A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims
Leslie W. MilesJulie L. ValentineLinda MabeyElizabeth HopkinsPaige J. StodtmeisterReilly B. RockwoodAlyssa N. H. Moxley
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Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem.Keywords:
Cognitive processing therapy
Exposure therapy
Posttraumatic stress disorder (PTSD) is highly prevalent among veterans. Although there are effective treatment approaches for PTSD, such as Prolonged Exposure (PE) and Cognitive Processing Therapy, many providers trained in these approaches do not use them, or use them without sufficient fidelity, and veterans drop out of these treatments at very high rates. The time intensive nature of these treatments is frequently cited as a barrier to receiving the treatment among veterans and delivering the treatment among providers. According, there is an urgent need to establish more efficient and effective PTSD treatment approaches in order to meet the needs of veterans seeking care. Written exposure therapy (WET) is an efficient, exposure-based treatment, and may represent a plausible alternative treatment option to address PTSD in veterans. Although WET has been found to be effective and non-inferior to more time intensive trauma-focused treatment, it has not yet been investigated with a veteran sample. In an ongoing randomized controlled trial (RCT) we are investigating whether WET is non-inferior in treating PTSD compared with the more time intensive PE. The study sample will include 150 men and women veterans diagnosed with PTSD who are randomly assigned to either WET (n = 75) or PE (n = 75). Participants are assessed prior to treatment and 10-, 20-, and 30-weeks after the first treatment session. The primary outcome is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Establishing that PTSD can be treated effectively with fewer treatment sessions would represent a significant advance in improving access to evidence-based care for veterans with PTSD.
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Methods Post-traumatic Stress Disorder (PTSD) is a disabling anxiety disorder that is highly prevalent among members of the Armed Services who have served in combat operations.1 Evidence-based cognitive behavioral therapies for PTSD include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and Eye Movement Desensitization and Reprocessing (EMDR) which lead to clinically improved outcomes in ~50% of all treated cases2-4 and typically require between 8-15 treatment sessions. Pharmacological approaches to treating PTSD do not resolve the cause of PTSD and patients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART) is a new exposure-based therapy that uses eye movements and is designed to be brief (i.e. 1-5 treatment sessions).
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Trauma-focused psychotherapies, such as prolonged exposure and cognitive processing therapy, are the most effective forms of treatment for posttraumatic stress disorder. These treatments are commonly delivered in the Veterans Health Administration; however, dropout means that some veterans fail to benefit. Ending treatment prematurely is a common problem across psychotherapies, with on average, 20% to 25% of patients dropping out. The purpose of this study was to examine veterans' self-reported reasons for dropping out of prolonged exposure or cognitive processing therapy. Veterans who dropped out from prolonged exposure or cognitive processing therapy (N = 28) completed qualitative interviews about their experiences. Interviews were coded by 2 coders using grounded theory. Therapy-related barriers were the largest category reported, and included lack of buy-in to the rationale or specific therapy tasks, believing that treatment was not working, alliance issues, or switching to a different treatment. Practical barriers and finding treatment "too stressful" were also common reasons for dropout. This research provides information that can shape how PTSD treatments are delivered in health care settings. Therapy-related barriers were the largest group, suggesting that providers may need to find more effective ways to communicate the rationale for these therapies or to tailor them to individual patients' needs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract This chapter provides an overview of cognitive behavioral therapy for posttraumatic stress disorder. The current diagnostic criteria for posttraumatic stress disorder are presented along with a brief discussion of expected changes to be implemented in the upcoming DSM ‐5 . The primary goal of the chapter is to outline the cognitive behavioral conceptualization of posttraumatic stress disorder and to illustrate how this has informed current treatments. Emotional processing and social cognitive theories are discussed, and treatments with significant empirical support are reviewed, including prolonged exposure therapy, virtual reality exposure therapy, cognitive processing therapy, stress inoculation treatment, and eye movement desensitization and reprocessing therapy. In addition, some emerging treatments for posttraumatic stress disorder are presented, including mindfulness, couples and family interventions, and interpersonal therapy. The inclusion of pharmacological interventions is briefly discussed, including the augmentation of exposure therapy with D‐cycloserine.
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Cognitive behavior therapy(CBT) has proven to be an effective treatment for posttraumatic stress disorder(PTSD),which typically comprises psychoeducation,exposure,cognitive restructuring,anxiety management training.CBT has been applied for PTSD caused by assault,terrorism,road traffic accidents,combat,earthquake,etc.Eye movement desensitization and reprocessing has been proposed as an effective treatment for PTSD.However,a debate has been triggered by efficacy.Randomized controlled trial of CBT for PTSD must be conducted to enhance the validity of studies results.
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To examine potential differential responses in men and women to cognitive behavior therapy for posttraumatic stress disorder (PTSD).Fifty-two men and 56 women diagnosed with PTSD participated in randomized controlled trials of cognitive behavior therapy for PTSD. Participants were randomly allocated to either (a) exposure-only therapy (Ex) or (b) exposure-based treatment combined with cognitive restructuring (ExCR).There were no significant differences between men and women in treatment response immediately after treatment in either Ex or ExCR. At 6-month follow-up, men displayed significantly more severe PTSD symptoms in the Ex group compared with women in the Ex group, and compared with men and women in the ExCR conditions.These findings suggest that men with PTSD have a reduced maintenance of treatment gains following exposure therapy compared with women, but display less relapse if exposure therapy is combined with cognitive therapy. These findings are consistent with evidence that women recall emotional memories and retain extinction memories more strongly than men, which may facilitate emotional processing and long-term treatment gains.
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This literature review examines the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) relative to other evidence-based treatments for Posttraumatic Stress Disorder (PTSD), such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). The paper explores the problem of PTSD; outlines the history, theory, and initial trials of EMDR; and examines five randomized controlled trials which compare EMDR to PE or CPT. Results suggest that neither treatment model produces significantly greater reductions in PTSD symptoms, though there is some evidence that EMDR may be better tolerated and produce desired results faster than other treatments.
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Methods Posttraumatic Stress Disorder (PTSD) is a prevalent, disabling anxiety disorder.1 Psychotherapies used to treat PTSD, including cognitive behavioral therapies (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), may require long-term treatment2 and provide only partial resolution of symptoms. Similarly, pharmacological approaches to treating PTSD do not resolve the cause of PTSD and clients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART), a new eye movement, exposure-based therapy, is brief (i.e. 1-5 sessions) and does not require an established client/therapist relationship.
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Introduction: Post-traumatic stress disorder (PTSD) is a condition that affects 10-20% of people who will experience a serious mental injury in their lives. Soldiers are one of the most vulnerable social groups to develop PTSD as they reach several factors which may induce the PTSD. The aim of the study: The purpose of this work was to find literature on PTSD among people in the military service. Material and method: Literature has been found and selected among articles found in the websides such as PubMed and Google Scholar. Description of the state of knowledge: Literature describes both - factors predisposing to PTSD, and describtions of numerous methods of therapy for soldiers such as cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CPT) and Exposure Therapy. In addition, the literature provides many innovative methods to help combat the PTSD. It is important not only to inform the soldier about the therapy, but also to enable him to undergo it regularly. It is worth mentioning, for example, video to home - VTH, which is an extension of Exposure Therapy. Thanks to it, even if someone for some reason cannot participate in therapy in the place where it takes place, it can be done at home without fear of getting to the therapy. Summary: There are many methods of PTSD therapy. In addition to pharmacological, psychotherapy is very important. Soldiers should undergo these therapies and should be encouraged to complete cycles so that they can feel the effects of the therapy.
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Combat stress reaction
Traumatic stress
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