Road traffic collisions (RTCs) are common precipitants of posttraumatic stress disorder (PTSD). Two preliminary studies suggest that cognitive-behavior therapy (CBT) is, on average, effective in treating this disorder, although the major patterns of treatment outcome remain to be identified. Such outcomes might include treatment response, partial response, and response followed by relapse. To identify these patterns. 50 people with RTC PTSD completed a 12-week course of CBT, with outcome assessment extending to 3-month follow up. Dynamic cluster analyses revealed 2 replicable patterns of outcome: one for responders (n = 30) and one for partial responders (n = 20). Partial responders, compared with responders, tended to have more severe pretreatment numbing symptoms and greater anger about their RTC, along with lower global levels of functioning, greater pain severity and interference, and greater depression and were more likely to be taking psychotropic medications. Responders and partial responders did not differ in homework adherence, number of sessions attended, therapist effects, or stressors occurring during therapy or in the presence or absence of RTC-related litigation. Implications for enhancing treatment outcome are discussed.

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Post traumatic stress disorder (PTSD) and other reactions including driving phobias and depression have in recent years been clearly identified as common motor vehicle accident (MVA) sequelae. To date, no treatment outcome data exist for PTSD following MVA beyond case study reports and one pilot investigation. The present study reports on the first randomized control trial for PTSD following MVA. Twenty volunteer participants who had motor vehicle accidents resulting in physical injury requiring medical attention and PTSD were recruited through rehabilitation service providers, other psychologists, community physicians, and lawyers. Assessments included a structured interview for diagnosis of post traumatic stress disorder (Clinician Administered PTSD Scale) by an independent rater, a range of self-report symptom questionnaires and a behavioural test wherein they had their heart rate and subjective distress measured in reaction to idiosyncratic audio descriptions of their accident. Participants were randomly assigned to eight to ten hours of individual cognitive-behavioural therapy (n=10) or to a wait list control group (n=10). Treatment included education about post-trauma reactions, relaxation training, exposure therapy with cognitive restructuring and instruction for self-directed graduated behaviour practice. Results demonstrated statistically and clinically significant treatment effects across structured interviews, self-report questionnaires and the behavioural test. Treatment gains were maintained over a 6 month follow-up using self-report questionnaires.

Behavioural relaxation training is a simplified technique which may be useful for those individuals who are unable to grasp and benefit from traditional procedures. One such population is Huntington's Disease patients who, in addition to characteristic choreiform movements, which are exacerbated by increased arousal, also suffer from progressive cognitive deterioration. This study used a multiple-baseline design to explore potential use of behavioural relaxation training with two patients who showed advanced disease. Improvement on heart rate and a behavioural measure of relaxation was noted. Results are discussed with respect to treatment of choreiform symptoms and the use of the procedure with other cognitively handicapped populations.

Social and conversational skills training has proven effective with chronic psychiatric populations. Little attention, however, has been directed towards examining the use of this training with individuals who have severe disabilities and have not been released from psychiatric institutions to the community. The present case study examined the utility of this training and constraints in attempting to conduct treatment with two groups of 4 and 3 female psychiatric inpatients who averaged 20 yr. of institutionalization. Significant improvement in orientation and attention, reduction in psychotic talk, and gains on three of five conversational skills were noted. Generalization gains were evident on two of the five specific skills. Observations of group process, examination of indicators of emotional impact, and suggestions for practice are discussed.