from the chapter) Reviews the treatment guidelines of eight different cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD): exposure therapy (EX), systematic desensitization, stress inoculation training, cognitive processing therapy, cognitive therapy, assertiveness training, biofeedback and relaxation training, as well as combination approaches. EX was found to be the most efficacious in treating PTSD patients. CBT techniques are generally very short-term, averaging approximately 8-12 sessions, meeting once or twice weekly. Recommendations and limitations for each of the treatments are examined.


 

Title:

Posttraumatic stress disorder: Psychological factors and psychosocial interventions.

Author(s):

Hembree, Elizabeth A., U Pennsylvania, School of Medicine, Dept of Psychiatry, Philadelphia, PA, US
Foa, Edna B.

Source:

Journal of Clinical Psychiatry, Vol 61(Suppl7), 2000. Special issue: New strategies for the treatment of posttraumatic stress disorder. pp. 33-39.

Publisher:

US: Physicians Postgraduate Press

Abstract:

In this article, it is proposed that successful processing of traumatic events involves emotional engagement with the trauma memory, organization of the trauma narrative, and correction of dysfunctional cognitions that often follow trauma. The authors further propose that the success of psychosocial treatments of posttraumatic stress disorder hinges on the ability of the treatments to address impairments in these processes. The presentation of psychosocial interventions is focused on cognitive-behavioral treatments (CBT), since this approach had gained the most empirical support to date, and describe the results of controlled trials that compare the relative efficacy of several CBT interventions.

Conference:

"Update on Posttraumatic Stress Disorder", Jun, 1999, Tysons Corner, VA, US


 

Title:

Psychosocial treatment of posttraumatic stress disorder.

Author(s):

Foa, Edna B., U Pennsylvania School of Medicine, Dept of Psychiatry, Philadelphia, PA, US

Source:

Journal of Clinical Psychiatry, Vol 61 (Suppl 5), 2000. Special issue: Focus on posttraumatic stress disorder. pp. 43-51.

Publisher:

US: Physicians Postgraduate Press

Abstract:

Reviews empirically validated psychosocial treatments for posttraumatic stress disorder (PTSD) and considers factors associated with successful therapy outcome. Most of the treatments whose efficacy was studied empirically fall within the broad category of cognitive-behavioral therapy. These include exposure therapy, anxiety management programs, and cognitive therapy. These therapy modalities have been developed to modify conditioned fear and erroneous cognitions that are thought to underlie PTSD. Exposure therapy has the most empirical support because it was found to be effective across different populations of trauma victims with PTSD. Combinations of therapies have also been used, and the value of these is discussed. In addition, this article presents recent evidence about the efficacy of eye movement and desensitization reprocessing. A growing body of evidence supports the use of psychosocial treatments for PTSD, but not all patients benefit. Future research should develop programs that increase the motivation of patients to take advantage of these efficacious treatments. A roundtable discussion follows.

Conference:

"Focus on Posttraumatic Stress Disorder", Apr, 1999, Montecatini, Italy

Conference Notes:

This article is derived from the proceedings of the fourth meeting held by the International Group on Depression and Anxiety.


 

Title:

Consensus statement on posttraumatic stress disorder from the international consensus group on depression and anxiety.

Author(s):

Ballenger, James C., Medical U of South Carolina, Dept of Psychiatry & Behavioral Sciences, Charleston, SC, US
Davidson, Jonathan R. T.
Lecrubier, Yves
Nutt, David J.
Foa, Edna B.
Kessler, Ronald C.
McFarlane, Alexander C.

Source:

Journal of Clinical Psychiatry, Vol 61 (Suppl 5), 2000. Special issue: Focus on posttraumatic stress disorder. pp. 60-66.

Publisher:

US: Physicians Postgraduate Press

Abstract:

Provided primary care clinicians with a better understanding of management issues in posttraumatic stress disorder (PTSD) and guided clinical practice with recommendations on the appropriate management strategy. The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles (see records 2000-15312-001, 2000-15312-002, 2000-15312-003, 2000-15312-004, 2000-15312-005, and 2000-15312-006). Group meetings were held over a 2 day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. PTSD is often a chronic and recurring condition associated with an increased risk of developing secondary, comorbid disorders, such as depression. Selective serotonin reuptake inhibitors are generally the most appropriate choice of first-line medication for PTSD, and effective therapy should be continued for 12 mo or longer. The most appropriate psychotherapy is exposure therapy, and it should be continued for 6 mo, with follow-up therapy as needed.

Conference:

"Focus on Posttraumatic Stress Disorder", Apr, 1999, Montecatini, Italy

Conference Notes:

This article is derived from the proceedings of the fourth meeting held by the International Group on Depression and Anxiety.


 

Title:

Pharmacotherapy of anxiety disorders.

Author(s):

Palmer, Katharine J., (Ed)

Source:

Kwai Chung, Hong Kong: Adis International Publications, 2000. iii, 113 pp.

Abstract:

(from the foreword) Outlines opinions on the drug treatment of anxiety disorders and reveals the benefits and shortcomings of existing drug strategies. Treatment approaches and options are discussed for generalized anxiety disorder, social phobia, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), and anxiety. This book focuses on drug treatment, but also highlights the role of techniques such as cognitive-behavioral and exposure therapy. It is noted that recommendations for the drug treatment of some anxiety disorders (such as generalized anxiety disorder) have remained fairly static over the years. For other disorders, the treatment options have been expanded recently by the approval of drugs such as paroxetine for social phobia/social anxiety disorder and sertraline for PTSD. It is maintained that the efficacy of such drugs not only improves the lives of affected individuals but also expands knowledge of the causes and neurobiology of specific anxiety disorders and may highlight potential new approaches to their treatment.


 

Title:

Cognitive therapy or imaginal exposure in the treatment of post-traumatic stress disorder.

Author(s):

Tarrier, Nicholas, Withington Hosp, Dept of Clinical Psychology, Manchester, England
Sommerfield, Claire
Pilgrim, Hazel
Humphreys, Lloyd

Source:

British Journal of Psychiatry, Vol 175, Dec 1999. pp. 571-575.

Publisher:

United Kingdom: Royal College of Psychiatrists

Abstract:

Investigated whether treatment benefits and equivalence are maintained at 12-mo follow-up in 54 patients with chronic posttraumatic stress disorder (PTSD) treated with either imaginal exposure or cognitive therapy. There was significant clinical improvement at 12 mo compared with pre-treatment. However, 39% of those followed-up still met criteria for PTSD. There were no significant differences between the 2 treatments. Victims of crime displayed higher levels of symptoms at follow-up than victims of accidents. Clinical benefits for exposure or cognitive therapy were maintained.


 

Title:

'Prolonged exposure therapy and irritable bowel syndrome: A case study examining the impact of a trauma-focused treatment on a physical condition': Erratum.

Author(s):

Weaver, Terri L., U Missouri, Ctr for Trauma Recovery, St Louis, MO, US
Nishith, Pallavi
Resick, Patricia A.

Source:

Cognitive and Behavioral Practice, Vol 6(1), Win 1999. pp. 68.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Reports an error in the original article by T. L. Weaver et al (Cognitive & Behavioral Practice, 1998 [Sum], Vol 5 [1], 103-122). On page 115, the sentence that reads "Jane's score on the BDI was markedly reduced at post- and follow-up assessment points should read that the change was statistically significant. (The following abstract of this article originally appeared in record 1998-04500-005.): Previous research has shown that psychological treatments, particularly those employing cognitive techniques, are particularly effective in the treatment of irritable bowel syndrome (IBS). It is presumed that these psychological interventions are effective at ameliorating the IBS by treating an underlying psychological disorder (often an anxiety disorder), which may be contributing to the autonomic reactivity. This case study examined the change in the physical symptoms of IBS for a 34-yr-old female patient seeking treatment for rape-related posttraumatic stress disorder (PTSD) with comorbid conditions of major depression and panic. At posttreatment, the patient no longer met criteria for PTSD, major depression, or panic. In addition, her primary symptom of IBS, diarrhea frequency, was significantly improved. These findings were maintained at 3 and 9 mo posttreatment /p./p./p.


 

Title:

Early versus delayed imaginal exposure for the treatment of Posttraumatic Stress Disorder following accidental injury. (occupational injury, trauma).

Author(s):

Weis, Jo M., Marquette U., US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 60(5-B), Dec 1999. pp. 2375.

Publisher:

US: Univ Microfilms International

Abstract:

The symptomology of posttraumatic stress disorder (PTSD) has been acknowledged and documented for more than one hundred years but formal recognition of PTSD did not occur until 1980 (American Psychiatric Association, 1980). The social and financial consequences of PTSD are far reaching and support the need for accessible, effective and timely treatment. Work-related injuries represent a special subset of those experiencing PTSD. Annually, 16 million persons experience upper extremity injuries, many of whom are likely to develop PTSD (Krieger, Kelsey, Harris & Pastides, 1981). Current research suggests that cognitive behavioral exposure-based therapies are the most effective to date for the treatment of PTSD. This study expanded the growing empirical data regarding prognostic factors for persons diagnosed with PTSD following upper extremity injuries by exploring the impact of early versus delayed imaginal exposure on amelioration of PTSD symptomology. The subjects were 60 participants who naturalistically fell into the early (30-60 days) and the delayed (greater then 120 days) treatment groups. These participants were referred to the Medical College of Wisconsin for treatment of PTSD resulting from traumatic injuries. All participants were assessed for PTSD symptomology using nine measures at onset of treatment, end of treatment and at 6-month follow up evaluations. A licensed psychologist using imaginal exposure treated all participants. Doubly multivariate analysis of variance yielded significant within-subject effects across all dependent variables at the three measurement points ( p <.001). There were no significant differences between groups in either reduction in PTSD symptomology or return to work status. Additionally, univariate F tests supported the efficacy of imaginal exposure for the reduction of PTSD symptomology across time (p <.001). The number of treatment sessions between the early versus delayed treatment group was significant (p <.001) using a West of independence. This indicated that the early treatment group required fewer treatment sessions than did the delayed treatment group. The significant findings of this research were discussed. Implications of these findings for the treatment of PTSD and suggestions for future research were outlined.


 

Title:

Treating acute stress disorder: An evaluation of cognitive behavior therapy and supporting counseling techniques.

Author(s):

Bryant, Richard A., U New South Wales, School of Psychology, Sydney, NSW, Australia
Sackville, Tanya
Dang, Suzanne T.
Moulds, Michelle
Guthrie, Rachel

Source:

American Journal of Psychiatry, Vol 156(11), Nov 1999. pp. 1780-1786.

Publisher:

US: American Psychiatric Assn

Abstract:

Acute stress disorder (ASD) permits an early identification of trauma survivors who are at risk of developing chronic posttraumatic stress disorder (PTSD). This study assessed the relative efficacy of prolonged exposure and anxiety management in the treatment of ASD. 45 trauma survivors with ASD (aged 18-60 yrs) were given 5 sessions of prolonged exposure (N=14), combined prolonged exposure and anxiety management (N=15), or supportive counseling (N= 16) within 2 wks of trauma. Ss were assessed pretreatment, posttreatment, and at 6-mo follow-up. Fewer Ss with prolonged exposure (14%, N=2) and prolonged exposure plus anxiety management (20%, N=3) than supportive counseling (56%, N=9) met the criteria for PTSD after initial treatment. 15% in the prolonged exposure group and 23% in the prolonged exposure plus anxiety management group had PTSD at 6-mo follow-up, compared with 67% in the supportive counseling group. Chronic PTSD in the supportive counseling condition was characterized by greater avoidance behaviors than in the prolonged exposure alone or plus anxiety management conditions. Findings suggest that PTSD can be effectively prevented with an early provision of cognitive behavior therapy and that prolonged exposure may be the most critical component in the treatment of ASD.


 

Title:

The use of virtual reality exposure in the treatment of anxiety disorders.

Author(s):

Rothbaum, Barbara Olasov, Emory U, School of Medicine, Dept of Psychiatry & Behavioral Sciences, Atlanta, GA, US
Hodges, Larry F.

Source:

Behavior Modification, Vol 23(4), Oct 1999. pp. 507-525.

Publisher:

US: Sage Publications

Abstract:

One possible alternative to standard in vivo exposure may be virtual reality exposure (VRE). Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment. VRE is potentially an efficient and cost-effective treatment of anxiety disorders. B. O. Rothbaum et al (1995), in a case study with a 19-yr-old male patient and in a controlled study with 17 undergraduates, successfully used VRE therapy to reduce acrophobia. In the latter study, outcome was assessed on measures of anxiety, avoidance, attitudes, and distress. Significant group differences were found on all measures such that the VRE group was significantly improved at posttreatment but the control group was unchanged. The efficacy of VRE therapy was also demonstrated in the case of a 42-yr-old female patient with fear of flying. The potential for VRE treatment for these and other disorders, e.g., posttraumatic stress disorder (PTSD), is discussed.


 

Title:

Cognitive behavioural treatment of post traumatic stress disorder after motor vehicle accident.

Author(s):

Fecteau, Gary, U New Brunswick, Fredericton, NB, Canada
Nicki, Richard

Source:

Behavioural and Cognitive Psychotherapy, Vol 27(3), Jul 1999. pp. 201-214.

Publisher:

US: Cambridge Univ Press

Abstract:

Evaluated the efficacy of cognitive-behavioral therapy for post traumatic stress disorder (PTSD) following a common motor vehicle accident (MVA). 20 volunteer Ss (aged 25-63 yrs) who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of PTSD (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioral test wherein Ss had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. Ss were randomly assigned to 8-10 hrs of individual cognitive-behavioral therapy or to a wait list control group. Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behavior practice. Results showed that treatment effects across structured interviews, self-report questionnaires and the behavioral test, were effective in PTSD symptom reduction. Treatment gains were maintained over a 6 mo follow-up using self-report questionnaires.


 

Title:

The current status of eye movement desensitization and reprocessing (EMDR).

Author(s):

Spector, John, Watford General Hosp, Shrodells Unit, Hertfordshire, England
Read, J.

Source:

Clinical Psychology & Psychotherapy, Vol 6(3), Jul 1999. pp. 165-174.

Publisher:

US: John Wiley & Sons

Abstract:

Notes that eye movement desensitization and reprocessing therapy (EMDR) has increasingly been proposed as an effective therapeutic procedure for posttraumatic stress disorder (PTSD) and other mental health problems. However, views on EMDR in the research literature have been polarized. Reasons for this are explored as is the nature and theoretical basis of EMDR. 15 controlled studies published on EMDR and PTSD are reviewed, and it is concluded that (1) EMDR is an effective psychotherapy, (2) EMDR's relative efficacy in comparison to behavioral exposure therapies has yet to be established, (3) the role of eye movements and laterality in attentional focus remains controversial, and (4) a direct link between the theoretical basis of the therapy and observable psychological and neurobiological changes has yet to be established.


 

Title:

Relatives' expressed emotion (EE) and PTSD treatment outcome.

Author(s):

Tarrier, Nicholas, U Manchester, School of Psychiatry & Behavioural Sciences, Dept of Clinical Psychology, Manchester, England
Sommerfield, C.
Pilgrim, H.

Source:

Psychological Medicine, Vol 29(4), Jul 1999. pp. 801-811.

Publisher:

US: Cambridge Univ Press

Abstract:

Investigated the effect of expressed emotion (EE) on treatment outcome in chronic post-traumatic stress disorder (PTSD). The key relatives of 31 PTSD patients participating in a treatment trial comparing imaginal exposure with cognitive therapy were interviewed and rated on EE prior to treatment allocation. The effect of EE on post-treatment clinical outcomes was assessed. 16 patients (52%) had high EE and 15 (48%) low EE relatives. Patients with high EE relatives showed lesser change scores on the main outcome variable of the trial, the total Clinician Administered PTSD Scale score, and on all the secondary outcome variables than those with low EE relatives. Using different multiple regression models the EE scales of criticism and hostility predicted just under 20% of the greatest variance. These 2 scales were highly correlated and criticism marginally predicted the greatest variance (19.7 %). (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Exposure counterconditioning (EC) as a treatment for severe PTSD and depression with an illustrative case.

Author(s):

Paunovic, Nenad, Stockholm U, Dept of Psychology, Stockholm, Sweden

Source:

Journal of Behavior Therapy and Experimental Psychiatry, Vol 30(2), Jun 1999. pp. 105-117.

Publisher:

Netherlands: Elsevier Science

Abstract:

Cognitive behavioral therapies have strong empirical support as the treatments of choice for posttraumatic stress disorder (PTSD). Still, a significant proportion of the patients retain distressing PTSD symptoms after treatment. A treatment named Exposure Counterconditioning (EC), based on J. Wolpe's (1995) reciprocal inhibition theory and Pavlovian conditioning mechanisms (J. D. Baldwin and J. I. Baldwin, 1986) is described. The EC treatment is proposed as an addition to the established treatments for PTSD. A case study from which the EC treatment was first developed illustrates the use of EC. The patient (male 34-yr-old) suffered from severe PTSD and depression. EC treatment was effective in eliminating the patient's PTSD and depression. His severe anger, guilt, and dissociation were also eliminated. These results and important clinical observations are discussed within a counterconditioning framework.


 

Title:

A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims.

Author(s):

Foa, Edna B., Hahnemann U, Medical Coll of Pennsylvania, Ctr for the Treatment & Study of Anxiety, Philadelphia, PA, US
Dancu, Constance V.
Hembree, Elizabeth A.
Jaycox, Lisa H.
Meadows, Elizabeth A.
Street, Gordon P.

Source:

Journal of Consulting and Clinical Psychology, Vol 67(2), Apr 1999. pp. 194-200.

Publisher:

US: American Psychological Assn

Abstract:

Ninety-six female assault victims with chronic posttraumatic stress disorder (PTSD) were randomly assigned to 4 treatment conditions: prolonged exposure (PE), stress inoculation training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Treatment consisted of 9 twice-weekly, individual sessions. Independent evaluations were conducted at pretreatment; posttreatment; and 3-, 6-, and 12-month follow-ups. All 3 active treatments reduced severity of PTSD and depression compared with WL but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure.


 

Title:

A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder.

Author(s):

Glynn, Shirley M., Veterans Affairs Medical Ctr, Research Service, Los Angeles, CA, US
Eth, Spencer
Randolph, Eugenia T.
Foy, David W.
Urbaitis, Marleen
Boxer, Laurie
Paz, George G.
Leong, Gregory B.
Firman, Gregory
Salk, Jonathan D.
Katzman, Jeffrey W.
Crothers, Judith

Source:

Journal of Consulting and Clinical Psychology, Vol 67(2), Apr 1999. pp. 243-251.

Publisher:

US: American Psychological Assn

Abstract:

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.


 

Title:

Virtual reality exposure therapy for PTSD Vietnam veterans: A case study.

Author(s):

Rothbaum, Barbara Olasov, Emory U School of Medicine, Dept of Psychiatry, Atlanta, GA, US
Hodges, Larry
Alarcon, Renato
Ready, David
Shahar, Fran
Graap, Ken
Pair, Jarrel
Hebert, Philip
Gotz, Dave
Wills, Brian
Baltzell, David

Source:

Journal of Traumatic Stress, Vol 12(2), Apr 1999. pp. 263-271.

Publisher:

US: John Wiley & Sons

Abstract:

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder(PTSD). This report presents the results of the 1st Vietnam combat veteran, a 50-yr-old male, with PTSD to have been treated with VRE. The patient was exposed to 2 virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-mo follow-up.


 

Title:

A virtual environment for the treatment of chronic combat-related post-traumatic stress disorder.

Author(s):

Hodges, Larry F., Georgia Inst of Technology, Coll of Computing, GVU Ctr, Atlanta, GA, US
Rothbaum, Barbara Olasov
Alarcon, Renato
Ready, David
Shahar, Fran
Graap, Ken
Pair, Jarrell
Hebert, Philip
Gotz, David
Wills, Brian
Baltzell, David

Source:

CyberPsychology & Behavior, Vol 2(1), Feb 1999. pp. 7-14.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

Posttraumatic stress disorder (PTSD) is one of the most disabling psychopathological conditions affecting veterans. Approximately 15.2% of the men and 8.5% of the women who fought in Vietnam were found to be suffering from PTSD 15 or more yrs after their service. Behavior therapies with an exposure element have proven more effective than most other types of treatment, but a significant number of patients do not seem to benefit from them, possibly because of difficulties imagining, visualizing, or describing their traumatic experiences. This article describes Virtual Vietnam (VV), a set of 2 virtual environments (VEs) developed as part of an uncontrolled treatment development study to evaluate the therapeutic effectiveness of virtual reality exposure for the treatment of combat-related PTSD in Vietnam veterans as one component of a comprehensive treatment program. The VV software consists of 2 distinct VEs, a helicopter environment and an open field environment, chosen because they represent 2 experiences that elicit strong emotional responses from Vietnam veterans with PTSD. Experiences with the initial patients in the study suggest that being immersed in VV can be an effective aid to assist PTSD sufferers in imagining, visualizing, and describing their traumatic experiences.

Conference:

Virtual Reality and Mental Health Symposium of the Medicine Meets Virtual Reality 7 Conference, Jan, 1999, San Francisco, CA, US


 

Title:

A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder.

Author(s):

Tarrier, N., U Manchester, Withington Hosp, Dept of Clinical Psychology, Manchester, England
Pilgrim, Hazel
Sommerfield, Claire
Faragher, Brian
Reynolds, Martina
Graham, Elizabeth
Barrowclough, Christine

Source:

Journal of Consulting and Clinical Psychology, Vol 67(1), Feb 1999. pp. 13-18.

Publisher:

US: American Psychological Assn

Abstract:

72) were randomly allocated to either IE or CT. There was a significant improvement in all measures over treatment and at follow-up, although there were no significant differences between the 2 treatments at any assessment. A significantly greater number of patients who showed worsening over treatment received IE, although this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credible, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reduction, although neither resulted in complete improvement. (PsycINFO Database Record (c) 2005 APA, all rights reserved)(journal abstract) = A randomized trial was performed in which imaginal exposure (IE) and cognitive therapy (CT) were compared in the treatment of chronic posttraumatic stress disorder (PTSD). Patients who continued to meet PTSD caseness at the end of a 4-week symptom-monitoring baseline period (n


 

Title:

Behavior therapy.

Author(s):

Weaver, Terri L., Ctr for Trauma Recovery, St Louis, MO, US
Resnick, Heidi S.
Glynn, Shirley M.
Foy, David W.

Source:

Handbook of comparative interventions for adult disorders (2nd ed.). Hersen, Michel (Ed); Bellack, Alan S. (Ed); pp. 433-461.
Hoboken, NJ, US: John Wiley & Sons, Inc, 1999. xii, 708 pp.

Abstract:

(from the chapter) This chapter on behavior therapy for posttraumatic stress disorder (PTSD) is intended to provide a practical overview of cognitive behavioral methods that are currently in use or under intensive development for treating psychological problems experienced by survivors of extreme or traumatic events. The authors present an interactional cognitive-behavioral conceptual model in which principles of classical and operant conditioning, as well as principles of information processing theory, are incorporated to explain the development of PTSD symptoms and to guide assessment and treatment planning. The authors also provide an overview of multisite field trial research, which was conducted to help establish the current Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) formulation of PTSD. Three primary types of behavioral treatment--exposure, cognitive restructuring, and skills training--are described and updated with respect to specific examples of their clinical applications. The use of prolonged exposure as a primary treatment approach for rape-related PTSD is detailed in a case illustration. Last, alternative behavioral treatment options are described.


 

Title:

A single session, group study of exposure and Eye Movement Desensitization and Reprocessing in treating posttraumatic stress disorder among Vietnam War veterans: Preliminary data.

Author(s):

Rogers, Susan, Dept of Veterans Affairs Medical Ctr, PTSD Program, Coatesville, PA, US
Silver, Steven M.
Goss, James
Obenchain, Jeanne
Willis, Amy
Whitney, Robert L.

Source:

Journal of Anxiety Disorders, Vol 13(1-2), Jan-Apr 1999. Special issue: Advances in conceptualization and research on the efficacy and mechanism of EMDR. pp. 119-130.

Publisher:

Netherlands: Elsevier Science

Abstract:

Summarizes data gathered from an ongoing study. Two groups (12 Ss total) of Vietnam War veterans diagnosed with posttraumatic stress disorder (PTSD) received a single session of exposure or Eye Movement Desensitization and Reprocessing (EMDR) focusing on the veterans' most distressing war experience. Group assignment was random, treatment providers were blind to assessment data, and the pre- and posttreatment assessor was blind to treatment assignment. Both groups showed improvement on the Impact of Event Scale. EMDR treatment resulted in greater positive changes in within-session Subjective Units of Discomfort levels and on self-monitored severity of intrusive recollection. A trend toward decreased heart rate reactivity was observed in both groups. Results must be considered carefully due to the small number of Ss used in the study.


 

Title:

Cognitive-behavioral treatment of traumatized adults.

Author(s):

Meadows, Elizabeth A., Central Michigan U, Mt Pleasant, MI, US
Foa, Edna B.

Source:

Posttraumatic stress disorder: A comprehensive text. Saigh, Philip A. (Ed); Bremner, J. Douglas (Ed); pp. 376-390.
Needham Heights, MA, US: Allyn & Bacon, 1999. xiv, 434 pp.

Abstract:

(from the chapter) In this chapter we focus on the cognitive-behavioral therapies that have been developed to treat adults with posttraumatic stress disorder (PTSD). These include exposure procedures, cognitive therapy, anxiety management techniques, and programs combining these procedures. Each of these treatments is discussed, focusing on theoretical underpinnings, descriptions of the treatments, a review of the efficacy literature, and a discussion of potential treatment obstacles.


 

Title:

Treatment for traumatic memories: Review and recommendations.

Author(s):

Leskin, Gregory A., Boston VA Medical Ctr, Boston, MA, US
Kaloupek, Danny G.
Keane, Terence M.

Source:

Clinical Psychology Review, Vol 18(8), Dec 1998. Special issue: Memory for trauma: The intersection of clinical psychology and cognitive science. pp. 983-1002.

Publisher:

Netherlands: Elsevier Science

Abstract:

The aim of this article is to provide recommendations concerning the use of exposure-based therapy for reduction of emotional responding to traumatic memories. Background for these recommendations consists of a summary of the literature on traumatic stress and symptoms of posttraumatic stress disorder (PTSD); an overview of biological, cognitive, and behavioral models for traumatic memory; and a selective review of evidence for the effectiveness of therapeutic exposure as a treatment for trauma memories and PTSD. The recommendations themselves demonstrate how clinical decision making during the course of treatment might be informed by empirical evidence and theoretical models concerning human memory, as well as ethical and legal considerations that mark this topic. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Management of anxiety in late life.

Author(s):

Flint, Alastair J., Toronto Hosp, Geriatric Psychiatry Program, Toronto, ON, Canada

Source:

Journal of Geriatric Psychiatry and Neurology, Vol 11(4), Win 1998. pp. 194-200.

Publisher:

US: Sage Publications

Abstract:

Epidemiologic data are used as a framework to discuss the pharmacologic and cognitive-behavioral management of anxiety disorders in late life. Generalized anxiety disorder (GAD) and phobias account for most cases of anxiety in late life. The high level of comorbidity between GAD and major depression, and the observation that the anxiety usually arises secondarily to the depression, suggests that antidepressant medication should be the primary pharmacologic treatment for many older people with GAD. Most individuals with late-onset agoraphobia do not have a history of panic attacks and the illness often starts after a traumatic event. Exposure therapy is the treatment of choice for agoraphobia without panic. It is uncommon for obsessive-compulsive disorder (OCD) and panic disorder to start for the first time in old age, but these disorders can persist from younger years into late life. Case reports and uncontrolled case series suggest that elderly people with OCD or panic disorder can benefit from pharmacologic and cognitive-behavioral treatments that are known to be effective in younger patients. Uncontrolled data support the use of selective serotonin reuptake inhibitors in war veterans with chronic symptoms of PTSD.


 

Title:

A task analysis tool for the creation of psychotherapeutic virtual environments.

Author(s):

Parent, Anne, National Research Council Canada, Ottawa, ON, Canada
Thibault, Guy

Source:

CyberPsychology & Behavior, Vol 1(3), Fal 1998. pp. 225-235.

Publisher:

US: Mary Ann Liebert Publishers

Abstract:

Explores the usefulness of a Virtual Environment Task Analysis Tool (VETAT-PSYCH) to help psychologists design virtual environments (VEs). The tool, in the form of a workbook, was developed to support the needs analysis process essential to the design of VEs applied to the resolution of various psychological disorders. The successful design of a VE rests on an analysis of the user and task requirements of a given application. VETAT-PSYCH aims to help close the gap between psychologists and developers, ensuring that applications meet both client and therapist expectations. The tool also aims to support the evaluation of various designs. To demonstrate the potential usefulness of the workbook, VETAT-PSYCH is applied to the relational obstacles encountered by a 35-yr-old female childhood sexual abuse survivor with posttraumatic stress disorder (PTSD). The 1st part of the article briefly introduces the case study and graded exposure, a cognitive-behavioral treatment component. The 2nd part of the article presents the information collected in the VETAT-PSYCH workbook. Organizational, user, and task-related factors are described, followed by the user and task requirements unique to the creation of a VE.


 

Title:

Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation.

Author(s):

Ehlers, Anke, U Oxford, Dept of Psychiatry, Warneford Hosp, Oxford, England
Clark, David M.
Dunmore, Emma
Jaycox, Lisa
Meadows, Elizabeth
Foa, Edna B.

Source:

Journal of Traumatic Stress, Vol 11(3), Jul 1998. pp. 457-471.

Publisher:

US: John Wiley & Sons

Abstract:

Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during reliving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.


 

Title:

Prolonged exposure therapy and irritable bowel syndrome: A case study examining the impact of a trauma-focused treatment on a physical condition.

Author(s):

Weaver, Terri L., U Missouri, Ctr for Trauma Recovery, St Louis, MO, US
Nishith, Pallavi
Resick, Patricia A.

Source:

Cognitive and Behavioral Practice, Vol 5(1), Sum 1998. pp. 103-122.

Publisher:

US: Assn for the Advancement of Behavior Therapy

Abstract:

Previous research has shown that psychological treatments, particularly those employing cognitive techniques, are particularly effective in the treatment of irritable bowel syndrome (IBS). It is presumed that these psychological interventions are effective at ameliorating the IBS by treating an underlying psychological disorder (often an anxiety disorder), which may be contributing to the autonomic reactivity. This case study examined the change in the physical symptoms of IBS for a 34-yr-old female patient seeking treatment for rape-related posttraumatic stress disorder (PTSD) with comorbid conditions of major depression and panic. At posttreatment, the patient no longer met criteria for PTSD, major depression, or panic. In addition, her primary symptom of IBS, diarrhea frequency, was significantly improved. These findings were maintained at 3 and 9 mo posttreatment. Implications for the assessment and treatment of IBS patients with PTSD are discussed. (PsycINFO Database Record (c) 2005 APA, all rights reserved)


 

Title:

Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study.

Author(s):

Marks, Isaac, U London, Inst of Psychiatry, London, England
Lovell, Karina
Noshirvani, Homa
Livanou, Maria
Thrasher, Sian

Source:

Archives of General Psychiatry, Vol 55(4), Apr 1998. pp. 317-325.

Publisher:

US: American Medical Assn

Abstract:

Examined the efficacy of cognitive restructuring with vs without prolonged exposure therapy in treating patients suffering from posttraumatic stress disorder (PTSD). 87 PTSD patients were randomly assigned to 1 of 4 treatment conditions: (1) prolonged exposure (PE); (2) cognitive restructuring (CR); (3)combined PE and CR; or (4) relaxation without PE or CR. Results show that both RE and CT were therapeutic on their own, but were not enhancing when combined. Both techniques were more effective than relaxation.


 

Title:

Effectiveness of anxiety management training in the treatment of posttraumatic stress disorder: A preliminary report.

Author(s):

Pantalon, Michael V., Yale U, School of Medicine, Dept of Psychiatry, New Haven, CT, US
Motta, Robert W.

Source:

Journal of Behavior Therapy and Experimental Psychiatry, Vol 29(1), Mar 1998. pp. 21-29.

Publisher:

Netherlands: Elsevier Science

Abstract:

Investigated the effectiveness of anxiety management training (AMT), a coping skills treatment similar to systematic desensitization, in comparison to implosive therapy (IT), an exposure-based treatment, for treating 6 Vietnam combat veterans with posttraumatic stress disorder (PTSD). The Clinician Administered PTSD Interview Scale (CAPS; D. D. Blake et al, 1988) and a self-monitoring measure (F. W. Weathers et al., 1991) were used as dependent measures. A single-S, multiple-baseline, crossover design was employed. A new statistic for such designs (K. T. Mueser et al, 1991) based on classical test theory, was used to assess treatment effects on intrusive war memories and avoidance of stimuli reminiscent of war. Within-S results indicate that AMT and IT were similarly effective in reducing the frequency and intensity of intrusions and avoidance. These results suggest that it may be productive to investigate multidimensional approaches (combining coping skills, exposure-based, and other approaches) to the treatment of combat-related PTSD.


 

Title:

Evaluating outcome: Exposure therapy and crime-related posttraumatic stress disorder.

Author(s):

Sugden, Laurel M., Pepperdine U, US

Source:

Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 58(8-B), Feb 1998. pp. 4475.

Publisher:

US: Univ Microfilms International

Abstract:

This case study describes the successful treatment of posttraumatic stress disorder (PTSD) using systematic desensitization. The client, a middle aged female, presented 5 months following a violent assault. She met full criteria in the four diagnostic categories of the DSM-IV for PTSD at the time of assessment. The Beck Anxiety Inventory (BAI) was administered across sessions, posttreatment, and at 6-month and 18-month follow-up. The BAI was used as the repeated-measure in a statistical analysis based on classical test theory for evaluating single-case repeated-measures data. Results showed statistically significant reductions in anxiety at posttreatment that were maintained at 18-month follow-up. Findings were supported by the CAPS-1, LASC, and IES-R, which measured overall PTSD symptomatology at pretreatment and follow-up phases. There was a notable reduction in PTSD symptoms across measures from PTSD-positive levels at pretreatment to PTSD-negative levels at 18-month follow-up.

Tests & Measures:

Beck Anxiety Inventory


 

Title:

Influence of emotional engagement and habituation on exposure therapy for PTSD.

Author(s):

Jaycox, Lisa H., Rand Corp, Santa Monica, CA, US
Foa, Edna B.
Morral, Andrew R.

Source:

Journal of Consulting and Clinical Psychology, Vol 66(1), Feb 1998. pp. 185-192.

Publisher:

US: American Psychological Assn

Abstract:

This study examined 2 process variables, emotional engagement and habituation, and outcome of exposure therapy for posttraumatic stress disorder. Thirty-seven female assault victims received treatment that involved repeated imaginal reliving of their trauma, and rated their distress at 10-min intervals. The average distress levels during each of 6 exposure sessions were submitted to a cluster analysis. Three distinct groups of clients with different patterns of distress were found: high initial engagement and gradual habituation between sessions, high initial engagement without habituation, and moderate initial engagement without habituation. Clients with the 1st distress pattern improved more in treatment than the other clients. The results are discussed within the framework of emotional processing theory, emphasizing the crucial role of emotional engagement and habituation in exposure therapy.


 

Title:

Psychological and behavioral treatments of post-traumatic stress disorder.

Author(s):

Keane, Terence M., Boston VA Medical Ctr/Outpatient Clinics, Psychology Service, Boston, MA, US

Source:

A guide to treatments that work. Nathan, Peter E. (Ed; Gorman, Jack M. (Ed); pp. 398-407.
New York, NY, US: Oxford University Press, 1998. xxx, 594 pp.

Abstract:

(from the chapter) This chapter discusses current psychological treatments of choice for posttraumatic stress disorder (PTSD) and examines the data supporting the use of exposure therapies, anxiety management therapies, their combinations, and eye-movement desensitization and reprocessing.

 

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