Cognitive-behavioral Treatment For Posttraumatic Stress Disorder Research Articles

Toxic stress in adolescence: A person-centered approach

Research has shown that posttraumatic stress disorder (PTSD), substance use disorder (SUD), criminality, and violence are powerfully intertwined. However, little is known about the prevalence of violence perpetration amongst individuals with co-occurring PTSD and SUD (PTSD + SUD) and how such histories impact and interact with varying treatment approaches. The present study examined the rates and effect upon treatment of violent offenses in individuals with PTSD + SUD. We analyzed psychiatric, legal, and demographic data of an ethnically diverse sample (n = 80) recruited from an urban, economically disadvantaged area to participate in a randomized controlled trial of two cognitive behavioral treatments for PTSD + SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention (RP). A majority of the sample (61.3%) endorsed a prior arrest history; 27.5% of individuals reported an arrest for a violent crime with men disproportionately represented among those with a violent offending history (60.3% vs.90.9%, p = .008). Two-level mixed effect models revealed an interaction between violent offending, treatment type, and time upon PTSD symptom severity, but not SUD symptom severity. Findings underscore the likelihood of criminal justice involvement among individuals suffering from PTSD + SUD and the relevance of trauma-informed care to justice-involved populations. Treatment which targets PTSD and SUD concurrently, in contrast to SUD-only interventions, may be particularly beneficial for individuals with histories of violence perpetration, suggesting a potential avenue for breaking cycles of victimization and violence.

Does a history of violent offending impact treatment response for comorbid PTSD and substance use disorders? A secondary analysis of a randomized controlled trial

Research has shown that posttraumatic stress disorder (PTSD), substance use disorder (SUD), criminality, and violence are powerfully intertwined. However, little is known about the prevalence of violence perpetration amongst individuals with co-occurring PTSD and SUD (PTSD + SUD) and how such histories impact and interact with varying treatment approaches. The present study examined the rates and effect upon treatment of violent offenses in individuals with PTSD + SUD. We analyzed psychiatric, legal, and demographic data of an ethnically diverse sample (n = 80) recruited from an urban, economically disadvantaged area to participate in a randomized controlled trial of two cognitive behavioral treatments for PTSD + SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention (RP). A majority of the sample (61.3%) endorsed a prior arrest history; 27.5% of individuals reported an arrest for a violent crime with men disproportionately represented among those with a violent offending history (60.3% vs.90.9%, p = .008). Two-level mixed effect models revealed an interaction between violent offending, treatment type, and time upon PTSD symptom severity, but not SUD symptom severity. Findings underscore the likelihood of criminal justice involvement among individuals suffering from PTSD + SUD and the relevance of trauma-informed care to justice-involved populations. Treatment which targets PTSD and SUD concurrently, in contrast to SUD-only interventions, may be particularly beneficial for individuals with histories of violence perpetration, suggesting a potential avenue for breaking cycles of victimization and violence.

Lagged effects of substance use on PTSD severity in a randomized controlled trial with modified prolonged exposure and relapse prevention.

To advance understanding of the effectiveness of evidence-based treatments for comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD), research must provide a more nuanced picture of how substance use affects change in PTSD symptoms over the course of treatments and whether prolonged exposure techniques can be efficacious during active substance use. A data set that included patients with PTSD/subthreshold-PTSD and SUD treated with an exposure-based intervention provided an opportunity to conduct a secondary analysis to test how patients' substance use impacted PTSD change over treatment. We applied growth models to week-to-week PTSD symptom and substance use changes during treatment and follow-up of a randomized controlled trial of two cognitive-behavioral treatments for PTSD and SUD: Concurrent Treatment of PTSD and SUD Using Prolonged Exposure (COPE) and Relapse Prevention Therapy (RPT). Cross-lagged analyses were used to determine whether prior week substance use impacted subsequent PTSD symptom severity. Both treatments evidenced significant reductions in PTSD symptom severity. In the context of continued substance use, results suggest that individuals still benefit from exposure-based treatment. Results provide evidence that RPT and COPE both led to significant reductions in PTSD, providing further support that exposure-based techniques tailored for SUD can be conducted without jeopardizing PTSD or SUD outcomes. Implications for clinical decision making around treatment selection are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Cognitive-Behavioral Treatment of PTSD With a Young Boy and His Mother Following the Experience of Chronic Domestic Violence

This case study follows a 7-year-old boy who presented with symptoms of posttraumatic stress disorder (PTSD) following exposure to domestic violence beginning at a very young age. During evaluation of this young boy’s symptoms, it became evident that his mother also was experiencing symptoms of PTSD. Consequently, treatment for both this young boy and his mother was proposed. Cognitive-behavioral therapy (CBT) has been used widely with both children and adults to treat PTSD. Fortunately, treatments have been tailored for young children (e.g., trauma-focused CBT [TF-CBT]; preschool PTSD treatment [PPT]) and for adults (e.g., cognitive processing therapy [CPT]). In the current case study, a combination of PPT and TF-CBT was utilized to treat this young boy, and CPT was utilized to treat his mother. With this course of treatment, this young boy demonstrated decreases in his PTSD symptoms and gained an understanding of coping skills and cognitive restructuring. His mother also demonstrated decreases in her PTSD symptoms. Overall, this dyad showed qualitative improvements in their general emotional and behavioral functioning, their individual self-regulation abilities, their social interactions, and their relationship. This case study provides evidence for the importance of treating both young child and parent when both have been exposed to and traumatized by domestic violence. Furthermore, this case study provides a framework for other health service providers to implement conjoint treatment of similarly traumatized families.

Impact of co-therapy in the cognitive behavioral treatment of PTSD

Cognitive behavioral therapy (CBT) is an effective treatment for Post Traumatic Stress Disorder (PTSD) and use techniques such as psychoeducation, cognitive restructuring, relaxation, breathing retraining, imaginal and in vivo exposure. The role of co-therapy in individual treatment of patients hasn’t been well investigated. The aim of the present study was to illustrate the adaptation of a version of Edna Foa’s protocol of CBT for the treatment of PTSD, highlighting the addition of co-therapy, not included at

Cognitive-Behavioral Treatment of PTSD in Severe Mental Illness: Pilot Study Replication in an Ethnically Diverse Population

Posttraumatic stress disorder (PTSD) is a common comorbid condition in persons with severe mental illnesses (SMI) such as bipolar disorder, schizophrenia, and major depression. A parent study conducted in New Hampshire examined the effects of a 12- to 16-week cognitive-behavioral therapy (CBT) intervention for PTSD among people with SMI. We conducted a pilot study examining the effects of this intervention with an ethnically diverse sample of 14 clients with PTSD and SMI in an urban setting in New Jersey. Results showed high levels of retention in treatment and improvement at three and six months posttreatment in PTSD. We discuss the importance of this intervention in this population.

Borderline Personality Characteristics and Treatment Outcome in Cognitive-Behavioral Treatments for PTSD in Female Rape Victims

Many studies report that comorbid borderline personality pathology is associated with poorer outcomes in the treatment of Axis I disorders. Given the high rates of comorbidity between borderline personality pathology and posttraumatic stress disorder (PTSD), it is essential to determine whether borderline symptomatology affects PTSD treatment outcome. This study examined the effects of borderline personality characteristics (BPC) on 131 female rape victims receiving cognitive-behavioral treatment for PTSD. Higher BPC scores were associated with greater pretreatment PTSD severity; however, individuals with higher levels of BPC were just as likely to complete treatment and also as likely to show significant treatment response on several outcome measures. There were no significant interactions between type of treatment and BPC on the outcome variables. Findings suggest that women with borderline pathology may be able to benefit significantly from cognitive-behavioral treatment for PTSD.

Clinicians' Perspectives on Cognitive-Behavioral Treatment for PTSD Among Persons With Severe Mental Illness

As an intermediate step in the development of a cognitive-behavioral posttraumatic stress disorder (PTSD) treatment program for persons with severe mental illness, a focus group gathered feedback from clinicians and clinical supervisors within a public-sector mental health system. Five qualitative focus group discussions were held with 33 clinicians and clinical supervisors within a state-funded community mental health center system. Clinicians perceived trauma to be a significant adverse factor in the lives of their mental health services consumers, were reluctant to address trauma with them, and yet believed that cognitive-behavioral treatments for PTSD may be effective and appropriate for them. Clinicians also offered practical suggestions to improve the feasibility and acceptability of the proposed cognitive-behavioral treatment program. Examples include creating gender-specific treatment groups; ensuring that trust and rapport with clients are established before the discussion of traumatic experiences; developing careful safety precautions for clients, especially for the exposure therapy component; preparing for the possibility that some consumers will lack the cognitive ability to understand treatment; and collaborating with other care providers to ensure optimal integration with other aspects of care and minimize clinic disruptions. These findings provide information relevant to the development and implementation of PTSD interventions for patients with severe mental illness treated in public-sector settings.

Cognitive-Behavioral Treatment of Rape- and War-Related Posttraumatic Stress Disorder With a Female, Bosnian Refugee

Prevalence of posttraumatic stress disorder (PTSD) among rape victims and war refugees is high. Cognitive-behavioral interventions have demonstrated effectiveness in alleviating PTSD in rape survivors. Effectiveness of such interventions when rape is perpetrated as part of war hostilities has not been examined. Rape and plunder of civilian populations characterized the 1991 to 1995 war in the former Yugoslavia. Rape camps terrorized civilians on all sides of that conflict. This case study illustrates a course of cognitive-behavioral treatment for PTSD with a female, Bosnian refugee and rape survivor. At post treatment, the client no longer met criteria for PTSD, and improvements were evident at 6- and 12-month follow-ups. Approaches to treating PTSD in war refugees are discussed.

Cognitive-Behavioral Treatment for PTSD in People with Severe Mental Illness: Three Case Studies

In this article, we present three case studies of clients with severe mental illness (SMI) and posttraumatic stress disorder (PTSD) who participated in a recently developed cognitive-behavioral treatment program (Mueser, Rosenberg, Jankowski, Hamblen, & Descamps, 2004). Each client had PTSD, and a DSM-IV Axis I diagnosis (1 bipolar disorder, 2 schizoaffective disorder), as well as multiple other problems that would ordinarily have resulted in exclusion from established cognitive-behavioral programs for PTSD (e.g., substance dependence, suicidal ideation, cognitive impairment, psychotic symptoms, acute psychosocial stressors). All clients were able to complete the program, and all demonstrated significant improvements in PTSD, with two out of three no longer meeting criteria for PTSD at the three-month follow-up. Clients also showed modest improvements in other psychiatric symptoms. These case studies, combined with the results of a larger pilot study of the treatment program (Rosenberg, Mueser, Jankowski,...

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

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.

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

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. Findings from this study suggest that, immediately following Multiple Channel Exposure Therapy (MCET), 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. Future directions and clinical implications are discussed.

Cognitive Behavioral Treatment of PTSD with Comorbid Panic Attacks

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.

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

This article 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 C. M. Nezu and Nezu's (1995) problem-solving model. 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. 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 from these treatments is discussed.