Psychosocial interventions for adults with crime-related PTSD.

Abstract

Summary Crime affects more than half of all adults in the United States atsome time during their lifetime. In some instances, this involvesdirect victimization in the form of robbery, physical assault, rape,or other events. In other cases, crime can affect individuals indi-rectly, such as when a person witnesses homicide or seriouscommunity violence or when a child repeatedly witnesses seriousdomestic violence in the home. Epidemiological research clearlydemonstrates that individuals who directly or indirectly experiencecrime are at risk for PTSD and other mental health and health-riskproblems. Whereas most crime victims are resilient or experiencerapid recovery of symptoms after short-term distress or impair-ment, some experience chronic mental health problems that arerelated to the victimization incident and require formal treatment.PTSD is the most prevalent mental health problem endorsed bycrime victims, and several interventions exist for this populationthat practitioners would likely find valuable to have in their toolkit. However, we recognize that other disorders are also prevalentfollowing criminal victimization, and therefore the fact that wehave limited our review to PTSD is a drawback. Despite thislimitation, several conclusions can be drawn from the literature.Cognitive–behavioral treatment protocols developed by Bryantet al. (1998, 1999, 2006; Bryant, Moulds, & Nixon, 2003) and Foa,Hearst-Ikeda, et al. (1995; Foa et al., 2006) may be beneficial tocrime victims who have high levels of distress and present fortreatment within 2–6 weeks of their victimization. Crime victimswith chronic PTSD, conversely, may benefit from a treatmentpackage such as PE, CPT, and SIT. All three of these treatmentapproaches are supported by multiple RCTs, and evidence forefficacy is strong. Unfortunately, however, little is known aboutthe use and success of these interventions in traditional mentalhealth settings, where front-line practitioners do not have access tothe intensive supervision that is available in tightly controlledresearch. Also, even in rigorously controlled research, when cli-nicians have high levels of fidelity to these protocols, a meaningfulpercentage of patients do not recover. Some patients continue tohave significant symptoms and functional impairment and evenmeet full diagnostic criteria for PTSD after treatment has beencompleted. More research is needed to learn how to reach thesetreatment nonresponders. Efforts in product development also areneeded to ensure that practitioners have access to resources thatenable them to implement these promising interventions whenserving patients who are likely to benefit from them.