Post-Traumatic Stress Disorder (PTSD)

Cottraux, J., Note, I., Yao, S. N., de Mey-Guillard, C., Bonasse, F., Djamoussian, D., Mollard, E., Note, B., & Chen, Y. (2008). Randomized controlled comparison of cognitive behavior therapy with Rogerian supportive therapy in chronic post-traumatic stress disorder: A 2-year follow-up. Psychotherapy and Psychosomatics, 77, 101-110.

Correspondence Address:
Jean Cottraux, Anxiety Disorder Unit, Hopital Neurologique, 59 Boulevard Pinel, Lyon, France, FR-69003, cottraux@univ-lyon1.fr.

Abstract
Background: To date, there have been no studies comparing cognitive behavior therapy (CBT) with Rogerian therapy in post-traumatic stress disorder. Method: Sixty outpatients with DSM-IV chronic post-traumatic stress disorder were randomized into two groups for 16 weekly individual sessions of CBT or Rogerian supportive therapy (ST) at two centers. No medication was prescribed. Measures included the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Hamilton Anxiety Scale, Beck Depression Inventory, and Quality of Life. The general criterion of improvement (GCI) was a score of less than 44 on the PCLS. Results: Forty-two patients were evaluated at post-test, 38 at week 52 and 25 at week 104. At post-test, the rate of patients leaving the trial due to worsening or lack of effectiveness was significantly higher in the ST group (p = 0.004). At this point, no between-group difference was found on the GCI and any of the rating scales. Intent-to-treat analysis found no difference for the GCI, but patients in the CBT group showed greater improvement on the PCLS and Hamilton Anxiety Scale. Naturalistic follow-up showed sustained improvement without between-group differences at weeks 52 and 104. Conclusions: CBT retained significantly more patients in treatment than ST, but its effects were equivalent to those of ST in the completers. CBT was better in the dimensional intent-to-treat analysis at post-test. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Duffy, M., Gillespie, K., & Clark, D. M. (2007). Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland: Randomised controlled trial. British Medical Journal, 334(7604), No Pagination Specified.

Correspondence Address:
Michael Duffy, University of Ulster at Magee, Londonderry, Northern Ireland, BT48 7JL, m.duffy1@ulster.ac.uk.

Abstract
Objective: To evaluate the effectiveness of cognitive therapy for post-traumatic stress disorder related to terrorism and other civil conflict in Northern Ireland. Design: Randomised controlled trial. Setting: Community treatment centre, Northern Ireland. Participants: 58 consecutive patients with chronic post-traumatic stress disorder (median 5.2 years, range 3 months to 32 years) mostly resulting from multiple traumas linked to terrorism and other civil conflict. Interventions: Immediate cognitive therapy compared with a waiting list control condition for 12 weeks followed by treatment. Treatment comprised a mean of 5.9 sessions during 12 weeks and 2.0 sessions thereafter. Main outcome measures: Primary outcome measures were patients' scores for post-traumatic stress disorder (post-traumatic stress diagnostic scale) and depression (Beck depression inventory). The secondary outcome measure was scores for occupational and social functioning (work related disability, social disability, and family related disability) on the Sheehan disability scale. Results: At 12 weeks after randomisation, immediate cognitive therapy was associated with significantly greater improvement than the waiting list control group in the symptoms of post-traumatic stress disorder (mean difference 9.6, 95% confidence interval 3.6 to 15.6), depression (mean difference 10.1, 4.8 to 15.3), and self reported occupational and social functioning (mean difference 1.3, 0.3 to 2.5). Effect sizes from before to after treatment were large: post-traumatic stress disorder 1.25, depression 1.05, and occupational and social functioning 1.17. No change was observed in the control group. Conclusion: Cognitive therapy is an effective treatment for post-traumatic stress disorder related to terrorism and other civil conflict. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)

Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: Development and evaluation. Behaviour Research & Therapy, 43, 413-431.

Correspondence Address:
Anke Ehlers, Department of Psychology, Institute of Psychiatry, King's College London, PO77 De Crespigny Park, London, United Kingdom, SE5 8AF, a.ehlers@iop.kcl.ac.uk .

Abstract (from the journal abstract)
The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6- month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., Fennell, M., Herbert, C., & Mayou, R. (2003). A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry, 60, 1024-1032.

Correspondence Address:
Anke Ehlers, Department of Psychology, Institute of Psychiatry, P.O. Box 77, De Crespigny Park, Denmark Hill, London England SE5 8AF, a.ehlers@iop.kcl.ac.uk .

Abstract
It is unclear what psychological help should be offered in the aftermath of traumatic events, and there is a lack of clarity about the best to identify people who are unlikely to recover from early posttraumatic symptoms without intervention. This study determined whether cognitive therapy or a self-help booklet given in the initial months after a traumatic event is more effective in preventing chronic posttraumatic stress disorder (PTSD) than repeated assessments. Ss were motor vehicle accident survivors (n=97) who had PTSD in the initial months after the accident and met symptom criteria that had predicted persistent PTSD in a large naturalistic prospective study of a comparable population. Patients completed a 3-week self-monitoring phase. Those who did not recover with self-monitoring (n=85) were randomly assigned to receive monitoring cognitive therapy (n=28), a self-help booklet based on principles of cognitive behavioral therapy (n=28), or repeated assessments (n=29). Symptoms of PTSD were assessed by self-report and independent assessors unaware of the patient's allocation at 3 months and 9 months. Twelve percent (n=12) of patients recovered with self-monitoring. Cognitive therapy was more effective in reducing symptoms than the self-help booklet or repeated assessments. (PsycINFO Database Record (c) 2003 APA, all rights reserved)

Ehntholt, K. A., Smith, P. A., & Yule, W. (2005). School-based Cognitive-Behavioural Therapy Group Intervention for Refugee Children who have Experienced War-related Trauma. Clinical Child Psychology & Psychiatry, 10, 235-250.

Correspondence Address:
Kimberly A. Ehntholt, Michael Rutter Centre for Children and Young People, Maudsley Hospital, De Crespigny Park, London, United Kingdom, SE5 8AZ, kim.ehntholt@slam.nhs.uk.

Abstract
(from the journal abstract) This study evaluated the effectiveness of a school-based group intervention designed for children who have experienced trauma. Twenty-six children (aged 11-15 years) who were refugees or asylum-seekers from war-affected countries participated. The manual-based intervention consisted of cognitive-behavioural therapy (CBT) techniques and was implemented within secondary schools. The treatment group (n = 15) received six sessions of group CBT over a 6-week period, while the control group (n = 11) were laced on a waiting list for 6 weeks and then invited to enter treatment. Children in the CBT group showed statistically significant, but clinically modest improvements following the intervention, with decreases in overall severity of post-traumatic stress symptoms. Significant improvements were also found in overall behavioural difficulties and emotional symptoms. Children in the waiting list control group did not show any improvements over the same period. However, follow-up data, which were only available for a small subset of eight children, suggest that gains in the CBT group were not maintained at 2-month follow-up. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Ehring, T., Ehlers, A., & Glucksman, E. (2008). Do cognitive models help in predicting the severity of posttraumatic stress disorder, phobia, and depression after motor vehicle accidents? A prospective longitudinal study. Journal of Consulting and Clinical Psychology, 76(2), 219-230.

Correspondence Address:
Anke Ehlers, Department of Psychology, Institute of Psychiatry, King's College London, PO77, De Crespigny Park, London, England, SE5 8AF, anke.ehlers@iop.kcl.ac.uk.

Abstract
The study investigated the power of theoretically derived cognitive variables to predict posttraumatic stress disorder (PTSD), travel phobia, and depression following injury in a motor vehicle accident (MVA). MVA survivors (N = 147) were assessed at the emergency department on the day of their accident and 2 weeks, 1 month, 3 months, and 6 months later. Diagnoses were established with the Structured Clinical Interview for DSM-IV. Predictors included initial symptom severities; variables established as predictors of PTSD in E. J. Ozer, S. R. Best, T. L. Lipsey, and D. S. Weiss's (2003) meta-analysis; and variables derived from cognitive models of PTSD, phobia, and depression. Results of nonparametric multiple regression analyses showed that the cognitive variables predicted subsequent PTSD and depression severities over and above what could be predicted from initial symptom levels. They also showed greater predictive power than the established predictors, although the latter showed similar effect sizes as in the meta-analysis. In addition, the predictors derived from cognitive models of PTSD and depression were disorder-specific. The results support the role of cognitive factors in the maintenance of emotional disorders following trauma. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Kubany, E. S., Hill, E. E., Owens, J. A., Iannce-Spencer, C., McCaig, M.A., Tremayne, K. J., & Williams, P. L. (2004). Cognitive trauma therapy for battered women with PTSD. Journal of Consulting & Clinical Psychology, 72, 3-18.

Correspondence Address:
Kubany, Edward S. National Center for PTSD, Pacific Islands Division, Department of Veterans Affairs, 1132 Bishop Street, Suite 307, Honolulu, HI US 96813, edward.kubany@med.va.gov.

Abstract
This article describes a second treatment-outcome study of cognitive trauma therapy for battered women with posttraumatic stress disorder (PTSD; CTT-BW). CTT-BW includes trauma history exploration: PTSD education; stress management; exposure to abuse and abuser reminders; self-monitoring of negative self-talk; cognitive therapy for guilt; and modules on self-dvocacy, assertiveness, and how to identify perpetrators. One hundred twenty-five ethnically diverse women were randomly assigned to immediate or delayed CTT-BW. PTSD remitted in 87% of women who completed CTT-BW, with large reductions in depression and guilt and substantial increases in self-esteem. White and ethnic minority women benefited equally from CTT-BW. Similar treatment outcomes were obtained by male and female therapists and by therapists with different levels of education and training. Gains were maintained at 3- and 6- month follow-ups. (PsycINFO Database Record (c) 2004 APA, all rights reserved)

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

Correspondence Address:
Candice M. Monson, Veterans Affairs National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, 150 South Huntington Avenue (116B-3), Boston, MA, US, 02130, Candice.Monson@va.gov.

Abstract
Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Mueser, K. T., Rosenberg, S. D., Xie, H., Jankowski, M. K., Bolton, E. E., Lu, W., Hamblen, J. L., Rosenberg, H. J., McHugo, G. J., Wolfe, R. (2008). A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76(2), 259-271.

Correspondence Address
Kim T. Mueser, Dartmouth Psychiatric Research Center, Main Building, 105 Pleasant Street, Concord, NH, US, 03301, kim.t.mueser@dartmouth.edu.

Abstract
A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Powers, M. B.; Halpern, J. M.; Ferenschak, M. P.; Gillihan, S. J.; & Foa, E. B. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review , May 2, 2010, no pagination reported.

Correspondence Address:
Mark B. Powers, Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, 6th Floor, Philadelphia, PA 19104.

Abstract
Two decades of research demonstrate the efficacy of exposure therapy for posttraumatic stress disorder (PTSD). The efficacy of prolonged exposure (PE), a specific exposure therapy program for PTSD that has been disseminated throughout the world, has been established in many controlled studies using different trauma populations. However, a meta-analysis of the effectiveness of PE for PTSD has not been conducted to date. The purpose of the current paper is to estimate the overall efficacy of PE for PTSD relative to adequate controls. We included all published randomized controlled trials of PE vs. control (wait-list or psychological placebo) for the treatment of PTSD in adolescents or adults. Treatments were classified as PE if they included multiple sessions of imaginal and in vivo exposure and were based on the manualized treatment developed by Foa, Rothbaum, Riggs, & Murdock (1991). Thirteen studies with a total sample size of 658 participants met the final inclusion criteria. The primary analyses showed a large effect for PE versus control on both primary (Hedges's g=1.08) and secondary (Hedges's g = 0.77) outcome measures. Analyses also revealed medium to large effect sizes for PE at follow-up, both for primary (Hedges's g = 0.68) and secondary (Hedges's g = 0.41) outcome measures. There was no significant difference between PE and other active treatments (CPT, EMDR, CT, and SIT). Effect sizes were not moderated by time since trauma, publication year, dose, study quality, or type of trauma. The average PE-treated patient fared better than 86% of patients in control conditions at post-treatment on PTSD measures. PE is a highly effective treatment for PTSD, resulting in substantial treatment gains that are maintained over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Smith, P., Yule, W., Perrin, S., Tranah, T., Dalgleish, T., & Clark, D. M. (2007). Cognitive-behavioral therapy for PTSD in children and adolescents: A preliminary randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 46(8), 1051-1061.

Correspondence Address:
Patrick Smith, Department of Psychology, Institute of Psychiatry, P077, de Crespigny Park, London, United Kingdom, SE5 8AF, patrick.smith@iop.kcl.ac.uk.

Abstract
Objective: To evaluate the efficacy of individual trauma-focused cognitive-behavioral therapy (CBT) for treating posttraumatic stress disorder (PTSD) in children and young people. Method: Following a 4-week symptom-monitoring baseline period, 24 children and young people (8-18 years old) who met full DSM-IV PTSD diagnostic criteria after experiencing single-incident traumatic events (motor vehicle accidents, interpersonal violence, or witnessing violence) were randomly allocated to a 10-week course of individual CBT or to placement on a waitlist (WL) for 10 weeks. Results: Compared to the WL group, participants who received CBT showed significantly greater improvement in symptoms of PTSD, depression, and anxiety, with significantly better functioning. After CBT, 92% of participants no longer met criteria for PTSD; after WL, 42% of participants no longer met criteria. CBT gains were maintained at 6-month follow-up. Effects of CBT were partially mediated by changes in maladaptive cognitions, as predicted by cognitive models of PTSD. Conclusions: Individual trauma-focused CBT is an effective treatment for PTSD in children and young people. (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Speckens, A. E. M., Ehlers, A., Hackmann, A., & Clark, D. M. (2006). Changes in intrusive memories associated with imaginal reliving in posttraumatic stress disorder. Journal of Anxiety Disorders, 20, 328-341.

Correspondence Address:
Anne E. M. Speckens: Department of Psychology, Institute of Psychiatry, Centre for Anxiety Disorders and Trauma, De Crespigny Park, 99 Denmark Hill, London, United Kingdom, SE5 8AF, a.speckens@psy.umcn.nl.

Abstract
The study investigated changes in intrusive memories associated with imaginal reliving of traumatic events in posttraumatic stress disorder (PTSD). The study population comprised 44 patients treated with imaginal reliving in the context of cognitive therapy for PTSD [Behav. Res. Ther. 38 (2000) 319-345]. For most patients, imaginal reliving did not lead to exacerbations in intrusion frequency. The decrease in intrusion frequency after reliving was gradual, as was the decrease in their distress, vividness, and perceived "nowness." Poorer outcome, i.e., a smaller reduction in residual gain scores for intrusion frequency with reliving, was associated with greater initial PTSD severity, greater anger, greater perceived "nowness" of intrusive memories, and more negative interpretations of PTSD symptoms. The patient's anxiety, depression, self-blame, and dissociation were not predictive of response to reliving. (PsycINFO Database Record (c) 2006 APA, all rights reserved)