Cognitive Behavioral Therapy as Treatment for Post-Traumatic Stress Disorder

Schnurr, P. P., Friedman, J. M., Engel, C. C., Foa, B. E., Shea, T. M., Chow, K. B., Resick, A. P et al. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized control trial. The Journal of the American Medical Association, 297 (8), 820-830

The authors aimed to identify and follow up on claims that cognitive therapy is effective for people suffering from posttraumatic stress disorder (PTSD) by comparing the patients who received this form of treatment, to others who used a supportive intervention type of treatment. The authors compared the effectiveness of prolonged exposure as a form of cognitive behavioral therapy, with present-centered therapy. The participants in the research included 277 female veterans who had served in the military and 7 females who were on active duty. The researchers showed women who had a symptom severity of 45 or more, based on the Clinician-Administered PTSD Scale, and had experienced trauma three or more month ago, had a clear memory of trauma. The research also included those who agreed not to receive any other form of treatment during the study.

Of all the participants, 141 received prolonged exposure therapy and 143 received present-centered therapy for ten weekly sessions, with each session lasting ninety minutes. The results indicated that PTSD symptoms were greatly reduced for women who received cognitive therapy compared to those who received present-centered therapy. In addition, women who underwent cognitive therapy were more likely to achieve total remission. Following the results, the authors concluded that cognitive therapy, through prolonged exposure, was effective in treating women veterans who experienced PTSD. The researchers solved the issue of bias by using blinded assessors who did not have any access to the patients’ study files, did not know the participants’ therapists, and who attended few study team meetings.

The purpose of the study was to examine the effectiveness of cognitive therapy in the cure of PTSD among female veterans. This study had some limitations. For instance, the researchers did not do enough to ensure that there was no bias in the research. The researchers admitted that some participants revealed information that they should not have, and this compromised the results of those participants. The researchers could have revealed more concerning the participants, especially concerning their age, and the years they had served. This would have enabled someone to know how long the participants had suffered from PTSD. In addition, the researchers concentrated more on sexual trauma, than they did on other forms of trauma. On the other hand, conducting this study was important because it dwelt on an area that many researchers have not studied. Many researchers have in the past conducted studies on PTSD, but they concentrated on men. It is important for researchers to advance more in this research because of the increasing number of women who are serving in the military and other organs dedicated to service delivery because they suffer different kinds of trauma. For instance, women involved in rescue missions, such as fire fighters, suffer different kinds of trauma, and they may suffer from PTSD.

Galovski, E. T., Monson, C., Bruce, E. S., & Resick, A. P., (2009). Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress, 22 (3), 197-204

The objective of the study was to investigate whether PTSD patients who received a full course of evidence-based treatment could improve health related concerns associated with the disorder, which includes sleep impairments. The research participants were 108 females over eighteen years old, who had suffered sexual assault. The participants had completed assessments before and after treatment. Fifty-four participants had undergone cognitive processing therapy and fifty-four patients had undergone prolonged exposure as a form of treatment. Ninety percent of the participants were white. Seventy-two percent of the participants were single. This included women who were divorced, widowed, or separated. The mean age of the participants was 33. The researchers used the Structured Clinical Interview DSM-III-R (SCID) to assess disorders such as mood, substance abuse and dependence, and panic. They used the clinician administered PTSD scale (CAPS) to assess PTSD. They used the Pennebaker Inventory of Limbic Languidness to examine the rate of common physical symptoms, and the Pittsburgh Sleep Quality Index to examine the sleep quality of the participants.

The treatments included two sessions per week for a period of 6 weeks. The participants were assessed in three intervals, which included time before the treatment began, two weeks after the treatment, and nine months after the treatment. The results indicated that patients who underwent prolonged exposure therapy used more sleep medication compared to patients who underwent cognitive processing therapy. However, more of the patients who received prolonged exposure (PE) therapy reduced their intake of sleep medication over time, compared to those who received cognitive processing therapy (CPT). Patients who received CPT had relatively fewer health concerns compared to patients receiving PE therapy.

The purpose of the study was to determine if female sexual assault victims suffering from PTSD could improve their health condition and sleep behavior if they received evidenced based treatment, which, in this case, was CPT and PE therapy. The researchers were able to determine this using the study. The study had several limitations. For instance, the researchers did not identify or define the health conditions they were concerned with in the study. Therefore, it is not possible for other people to know the health concerns which they can address using the two treatments. The study was too specific because it involved women over the age of eighteen who had suffered sexual assault. Therefore, it is not possible to determine whether the study can be useful for younger women, or for women who have suffered other kinds of trauma. However, this study is important because it addresses an important concern for patients suffering from PTSD. Many PTSD patients lose sleep and they have unhealthy sleeping patterns because of sleep disturbances. This brings about secondary symptoms, which are associated with lack of sleep, and not necessarily with PTSD. Finding a way to improve the sleeping behavior of patients with PTSD will help in reducing health concerns that are associated with unhealthy sleeping behaviors.

McDonagh, A., McHugo, G., Sengupta, A., Demment, C. C., Schnurr, P. P., Friedman, M., & Ford J. et al. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73 (3), 515-534

The authors’ hypothesis for the research was that cognitive behavioral therapy is more effective than present-centered therapy and wait-list control in reducing PTSD symptoms, improving the quality of life, and reducing self-reported symptoms such as cognitive distortions, and anxiety, depressive, and dissociative symptoms. The participants were seventy-four women with a history of child sexual abuse. This followed the screening of 248 women for the study. The 174 women who did not receive treatment were excluded for several reasons, such as failure to meet PTSD criteria and failure to meet child sexual abuse criteria. Some did not want to stop their current therapy for purposes of research, the others lacked the willingness or ability to participate in the research and had other exclusion criteria such as substance abuse and had been diagnosed with psychiatric conditions. Sexual abuse case had to have happened when the participant was older than five years and younger than sixteen years. The participants had experienced different traumas in their adulthood and childhood, were well educated, and they were middle aged.

The researchers used different measures when conducting the study. They determined the nature of PTSD in the participants using CAPS. They used SCID to diagnose Axis I and Axis II disorders, Beck Depression Inventory to assess depression, the Spielberger State-Trait Anxiety Inventory to assess anxiety, and the traumatic stress Institute beliefs scale to assess the participants’ disruption in what they believed about themselves was based on the trauma they have experienced. They measured dissociative symptoms using dissociative experiences scale, the quality of life inventory to determine the participants’ quality of life.

The researchers assigned the women randomly to CBT, PCT, and WI forms of treatment for fourteen weeks. Twenty-three percent of the participants dropped out of the study. The study results indicated that CBT and PCT were more effective forms of treatment than WI for the participants. CBT and PCT treatments reduced the patients PTSD symptom severity, anxiety, and trauma related cognitive schemas. WI treatment was more effective than CBT and PCT in improving the quality of life, and in reducing depressive and dissociative symptoms, anger, and hostility.

The authors’ decision to use inexperienced therapists for the research might have affected the research. The authors reported that 29% of the participants who dropped out of the study were receiving treatment from a therapist who only had one-year experience before the beginning of the research. The study was limited by the fact that the researchers used participants who had experienced other forms of traumas in their childhood and in their adulthood. Because of this, the researchers were not able to determine and distinguish the PTSD symptoms, which occurred because of child sexual abuse and symptoms that occurred because of other forms of trauma. The researchers’ intent was to focus on people who have experienced trauma because of child sexual abuse. Although the researchers concluded that CBT was an effective form of therapy, there was a high drop out rate for the participants undergoing cognitive behavioral therapy. Because of such limitations, it is necessary for other researchers to conduct their work in depth research to determine the effectiveness of the therapies used. This research was important because it provided a basis for the type of treatment to focus on when treating adults who faced trauma when being children because of sexual abuse. Cases of child sexual abuse continue and this affects people greatly even in their adulthood. Therefore, there is a need to find the most effective forms of therapies that will ensure that the victims are able to handle and manage their experiences and that they have the better quality of life.