The purpose of this study was to compare cognitive-processing therapy (CPT) with prolonged exposure and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. One hundred seventy-one female rape victims were randomized into 1 of the 3 conditions, and 121 completed treatment. Participants were assessed with the ClinicianAdministered PTSD Scale, the PTSD Symptom Scale, the Structured Clinical Interview for DSM-IV, the Beck Depression Inventory, and the Trauma-Related Guilt Inventory. Independent assessments were made at pretreatment, posttreatment, and 3 and 9 months posttreatment. Analyses indicated that both treatments were highly efficacious and superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales.Cognitive-processing therapy (CPT) was introduced as a possible treatment for posttraumatic stress disorder (PTSD) nearly a decade ago. CPT, specifically designed for the treatment of PTSD resulting from sexual assault, consists of two integrated components: cognitive therapy and exposure in the form of writing and reading about the traumatic event Resick & Schnicke, 1992. The therapy focuses initially on assimilated-distorted beliefs such as denial and self-blame. Then the focus shifts to overgeneralized beliefs about oneself and the world. Beliefs and assumptions held before the trauma are also considered. Clients are taught to challenge their beliefs and assumptions through Socratic questioning and the use of daily worksheets. Once dysfunctional beliefs are deconstructed, more balanced self-statements are generated and practiced. The exposure component consists of having clients write detailed accounts of the most traumatic incident(s) that they read to themselves and to the therapists. Clients are encouraged to experience their emotions while writing and reading, and the accounts are then used to determine "stuck points": areas of conflicting beliefs, leaps of logic, or blind assumptions.In addition to a series of case study reports that indicated the therapy to be promising (Calhoun & Resick, 1993;Resick & Markway, 1991), Resick and Schnicke (1992) reported on CPT presented in a group-therapy format as compared with a naturally occurring wait-list condition. This 12-session therapy appeared to be effective for both PTSD and depressive symptoms in a first report in which 19 women treated with CPT were compared with 20 wait-list women. At 3-and 6-month follow-ups, none of the treated women met the NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript criteria for PTSD (Resick & Schnicke, 1992). Although there was no specific bias in assignment to condition, there was not, unfortunately, random assignment to groups, nor was there independent assessment. Subsequently, the treatment manual was published with data reported on 36 women who were treated in a group format and 9 who completed individual treatment. The therapy package continued to be quite promising.Clearly, the ...

The purpose of the present study was to investigate the relationships among numbing, arousal, intrusion, and avoidance in a sample of 272 female rape survivors. Multiple regression analyses were conducted to test a theoretical model, which posits that hyperarousal and numbing are functionally related mechanisms and intrusions and avoidance are functionally related. Results supported the hypothesis that arousal explained the majority of the variance in numbing beyond that explained by avoidance and intrusion. In addition, intrusive symptoms explained the majority of the variance in effortful avoidance beyond that explained by numbing and arousal. The findings suggest that numbing and effortful avoidance may be separate mechanisms associated with symptoms of arousal and intrusion, respectively.The symptom criteria and the organization of the posttraumatic stress disorder (PTSD) diagnosis have changed substantially since the introduction of the disorder in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III) (APA, 1980). In the DSM-IV (APA, 1994) the diagnostic category includes three clusters: reexperiencing, avoidance, and arousal. In recent years there has been some debate over whether or not these clusters accurately represent the dimensions underlying the disorder (Foa, Riggs, & Gershuny, 1995;Litz et al., 1997;Taylor, Koch, Kuch, Crockett, & Passey, 1998). Previous studies of the structure of PTSD have generally focused on veteran populations. The majority predated the publication of the DSM-IV and generally did not focus exclusively on the 17 items now included as PTSD criteria in the DSM-IV (Keane, Caddell, & Taylor, 1988;King & King, 1994;McFall, Smith, McKay, & Tarver, 1990;Silver & Iacono, 1984;Watson et al., 1991). Older factor analytic studies of PTSD have not supported the current DSM-IV organization of the clusters. These studies have found factors representing reexperiencing or intrusion, withdrawal, numbing or impoverished interpersonal relationships, and guilt or "selfpersecution" (Keane et al., 1988;King & King, 1994;Silver & Iacono, 1984;Watson et al., 1991).Although there is wide variation in the number and types of factors identified in these studies, they have all included a factor representing intrusion or arousal and a separate numbing, withdrawal, or avoidance factor. A 1998 confirmatory factor analysis study by King, Leskin, King, and Weathers (1998) tested a variety of nested models of PTSD in a sample of 524 treatment-seeking male veterans. They included a four-factor first-order solution, a two-factor higher-order solution, a single-factor higher-order solution, and a single-factor first-order solution. King and associates (1998) found the best fit to be the four-factor first-order solution containing moderately to highly correlated yet distinct first-order factors corresponding to reexperiencing, effortful avoidance, emotional numbing, and hyperarousal aspects of PTSD. Fewer studies of the factor structure of PTSD have assessed civilian samples. ...

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