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

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.

[1]  E. Foa,et al.  9/11: Mental Health in the Wake of Terrorist Attacks: Dissemination of prolonged exposure therapy for posttraumatic stress disorder: successes and challenges , 2006 .

[2]  A. Beck,et al.  Anxiety disorders and phobias : a cognitive perspective , 2005 .

[3]  Barbara O Rothbaum,et al.  Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. , 2004, Archives of general psychiatry.

[4]  E. Foa,et al.  Cognitive changes during prolonged exposure versus prolonged exposure plus cognitive restructuring in female assault survivors with posttraumatic stress disorder. , 2004, Journal of consulting and clinical psychology.

[5]  C. Becker,et al.  A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD. , 2004, Behaviour research and therapy.

[6]  Steven Taylor,et al.  Advances in the treatment of posttraumatic stress disorder : cognitive-behavioral perspectives , 2004 .

[7]  R. Bryant,et al.  Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder. , 2003, Journal of consulting and clinical psychology.

[8]  E. Foa,et al.  Effect of Cognitive-Behavioral Treatments for PTSD on Anger , 2003, Journal of Cognitive Psychotherapy.

[9]  Loretta S. Malta,et al.  A controlled evaluation of cognitive behavioural therapy for posttraumatic stress in motor vehicle accident survivors. , 2003, Behaviour research and therapy.

[10]  Marylene Cloitre,et al.  Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse. , 2002, Journal of consulting and clinical psychology.

[11]  P. Nishith,et al.  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. , 2002, Journal of consulting and clinical psychology.

[12]  Lars-Göran Öst,et al.  Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. , 2001, Behaviour research and therapy.

[13]  E. Foa,et al.  The investigation of exposure and cognitive therapy: comment on Tarrier et al (1999). , 2001, Journal of Consulting and Clinical Psychology.

[14]  E. Foa,et al.  A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. , 2009, Journal of consulting and clinical psychology.

[15]  Edna B. Foa,et al.  The Posttraumatic Cognitions Inventory (PTCI): Development and validation. , 1999 .

[16]  K. Lovell,et al.  Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. , 1998, Archives of general psychiatry.

[17]  M. Kozak,et al.  Beyond the efficacy ceiling? Cognitive behavior therapy in search of theory * , 1997 .

[18]  B. Rothbaum,et al.  Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD , 1997 .

[19]  R. Heimberg,et al.  Dismantling cognitive-behavioral group therapy for social phobia. , 1995, Behaviour research and therapy.

[20]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[21]  Barbara O. Rothbaum,et al.  Reliability and validity of a brief instrument for assessing post‐traumatic stress disorder , 1993 .

[22]  B. Rothbaum,et al.  Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive-behavioral procedures and counseling. , 1991, Journal of consulting and clinical psychology.

[23]  Dennis S. Charney,et al.  A CLINICIAN RATING SCALE FOR ASSESSING CURRENT AND LIFETIME PTSD: THE CAPS-1 , 1990 .

[24]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[25]  S. Williams,et al.  Cognitive treatment in the natural environment for agoraphobics , 1983 .

[26]  M. Weissman,et al.  The depressed woman: A study of social relationships , 1974 .

[27]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.