4
Evidence and Conclusions: Psychotherapy

Psychotherapeutic interventions for posttraumatic stress disorder (PTSD) vary in their emphasis on reexposure to trauma-related memories and stimuli, cognitive restructuring of the trauma experience, expression and management of emotion, training in stress management (including relaxation training), and general social and vocational support. Although a number of these treatments emphasize one of these components, many combine more than one either implicitly or by design, and relatively few studies dismantled effective components of the psychotherapy. A more complete description of psychotherapy is provided in Appendix A.

The committee noted that virtually all of the recent literature on psychotherapies for PTSD examines interventions that some experts consider components of cognitive-behavioral therapy (CBT). For example, Harvey et al. (2003) describe four basic components of CBT: psychoeducation, exposure, cognitive restructuring, and anxiety management training. The theoretical literature also acknowledges the overlap among these approaches as well as incomplete understanding of the mechanisms at work when these interventions are used (Foa and Meadows, 1997; Foa et al., 2000; Harvey et al., 2003). Nonetheless, the committee found that the psychotherapeutic approaches studied in the literature are segmented into CBT components alone and in various combinations. In presenting the summaries below, the committee has grouped therapies based on its understanding of the psychotherapeutic literature and for convenience of exposition, but is aware that others have and may organize the literature differently. The committee identified the following categories of psychotherapies (as used in a treatment condition or “arm”): exposure, cognitive restructuring, coping skills



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4 Evidence and Conclusions: Psychotherapy P sychotherapeutic interventions for posttraumatic stress disorder (PTSD) vary in their emphasis on reexposure to trauma-related memories and stimuli, cognitive restructuring of the trauma experience, expression and management of emotion, training in stress management (including relaxation training), and general social and vocational support. Although a number of these treatments emphasize one of these components, many combine more than one either implicitly or by design, and relatively few studies dismantled effective components of the psychotherapy. A more com- plete description of psychotherapy is provided in Appendix A. The committee noted that virtually all of the recent literature on psycho- therapies for PTSD examines interventions that some experts consider com- ponents of cognitive-behavioral therapy (CBT). For example, Harvey et al. (2003) describe four basic components of CBT: psychoeducation, exposure, cognitive restructuring, and anxiety management training. The theoretical literature also acknowledges the overlap among these approaches as well as incomplete understanding of the mechanisms at work when these inter- ventions are used (Foa and Meadows, 1997; Foa et al., 2000; Harvey et al., 2003). Nonetheless, the committee found that the psychotherapeutic approaches studied in the literature are segmented into CBT components alone and in various combinations. In presenting the summaries below, the committee has grouped therapies based on its understanding of the psycho- therapeutic literature and for convenience of exposition, but is aware that others have and may organize the literature differently. The committee identified the following categories of psychotherapies (as used in a treat- ment condition or “arm”): exposure, cognitive restructuring, coping skills 

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER training, exposure plus cognitive restructuring, exposure plus coping skills, eye movement desensitization and reprocessing (EMDR), other psycho- therapies, and group format psychotherapy. Exposure refers to several closely related techniques such as prolonged exposure, direct exposure therapy, and multiple channel exposure therapy, and they are evaluated here as one category, both alone and in combination with other approaches. The category of coping skills training includes stress inoculation therapy, relaxation, biofeedback, and so on. The category of cognitive restructuring refers to psychotherapies designed to help individuals with PTSD alter their understanding of the meaning of their traumatic experiences, for example, by considering their adaptive responses to the trauma as well as the help- lessness inflicted by it. The treatment modalities assessed in this chapter were individually administered with a few exceptions where psychotherapy was administered in a group format. The majority of psychotherapy studies compared one or more active treatments to a wait-list control. Less frequently, the control was usual care (such as non-PTSD specific care) or minimum care (such as phone counsel- ing). A smaller proportion of the psychotherapy studies compared active treatment to an active control such as a coping skills training program (e.g., relaxation) or present-centered therapy. The committee included 52 studies of psychotherapies (reasons for exclusion are listed in the individual sections below). Of the included studies, 18 had no major limitations and thus were most informative to the committee’s conclusions regarding efficacy of a treatment modality (see evi- dence tables following each treatment for a summary of these studies), but such studies were considered in the context of the body of evidence for each treatment modality. Trauma types in these studies included combat (within the United States and internationally), sexual abuse, physical assault, ac- cidental injury, motor vehicle accidents (MVAs), natural disaster, witnessing (death or genocide), being a victim of crime, and being a refugee. When analyzing the studies by sex, population, or trauma type, the committee labeled the study as being “predominantly” one type of sex, population, or trauma if 80 percent of the study population or more was of one type of sex, population, or trauma. The committee labeled the study as “mixed” if 79 percent or less of the study population was of one type of sex, population, or trauma. Eleven studies had a predominantly male population, 25 had a female population, and 15 had a mixed (male and female) population. Ten studies were in veteran populations, 17 in- cluded victims of sexual or physical abuse, and 23 had a mixed or other trauma type.1 The committee found that in the psychotherapy literature, as in the pharmacotherapy literature, with few exceptions, when a veteran 1 Some studies did not include sex or trauma type.

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 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY population predominated, the participants were mostly male, and when the majority of cases had been sexually abused or assaulted, participants were mostly female although there are instances when that is not the case. With mixed trauma type, the sex ratios were more equally divided. EXPOSURE THERAPIES The committee found a substantial number of randomized controlled trials (RCTs) comparing exposure therapies (alone or with some other component) to wait-list or usual care controls. The category of exposure comprised exposure therapies alone and several different combinations of exposure with cognitive restructuring or coping skills training. The large number of studies of exposure therapy comprises the range of features found in the rest of the psychotherapy studies, with regard to length of treatment, variety of trauma, age of participants, training of clinicians, and so on. Participants in the exposure therapy studies had suffered a variety of traumas, including combat-related, sexual abuse and/or assault, civil war, and motor vehicle accident. The mean age of study participants ranged from early-20s to the 50s, with most studies reporting a mean age between the mid-30s and mid-40s. Few studies reported duration of illness, but many provided information about the time since trauma, which ranged from several months in studies with rape survivors to more than two decades in studies with veterans. Some studies, such as those in survivors of sexual assault, included only female participants, while many others had a mix of men and women, and studies in people traumatized by combat had all male participants. Some, but not all, studies provided information about the race/ethnicity of participants. In most studies, participants were white, with a smaller number of studies reporting percentages of non-white participants at approximately 20 percent, 30 percent, and in a few cases, nearly 50 percent. Exposure therapy included psychoeducation, breathing retraining, and relaxation, in addition to exposure (specifically imaginal and in vivo expo- sure, flooding, directed therapeutic exposure, etc.). Some exposure therapy programs also required completing homework, generally repeated exposure to a trauma tape or other record of the trauma narrative. Exposure studies, like other psychotherapy studies, are lengthy and require considerable investment of time, emotion, and effort. Most studies administered expo- sure and usually also the comparison treatments for at least several weeks (e.g., 4.5, 9–12, 30 weeks). Only a small number of studies provided treat- ment in one session or for a short time: one 60-minute session in Basoglu et al. (2005), one session in Basoglu et al. (2007), two 90-minute sessions in Boudewyns et al. (1993).

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER Most studies reported that study therapists had at least master’s level training and frequently held doctorates in psychology, clinical psychology, or clinical social work. Only one study used therapists with less then gradu- ate training but considerable counseling experience, and a few studies used graduate students. Most studies used psychologists, but several studies also used marriage and family counselors (MFCCs), licensed clinical social workers, and one study also used nurses. The majority of studies reported that study therapists were trained and supervised. The majority of exposure therapy studies did not report on or measure adverse events associated with their treatment condition. Only Monson et al. (2006), Foa et al. (2005), Schnurr et al. (2007), and Chard (2005) measured adverse events. Many studies conducted follow-up after the completion of treatment. The earliest timing of follow-up assessments was 1 month, and the latest was between 1 and 2 years after treatment. Some studies took follow-up measures at 3, 6, and 9 months post-treatment. Of the 23 studies in this category, 16 had major limitations including high dropout rates,2 absent or weak treatment of missing values, lack of assessor independence, not conducting an intention to treat analysis, or failure to report a critical characteristic (Blanchard and Hickling, 2004; Boudewyns et al., 1993; Classen et al., 2001; Cloitre et al., 2002; Falsetti et al., 2001; Foa et al., 1991, 1999, 2005; Glynn et al., 1999; Keane et al., 1998; Kubany et al., 2003, 2004; McDonagh et al., 2005; Power et al., 2002; Resick et al., 2002; Rothbaum et al., 2005). Eight studies met most or all of the quality criteria outlined in Chapter 2 (the main shortcoming in two of these studies was in the handling of substantial dropout rates with less robust statistical methods and or assessor blinding or independence) (Basoglu et al., 2005, 2007; Chard, 2005; Fecteau and Nicki, 1999; Hinton et al., 2005; Keane et al., 1989; Monson et al., 2006; Rothbaum et al., 2005). All eight of these studies demonstrated a statistically significant im- provement with treatment to a primary PTSD scale or to the loss of PTSD diagnosis. One of these studies with no major limitations in male veterans with chronic PTSD showed both reductions in a primary PTSD scale and the loss of PTSD diagnosis with cognitive processing therapy (a combina- tion of exposure and cognitive restructuring) (Monson et al., 2006). The committee identified eight additional RCTs comparing exposure therapies to an active control (coping skills training program or present- centered therapy). Four of the studies had major limitations, such as high dropout rates and either presenting only a completer analysis or using last observation carried forward (LOCF) despite dropout rates of up to 2The APA (2004) review of the literature identifies high rate of dropout as a challenge of exposure therapies.

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 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY 40 percent (Boudewyns et al., 1990; Marks et al., 1998, 2007; Taylor et al., 2003; Vaughan et al., 1994). Four studies had few or no limitations. One small study conducted among mostly female victims of abuse or MVA found substantial decrease in Clinician Administered PTSD Scale (CAPS) scores and loss of diagnosis (Bryant et al., 2003). One was conducted in male veterans with chronic PTSD showing no benefit of trauma-focused therapy administered in groups compared with present-centered therapy (Schnurr et al., 2003). Another study among female veterans with PTSD, 70 percent of whom nominated sexual assault as their index (worst) trauma, showed a benefit of individually administered exposure therapy (Schnurr et al., 2007). A single small study of female victims of sexual assault showed significant improvements in both a global PTSD scale and in loss of diag- nosis (Echeburua et al., 1997). The committee found it difficult to judge the validity of the results comparing exposure therapy to a coping skills training program or present-centered therapy overall because four of the eight studies had major limitations, but the remaining studies support the overall conclusion that exposure therapy is efficacious. Synthesis: The committee judged that the quality of the overall body of evidence supporting exposure therapies is moderate to high, with the best studies all pointing in the same direction with an important clinical benefit. The committee is confident in both the presence of a positive effect and in its clinical significance. Further research is likely to refine estimates of the effect in different settings and populations, but is unlikely to change confi- dence in the overall estimate of effect. Conclusion: The committee finds that the evidence is sufficient to con- clude the efficacy of exposure therapies in the treatment of PTSD. Comment The evidence for efficacy of exposure therapy in veterans—especially in males with chronic PTSD—is less consistent than the general body of evidence. Also, it should be noted that, as described above and in Appendix A, exposure therapies (e.g., prolonged exposure), as delivered often contain components of other CBT approaches, such as cognitive restructuring and coping skills training. Thus the conclusion that the evidence supports the efficacy of exposure therapy should not be interpreted too narrowly. Head-to-Head Comparisons Because the committee judged the evidence sufficient to establish efficacy of exposure therapies, it also reviewed the literature where an

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER exposure therapy was compared with some other intervention.3 If evi- dence strongly supported equivalency of the other therapy compared with exposure therapy, it would add support for the other therapy. We identi- fied seven such studies, but only one—a comparison of exposure therapy with cognitive restructuring in a mixed trauma population (Tarrier et al., 1999)—had no major limitations and it showed that the two therapies were equivalent. The study was small, however, so the committee could not judge whether it had adequate power to detect a clinically significant difference, and thus did not reach a conclusion regarding the equivalency of the two treatments. Exclusion Notes Several exposure trials were excluded because they were not random- ized (or only partially randomized) (Brady et al., 2001;4 Cloitre and Koenen, 2001;5 Cooper and Clum, 1989;6 Humphreys et al., 1999;7 Monson et al., 20058). Trials that did not include a comparison or control group were also excluded (Basoglu et al., 2003;9 Forbes et al., 2002;10 Frommberger et al., 2004;11 Najavits et al., 1998). Three trials included participants not formally diagnosed with PTSD, or only part of the sample was diagnosed so were excluded (Foa et al., 1995;12 Lubin et al., 1998;13 Valentine and Smith, 2001). There were also two studies where PTSD was not the main 3 After this report was released an additional head-to-head study was brought to the com- mittee’s attention (Ironson et al., 2002). Because of lack of clarity regarding inclusion criteria, the randomization protocol, and the treatment actually delivered, the study was uninformative regarding the principal comparison of PE to EMDR. 4This study also looked at dual diagnosis (PTSD and cocaine addiction) and had a high dropout rate greater than 50 percent. 5This was a naturalistic study where treatment was interpersonal process group therapy in patients with and without bipolar disorder. 6Randomization was not 100 percent. Patients were assigned to standard treatment or standard treatment plus imaginal flooding. 7Program evaluation. 8This was a preliminary program effectiveness study that compared two variations of CBT in a veteran population. 9Modified behavioral treatment given to N = 231 earthquake survivors; duration of treat- ment and improvement of symptoms were outcomes. 10Longitudinal trial examining predictors of response versus treatment efficacy. 11This trial compared paroxetine treatment (10–50 mg dosages given) versus CBT treat- ment (exposure and cognitive restructuring). PTSD and depression symptomatology were outcome variables. 12Subjects diagnosed with PTSD per Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), but mean duration of illness was 15 days (9.40 for control), correspond- ing to the current definition for acute stress disorder. 13Patients only had PTSD symptoms, not PTSD diagnosis.

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 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY study outcome, and neither study included overall PTSD outcome measures (Boudewyns and Hyer, 1990; Chemtob et al., 199714). Falsetti et al. (2003) was excluded because it is an additional analysis of Falsetti et al. (2001) that does not include PTSD outcome data (although it includes other data for the complete sample, unlike the 2001 publication, which was prelimi- nary). See Tables 4-1, 4-2, and 4-3 for a summary of included studies. EYE MOVEMENT DESENSITIZATION AND REPROCESSING The committee identified a diverse literature of 10 randomized trials of EMDR compared with various other therapies and wait list or alone compared with wait-list control. The mean age in these studies was in the 30s to the 40s (with a wider range for civilian studies, typically including participants from age 18 to the 70s, and a narrower range for studies in veterans, generally of the Vietnam War). The sex of participants varied in a pattern similar to that described in Chapter 3—in four studies where the trauma was combat, most or all participants were male; participants in the two studies with sexual assault/abuse victims were all female, and partici- pants with a variety of trauma types included a mix of men and women. Approximately half of the studies provided race/ethnicity data, with the range of white participants from 54 to 68 percent. Most studies reported duration of PTSD diagnosis or exposure to index trauma with a range from approximately 1 year in a study of occupational witnessing man-under- train accidents to two decades in the case of veterans. Treatment length ranged from 2 sessions to 10 weekly sessions, and duration of sessions was generally 90 minutes. Most studies provided information about therapists administering the treatment, and they typically were reported as being licensed, trained at master’s level or above, and having received EMDR training (some had level II training). Most therapists also were supervised. Some studies did not conduct follow-up after the completion of treatment, while others conducted follow-up at 3, 6, 12, or 15 months. Six trials had major limitations such as lack of assessor blinding or independence, high dropout rates, or weak (or no) treatment of missing values (Boudewyns et al., 1993; Jensen, 1994; Marcus et al., 1997; Power et al., 2002; Rothbaum, 1997; Silver et al., 1995). Four studies had few or no major limitations, and of those, two showed statistically significant improvement in CAPS score or a significant difference in loss of diagnosis in the treated group (Carlson et al., 1998; Hogberg et al., 2007; Rothbaum et al., 2005; van der Kolk et al., 2007). The study by Carlson and colleagues was a small trial in male veterans, and it showed no effect post-treatment. The study by van der Kolk and colleagues was an RCT comparing EMDR, 14Anger is main outcome. This trial was done with Vietnam War veterans.

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00 TREATMENT OF POSTTRAUMATIC STRESS DISORDER TABLE 4-1 Exposure Handling of Dropouts PTSD and % Completed Tx Outcome Populationa Study Arm (N) by Arm Measure Basoglu et al., Female, nat. Total (31) 100% CAPS 2007 disaster E (16) WL (15) Monson et al., Male, combat Total (60) ITT (random CAPS 2006 regression) E+CR (30) 80% WL (30) 87% Basoglu et al., Female, nat. Total (59) 100% CAPS 2005c disaster E+CR (31) WL (28) Chard, 2005 Female, Total (71) ITT (LOCF) CAPS sexual abuse E+CR (36) 83.3% MC (35) 80.0% ITT (BOCF)d Foa et al., 2005 Female, Total (179) PSS-I S&NS abuse E (79) 59% E+CR (74) 66% WL (26) 96% Hinton et al., Mixed sex, Total (40) None CAPS 2005 witness E+CR No dropouts genocide WL, then E+CRe McDonagh et al., Female, Total (74) ITT (LOCF) CAPS 2005 sexual abuse E+CR (29) 59% CS (22) 91% WL (23) 87% Rothbaum et al., Female, Total (72) ITT (but only CAPS 2005 sexual abuse, completer reported) assault 83.3% total E (23) 87.0% EMDR (25) 80.0% WL (24) 83.3%

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0 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Baselineb and Statistically Assessor Change in Significant? Loss of Blinded? PTSD Measure (versus control) Diagnosis (%) Principal Limitations Yes No major limitations –32.9 Yes –13.2 Yes 76.73, 79.10 Yes No major limitations –24.59 –3.07 40% 3% Yes Yes NR No major limitations –23.4 –5.8 Yes 65.46, 68.30 Yes 93% No major limitations –56.5 26% –5.3 Yes 35.1, 30, 35.5 NR High dropout handled –16.1 with BOCF, high –13.7 Yes differential dropout –6.5 Yes Yes 74.85, 75.91 Yes 60% No major limitations –35.60 (compared to 0%, then –2.86, then delayed WL 50% –28.00 group, no after WL treated ) Yes 69.9, 67.7, 72.0 High attrition handled –16.8 Yes 27.6% with LOCF, high –20.5 Yes 31.8% differential dropout –6.5 17.4% Yes M(SD) NR Treatment of missing data not reported Yes 95% Yes 75% 10% continued

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0 TREATMENT OF POSTTRAUMATIC STRESS DISORDER TABLE 4-1 Continued Handling of Dropouts PTSD and % Completed Tx Outcome Populationa Study Arm (N) by Arm Measure Blanchard et al., Mixed sex, Total (98) ITT (reanalysis incl. CAPS 2004 MVA dropouts) E+CR (36) 75.0% CS (37) 72.9% WL (25) 96.0% ITTg Kubany et al., Female, abuse Total (125) CAPS E+CR-If (63) 2004 73.1% E+CR-Df (62) 56.5% Neuner, 2004 Female, mixed Total (43) Restricted maximum PTSD likelihood procedure diagnosis E (17) 94% per PDS CS (14) 86% MC (12) 100% Kubany et al., Female, Total (37) ITT (LOCF) CAPS E+CR-If (19) 2003 assault 94.7% E+CR-Df (18) 77.7% Cloitre et al., 2002 Female, Total (58) ITT (LOCF) CAPS S&NS abuse E+CS (31) 71% WL (27) 89% IOEj Power et al., 2002 Mixed sex, Total (105) None MVA, other EMDR (39) 70% E+CR (37) 59% WL (29) 83% Resick et al., 2002 Female, Total (121) ITT (LOCF) CAPS sexual abuse, E+CR (41) 73.2% assault E (40) 72.7% MC (40) 85.1%

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0 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Baselineb and Statistically Assessor Change in Significant? Loss of Blinded? PTSD Measure (versus control) Diagnosis (%) Principal Limitations Yes 68.2, 65.0, High dropout handled 65.8 with LOCF and high Yes 76.2% differential dropout –44.5 Yes 44.4% –24.9 –11.8 72.9, 71.9h Yes High dropout handled –57.1 Yes 91% with LOCF and high –5.6, then No, then yes 80% differential dropout –49.8 Yes 25.2, 2.0, 19.5 (at 1-year No major limitations follow-up) Yesi –6.1 –2.2 No 71% +1.7 21% 20% Yes 80.9, 79.1 High dropout handled –70.8 Yes 94% with LOCF and high –3.0, then Yes 93% differential dropout –67.5 Yes 69 NR High dropout handled –38 Yes with LOCF and high –7 differential dropout Yes Yes NR High dropout, no –23.3 treatment of missing data, –13.5 high differential dropout –3 Yes Relatively high dropout –35.68 Yes 53% handled with LOCF –31.71 Yes 53% –0.59 2% continued

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER TABLE 4-8 Other Psychotherapies Handling of Dropouts PTSD and % Completed Tx Outcome Populationa Study Arm (N) by Arm Measure Lindauer et al., Mixed sex, Total (24) ITT PTSD OT (BEP)c (12) 2005 mixed trauma 58% diagnosis WL (12) 92% per SI-PTSD Gersons et al., Mixed sex, Total (42) NR PTSD symptomsd 2000 police work OT (BEP) (22) 100% WL (20) 95% (SI-PTSD data NR) Peniston and Total (29) MMPI- OT (BN)f (15) Kulkosky, 1991 Male, trauma PTSD UCg (14) type NR 100% Brom et al., 1989 Mixed sex, Total (112) NR IES Total mixed trauma E (31) 90.3% OT (H)h (29) 89.7% OT (P)i (29) 89.7% WL (23) 86.9%+ aIn the population column, male alone or female alone denotes that at least 80% of the study population was male or female. If only one trauma type is listed, at least 80% of the study population reported that type of trauma. bPTSD outcome measure change data were obtained either directly from the study, when provided, or by subtracting data reported at treatment completion (not follow-up data) from baseline data (before treatment began). Average baseline score when reported or when baseline scores for all arms are nearly the same; otherwise, baseline scores listed individually in order of arm. cBrief eclectic psychotherapy, a combination of CBT and psychodynamic approaches includ- ing relationship and work issues. what was considered an adequate dose of 80 percent of treatment sessions). See Table 4-9 for a summary of included studies. Synthesis: The committee judged the overall body of evidence regarding group therapy formats to be low quality to inform a conclusion regarding efficacy because of the lack of well-designed studies comparing group and individual formats and including appropriate controls. The committee is uncertain about the presence of an effect, and believes that future well- designed studies will have an important impact on confidence in the effect and the size of the effect.

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 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Baselineb and Statistically Assessor Change in Significant? Loss of Blinded? PTSD Measure (versus control) Diagnosis (%) Principal Limitations Yes 100.0% Same as 42% dropout –83.3% Yes baseline and –25.0% change 11.5e Yes No major limitations (but –8 Yes 91% broken –3 50% in 4 Ss) No No relapse No assessor blinding or Yes at 30 months independence 31, 36 –21 80% –0 0% NR NR Assessor blinding or 19.4 Yes independence not reported 17.1 Yes 13.6 Yes 4.6 dOutcome measure was “recovery proportions,” including no PTSD and fewer than six symptoms (SI-PTSD used to determine both). eData not provided; figures estimated based on visual inspection of a bar graph, with the help of a ruler. fBrainwave neurofeedback. gUsual care. hHypnosis. iPsychodynamic therapy. Conclusion: The committee concludes that the evidence is inadequate to determine the efficacy of group therapy formats in the treatment of PTSD. SUMMATION Based on its assessment of the psychotherapy approaches for which randomized controlled trials were available—exposure, EMDR, cognitive

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER TABLE 4-9 Group Therapy Handling of Dropouts PTSD and % Completed Tx Outcome Populationa Study Arm (N) by Arm Measure Chard et al., 2005 Female, Total (71) ITT (LOCF) CAPS sexual abuse E+CR (36) 83.3% MC (35) 80.0% Falsetti, et al. Female, mixed Total (22) NR CAPS 2001 trauma E (7) Unclear WL (15)m Schnurr et al., Male, combat Total (360) Mixed model CAPS 2003 E+CR (180) 66% CS (PCT) 75% (180) Total (48)c Zlotnick, 1997 Female, Completers DTS childhood CS (17) 71% sexual abuse WL (16) 75% aIn the population column, male alone or female alone denotes that at least 80% of the study population was male or female. If only one trauma type is listed, at least 80% of the study population reported that type of trauma. bPTSD outcome measure change data were obtained either directly from the study, when restructuring, coping skills training, other therapies, and psychotherapies administered in a group format—the committee found the evidence for all but one psychotherapeutic approach inadequate to reach a conclusion regarding efficacy. The evidence was sufficient to conclude the efficacy of exposure therapies in treating patients with PTSD. REFERENCES APA (American Psychiatric Association). 2004. Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Washington, DC: APA. Basoglu, M., M. Livanou, E. Salcioglu, and D. Kalender. 2003. A brief behavioural treatment of chronic post-traumatic stress disorder in earthquake survivors: Results from an open clinical trial. Psychological Medicine 33(4):647-654. Basoglu, M., E. Salcioglu, M. Livanou, D. Kalender, and G. Acar. 2005. Single-session be- havioral treatment of earthquake-related posttraumatic stress disorder: A randomized waiting list controlled trial. Journal of Traumatic Stress 18(1):1-11. Basoglu, M., E. Salcioglu, and M. Livanou. 2007. A randomized controlled study of single- session behavioural treatment of earthquake-related post-traumatic stress disorder using an earthquake simulator. Psychological Medicine 37(2):203-213.

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 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Baselineb and Statistically Assessor Change in Significant? Loss of Blinded? PTSD Measure (versus control) Diagnosis (%) Principal Limitations Yes 65.46, 68.30 Yes 93% No major limitations –56.5 26% –5.3 Yes M(SD) NR Dropout or completer Yes 91.7% numbers not reported 33.3% ≥10 pts drop Yes 80.41, 82.01 No No major limitations –6.41 (34% dropout well on CAPS –5.98 handled) 38.8% 37.5% No (self- 66.88, 74.69 29% dropout rate with response) –21.12 Yes 87% completers analysis – 1.63 41% provided, or by subtracting data reported at treatment completion (not follow-up data) from baseline data (before treatment began). Average baseline score when reported or when baseline scores for all arms are nearly the same; otherwise, baseline scores listed individually in order of arm. cFifteen dropped out. Blanchard, E. B., and E. J. Hickling. 2004. The Albany treatment study: A randomized, controlled comparison of cognitive-behavioral therapy and support in the treatment of chronic PTSD secondary to MVAs. In After the crash: Psychological assessment and treatment of survivors of motor vehicle accidents, 2nd ed. Washington, DC: American Psychological Association. Pp. 315-347. Boudewyns, P. A., and L. Hyer. 1990. Physiological response to combat memories and prelimi- nary treatment outcome in Vietnam veteran PTSD patients treated with direct therapeutic exposure. Behavior Therapy 21(1):63-87. Boudewyns, P. A., and L. A. Hyer. 1996. Eye movement desensitization and reprocessing (EMDR) as treatment for post-traumatic stress disorder. Clinical Psychology and Psy- chotherapy 3(3):185-195. Boudewyns, P. A., L. Hyer, M. G. Woods, W. R. Harrison, and E. McCranie. 1990. PTSD among Vietnam veterans: An early look at treatment outcome using direct therapeutic exposure. Journal of Traumatic Stress 3(3):359-368. Boudewyns, P. A., S. Stwertka, L. Hyer, J. Albrecht, and E. Sperr. 1993. Eye movement de- sensitization for PTSD of combat: A treatment outcome pilot study. Behavior Therapist 16(2):29-33. Brady, K. T., B. S. Dansky, S. E. Back, E. B. Foa, and K. M. Carroll. 2001. Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of Substance Abuse Treatment 21(1):47-54.

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0 TREATMENT OF POSTTRAUMATIC STRESS DISORDER Brom, D., R. J. Kleber, and P. B. Defares. 1989. Brief psychotherapy for posttraumatic stress disorders. Journal of Consulting and Clinical Psychology 57(5):607-612. Bryant, R. A., M. L. Moulds, R. M. Guthrie, S. T. Dang, and R. D. Nixon. 2003. Ima- ginal exposure alone and imaginal exposure with cognitive restructuring in treat- ment of posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 71(4):706-712. Carlson, J. G., C. M. Chemtob, K. Rusnak, N. L. Hedlund, and M. Y. Muraoka. 1998. Eye movement desensitization and reprocessing (EDMR) treatment for combat-related post- traumatic stress disorder. Journal of Traumatic Stress 11(1):3-24. Chard, K. M. 2005. An evaluation of cognitive processing therapy for the treatment of post- traumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology 73(5):965-971. Chemtob, C. M., R. S. Hamada, R. W. Novaco, and D. M. Gross. 1997. Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 65(1):184-189. Classen, C., L. D. Butler, C. Koopman, E. Miller, S. DiMiceli, J. Giese-Davis, P. Fobair, R. W. Carlson, H. C. Kraemer, and D. Spiegel. 2001. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry 58(5):494-501. Cloitre, M., and K. C. Koenen. 2001. The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse. International Journal of Group Psychotherapy 51(3):379-398. Cloitre, M., K. C. Koenen, L. R. Cohen, and H. Han. 2002. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology 70(5):1067-1074. Cooper, N. A., and G. A. Clum. 1989. Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behavior Therapy 20(3):381-391. Creamer, M., P. Elliott, D. Forbes, D. Biddle, and G. Hawthorne. 2006. Treatment for combat- related posttraumatic stress disorder: Two-year follow-up. Journal of Traumatic Stress 19(5):675-685. Cusack, K., and C. Spates. 1999. The cognitive dismantling of eye movement desensitization and reprocessing (EMDR) treatment of posttraumatic stress disorder (PTSD). Journal of Anxiety Disorders 13(1-2):87-99. Devilly, G. J., and S. H. Spence. 1999. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder. Journal of Anxiety Disorders 13(1-2):131-157. Devilly, G. J., S. H. Spence, and R. M. Rapee. 1998. Statistical and reliable change with eye movement desensitization and reprocessing: Treating trauma within a veteran population. Behavior Therapy 29(3):435-455. Echeburua, E., P. de Corral, I. Zubizarreta, and B. Sarasua. 1997. Psychological treatment of chronic posttraumatic stress disorder in victims of sexual aggression. Behavior Modifica- tion 21(4):433-456. Ehlers, A., and D. M. Clark. 2003. Early psychological interventions for adult survivors of trauma: A review. Biological Psychiatry 53(9):817-826. Ehlers, A., D. M. Clark, A. Hackmann, F. McManus, M. Fennell, C. Herbert, and R. Mayou. 2003. A randomized controlled trial of cognitive therapy, a self-help booklet, and re- peated assessments as early interventions for posttraumatic stress disorder. Archives of General Psychiatry 60:1024-1032.

OCR for page 93
 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Falsetti, S. A., H. S. Resnick, J. Davis, and N. G. Gallagher. 2001. Treatment of posttraumatic stress disorder with comorbid panic attacks: Combining cognitive processing therapy with panic control treatment techniques. Group Dynamics: Theory, Research, and Prac- tice 5(4):252-260. Falsetti, S. A., B. A. Erwin, H. S. Resnick, J. Davis, and A. M. Combs-Lane. 2003. Multiple channel exposure therapy of PTSD: Impact of treatment on functioning and resources. Journal of Cognitive Psychotherapy 17(2):133-147. Fecteau, G., and R. Nicki. 1999. Cognitive behavioural treatment of post traumatic stress disorder after motor vehicle accident. Behavioural and Cognitive Psychotherapy 27(3):201-214. Foa, E. B., and E. A. Meadows. 1997. Psychosocial treatments for posttraumatic stress disor- der: A critical review. Annual Review of Psychology 48:449-480. Foa, E. B., B. O. Rothbaum, D. S. Riggs, and T. B. Murdock. 1991. Treatment of posttrau- matic stress disorder in rape victims: A comparison between cognitive-behavioral proce- dures and counseling. Journal of Consulting and Clinical Psychology 59(5):715-723. Foa, E. B., D. Hearst-Ikeda, and K. J. Perry. 1995. Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consult- ing and Clinical Psychology 63(6):948-955. Foa, E. B., C. V. Dancu, E. A. Hembree, L. H. Jaycox, E. A. Meadows, and G. P. Street. 1999. A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology 67(2):194-200. Foa, E., T. Keane, and M. Friedman. 2000. Effective treatments for PTSD, Practice guidelines from the International Society for Traumatic Stress Studies. New York: The Guilford Press. Foa, E. B., E. A. Hembree, S. P. Cahill, S. A. Rauch, D. S. Riggs, N. C. Feeny, and E. Yadin. 2005. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology 73(5):953-964. Forbes, D., M. Creamer, N. Allen, P. Elliott, T. McHugh, P. Debenham, and M. Hopwood. 2002. The MMPI-2 as a predictor of symptom change following treatment for posttrau- matic stress disorder. Journal of Personality Assessment 79(2):321-336. Forbes, D., A. J. Phelps, A. F. McHugh, P. Debenham, M. Hopwood, and M. Creamer. 2003. Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. Journal of Traumatic Stress 16(5):509-513. Frommberger, U., R. D. Stieglitz, E. Nyberg, H. Richter, U. Novelli-Fischer, J. Angenendt, R. Zanineli, and M. Berger. 2004. Comparison between paroxetine and behaviour therapy in patients with posttraumatic stress disorder (PTSD): A pilot study. International Journal of Psychiatry in Clinical Practice 8(1):19-23. Gersons, B. P., I. V. Carlier, R. D. Lamberts, and B. A. van der Kolk. 2000. Randomized clinical trial of brief eclectic psychotherapy for police officers with posttraumatic stress disorder. Journal of Traumatic Stress 13(2):333-347. Glynn, S. M., S. Eth, E. T. Randolph, D. W. Foy, M. Urbaitis, L. Boxer, G. G. Paz, G. B. Leong, G. Firman, J. D. Salk, J. W. Katzman, and J. Crothers. 1999. A test of behavioral family therapy to augment exposure for combat-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 67(2):243-251. Hammarberg, M., and S. M. Silver. 1994. Outcome of treatment for post-traumatic stress disorder in a primary care unit serving Vietnam veterans. Journal of Traumatic Stress 7(2):195-216.

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 TREATMENT OF POSTTRAUMATIC STRESS DISORDER Harvey, A. G., R. A. Bryant, and N. Tarrier. 2003. Cognitive behaviour therapy for post- traumatic stress disorder. Clinical Psychology Review 23(3):501-522. Hembree, E. A., S. P. Cahill, and E. B. Foa. 2004. Impact of personality disorders on treatment outcome for female assault survivors with chronic posttraumatic stress disorder. Journal of Personality Disorders 18(1):117-127. Hien, D. A., L. R. Cohen, G. M. Miele, L. C. Litt, and C. Capstick. 2004. Promising treat- ments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry 161(8):1426-1432. Hinton, D. E., D. Chean, V. Pich, S. A. Safren, S. G. Hofmann, and M. H. Pollack. 2005. A randomized controlled trial of cognitive-behavior therapy for Cambodian refugees with treatment-resistant PTSD and panic attacks: A cross-over design. Journal of Traumatic Stress 18(6):617-629. Hogberg, G., M. Pagani, O. Sundin, J. Soares, A. Aberg-Wistedt, B. Tarnell, and T. Hallstrom. 2007. On treatment with eye movement desensitization and reprocessing of chronic post- traumatic stress disorder in public transportation workers—a randomized controlled trial. Nordic Journal of Psychiatry 61(1):54-61. Humphreys, L., J. Westerink, L. Giarratano, and R. Brooks. 1999. An intensive treatment program for chronic posttraumatic stress disorder: 2-year outcome data. Australian and New Zealand Journal of Psychiatry 33(6):848-854. Igreja, V., W. C. Kleijn, B. J. Schreuder, J. A. Van Dijk, and M. Verschuur. 2004. Testi- mony method to ameliorate post-traumatic stress symptoms. Community-based in- tervention study with Mozambican Civil War survivors. British Journal of Psychiatry 184:251-257. Ironson G., B. Freund, J. Strauss, and J. Williams. 2002. Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology 59(1):113-128. Jensen, J. A. 1994. An investigation of eye movement desensitization and reprocessing (EMD/ R) as a treatment for posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans. Behavior Therapy 25(2):311-325. Johnson, D. R., R. Rosenheck, A. Fontana, H. Lubin, O. Charney, and S. Southwick. 1996. Outcome of intensive inpatient treatment for combat-related posttraumatic stress disor- der. American Journal of Psychiatry 153(6):771-777. Keane, T. M., J. A. Fairbank, J. M. Caddell, and R. T. Zimering. 1989. Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy 20(2):245-260. Krakow, B., M. Hollifield, R. Schrader, M. Koss, D. Tandberg, J. Lauriello, L. McBride, T. D. Warner, D. Cheng, T. Edmond, and R. Kellner. 2000. A controlled study of imagery rehearsal for chronic nightmares in sexual assault survivors with PTSD: A preliminary report. Journal of Traumatic Stress 13(4):589-609. Krakow, B., M. Hollifield, L. Johnston, M. Koss, R. Schrader, T. D. Warner, D. Tandberg, J. Lauriello, L. McBride, L. Cutchen, D. Cheng, S. Emmons, A. Germain, D. Melendrez, D. Sandoval, and H. Prince. 2001. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association 286(5):537-545. Kubany, E. S., E. E. Hill, and J. A. Owens. 2003. Cognitive trauma therapy for battered women with PTSD: Preliminary findings. Journal of Traumatic Stress 16(1):81-91. Kubany, E. S., E. E. Hill, J. A. Owens, C. Iannce-Spencer, M. A. McCaig, K. J. Tremayne, and P. L. Williams. 2004. Cognitive trauma therapy for battered women with PTSD (CTT- BW). Journal of Consulting and Clinical Psychology 72(1):3-18.

OCR for page 93
 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Lange, A., J. P. van de Ven, B. Schrieken, and P. M. Emmelkamp. 2001. Interapy, treatment of posttraumatic stress through the internet: A controlled trial. Journal of Behavior Therapy and Experimental Psychiatry 32(2):73-90. Lange, A., D. Rietdijk, M. Hudcovicova, J. P. Van de Ven, B. Schrieken, and P. M. G. Emmelkamp. 2003. Interapy: A controlled randomized trial of the standardized treat- ment of posttraumatic stress through the internet. Journal of Consulting and Clinical Psychology 71(5):901-909. Lee, C., H. Gavriel, P. Drummond, J. Richards, and R. Greenwald. 2002. Treatment of PTSD: Stress inoculation training with prolonged exposure compared to EMDR. Journal of Clinical Psychology 58(9):1071-1089. Lindauer, R. J., B. P. Gersons, E. P. van Meijel, K. Blom, I. V. Carlier, I. Vrijlandt, and M. Olff. 2005. Effects of brief eclectic psychotherapy in patients with posttraumatic stress disorder: Randomized clinical trial. Journal of Traumatic Stress 18(3):205-212. Lubin, H., M. Loris, J. Burt, and D. R. Johnson. 1998. Efficacy of psychoeducational group therapy in reducing symptoms of posttraumatic stress disorder among multiply trauma- tized women. American Journal of Psychiatry 155(9):1172-1177. Marcus, S. V., P. Marquis, and C. Sakai. 1997. Controlled study of treatment of PTSD us- ing EMDR in an HMO setting. Psychotherapy: Theory, Research, Practice, Training 34(3):307-315. Marks, I., K. Lovell, H. Noshirvani, M. Livanou, and S. Thrasher. 1998. Treatment of post- traumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry 55(4):317-325. McDonagh, A., M. Friedman, G. McHugo, J. Ford, A. Sengupta, K. Mueser, C. C. Demment, D. Fournier, P. P. Schnurr, and M. Descamps. 2005. Randomized trial of cognitive-be- havioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology 73(3):515-524. Monson, C. M., B. F. Rodriguez, and R. Warner. 2005. Cognitive-behavioral therapy for PTSD in the real world: Do interpersonal relationships make a real difference? Journal of Clinical Psychology 61(6):751-761. Monson, C. M., P. P. Schnurr, P. A. Resick, M. J. Friedman, Y. Young-Xu, and S. P. Stevens. 2006. Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 74(5):898-907. Najavits, L. M., R. D. Weiss, S. R. Shaw, and L. R. Muenz. 1998. “Seeking safety:” Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disor- der and substance dependence. Journal of Traumatic Stress 11(3):437-456. Neuner, F., M. Schauer, C. Klaschik, U. Karunakara, and T. Elbert. 2004. A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology 72(4):579-587. Otto, M. W., D. Hinton, N. B. Korbly, A. Chea, P. Ba, B. S. Gershuny, and M. H. Pollack. 2003. Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: A pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone. Behaviour Research and Therapy 41(11):1271-1276. Ouimette, P. C., C. Ahrens, R. H. Moos, and J. W. Finney. 1997. Posttraumatic stress disorder in substance abuse patients: Relationship to 1-year posttreatment outcomes. Psychology of Addictive Behaviors 11(1):34-47. Paunovic, N., and L. G. Ost. 2001. Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees. Behaviour Research and Therapy 39(10):1183-1197. Peniston, E. G., and P. J. Kulkosky. 1991. Alpha-theta brainwave neuro-feedback therapy for Vietnam veterans with combat-related post-traumatic stress disorder. Medical Psycho- therapy: An International Journal 4:47-60.

OCR for page 93
 TREATMENT OF POSTTRAUMATIC STRESS DISORDER Pitman, R. K., S. P. Orr, B. Altman, R. E. Longpre, R. E. Poire, and M. L. Macklin. 1996. Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder. Comprehensive Psychiatry 37(6):419-429. Power, K., T. McGoldrick, K. Brown, R. Buchanan, D. Sharp, V. Swanson, and A. Karatzias. 2002. A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post-trau- matic stress disorder. Clinical Psychology and Psychotherapy 9(5):299-318. Raboni, M. R., S. Tufik, and D. Suchecki. 2006. Treatment of PTSD by eye movement desen- sitization reprocessing (EMDR) improves sleep quality, quality of life, and perception of stress. Annals of the New York Academy of Sciences 1071:508-513. Ragsdale, K. G., R. D. Cox, P. Finn, and R. M. Eisler. 1996. Effectiveness of short-term special- ized inpatient treatment for war-related posttraumatic stress disorder: A role for adven- ture-based counseling and psychodrama. Journal of Traumatic Stress 9(2):269-283. Renfrey, G., and C. R. Spates. 1994. Eye movement desensitization: A partial dismantling study. Journal of Behavior Therapy and Experimental Psychiatry 25(3):231-239. Resick, P. A., P. Nishith, T. L. Weaver, M. C. Astin, and C. A. Feuer. 2002. 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. Journal of Consulting and Clinical Psychology 70(4):867-879. Rogers, S., S. M. Silver, J. Goss, J. Obenchain, A. Willis, and R. L. Whitney. 1999. A single session, group study of exposure and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data. Journal of Anxiety Disorders 13(1-2):119-130. Rothbaum, B. O. 1997. A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic 61(3):317-334. Rothbaum, B. O., M. C. Astin, and F. Marsteller. 2005. Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress 18(6):607-616. Sanderson, A., and R. Carpenter. 1992. Eye movement desensitization versus image confronta- tion: A single-session crossover study of 58 phobic subjects. Journal of Behavior Therapy and Experimental Psychiatry 23(4):269-275. Scheck, M. M., J. A. Schaeffer, and C. Gillette. 1998. Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocess- ing. Journal of Traumatic Stress 11(1):25-44. Schnurr, P., M. Friedman, D. Foy, M. Shea, F. Hsieh, P. Lavori, S. Glynn, M. Wattenberg, and N. Bernardy. 2003. Randomized trial of trauma-focused group therapy for posttrau- matic stress disorder: Results from a Department of Veterans Affairs cooperative study. Archives of General Psychiatry 60(5):481-489. Schnurr, P. P., M. J. Friedman, C. C. Engel, E. B. Foa, M. T. Shea, B. K. Chow, P. A. Resick, V. Thurston, S. M. Orsillo, R. Haug, C. Turner, and N. Bernardy. 2007. Cognitive be- havioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of the American Medical Association 297(8):820-830. Silver, S. M., A. Brooks, and J. Obenchain. 1995. Treatment of Vietnam War veterans with PTSD: A comparison of eye movement desensitization and reprocessing, biofeedback, and relaxation training. Journal of Traumatic Stress 8(2):337-342. Solomon, Z., A. Shalev, S. E. Spiro, A. Dolev, and et al. 1992. Negative psychometric out- comes: Self-report measures and a follow-up telephone survey. Journal of Traumatic Stress 5(2):225-246.

OCR for page 93
 EVIDENCE AND CONCLUSIONS: PSYCHOTHERAPY Tarrier, N., H. Pilgrim, C. Sommerfield, B. Faragher, M. Reynolds, E. Graham, and C. Barrowclough. 1999. A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 67(1):13-18. Taylor, S., D. S. Thordarson, L. Maxfield, I. C. Fedoroff, K. Lovell, and J. Ogrodniczuk. 2003. Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology 71(2):330-338. Valentine, P. V., and T. E. Smith. 2001. Evaluating traumatic incident reduction therapy with female inmates: A randomized controlled clinical trial. Research on Social Work Practice 11(1):40-52. van der Kolk B. A., S. J. Spinazzola, M. E. Blaustein, J. W. Hopper, E. K. Hooper, D. L. Korn, and W. B. Simpson. 2007. A randomized clinical trial of eye movement desen- sitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Clinical Psychiatry 68(1):37-46. van Minnen, A., and E. B. Foa. 2006. The effect of imaginal exposure length on outcome of treatment for PTSD. Journal of Traumatic Stress 19(4):427-438. Vaughan, K., M. S. Armstrong, R. Gold, N. O’Connor, W. Jenneke, and N. Tarrier. 1994. A trial of eye movement desensitization compared to image habituation training and ap- plied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry 25(4):283-291. Watson, C. G., J. R. Tuorila, K. S. Vickers, L. P. Gearhart, and C. M. Mendez. 1997. The ef- ficacies of three relaxation regimens in the treatment of PTSD in Vietnam War veterans. Journal of Clinical Psychology 53(8):917-923. Wilson, S. A., L. A. Becker, and R. H. Tinker. 1995. Eye movement desensitization and re- processing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology 63(6):928-937. Wilson, S. A., L. A. Becker, and R. H. Tinker. 1997. Fifteen-month follow-up of eye move- ment desensitization and reprocessing treatment for posttraumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology 65:1047-1056. Zatzick, D., P. Roy-Byrne, J. Russo, F. Rivara, R. Droesch, A. Wagner, C. Dunn, G. Jurkovich, E. Uehara, and W. Katon. 2004. A randomized effectiveness trial of stepped collab- orative care for acutely injured trauma survivors. Archives of General Psychiatry 61(5):498-506. Zayfert, C., J. C. Deviva, C. B. Becker, J. L. Pike, K. L. Gillock, and S. A. Hayes. 2005. Ex- posure utilization and completion of cognitive behavioral therapy for PTSD in a “real world” clinical practice. Journal of Traumatic Stress 18(6):637-645. Zlotnick, C., T. M. Shea, K. Rosen, E. Simpson, K. Mulrenin, A. Begin, and T. Pearlstein. 1997. An affect-management group for women with posttraumatic stress disorder and histories of childhood sexual abuse. Journal of Traumatic Stress 10(3):425-436.

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