Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients.

Exposure-based therapy leads to greater reduction in subsequent PTSD symptoms in patients with ASD when compared with cognitive restructuring. Exposure should be used in early intervention for people who are at high risk for developing PTSD.

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The aim of the present study was to examine whether the finding of suppressed physiological activity in dissociative rape-trauma victims (Griffin, Resick, & Mechanic, 1997) was replicable in a nonsexual assault trauma group. A sample of 17 high-dissociating (HD) participants and 18 low-dissociating (LD) participants who had experienced a motor vehicle accident or physical assault described their trauma while skin conductance, heart rate activity, and self-reported mood were recorded. HD individuals demonstrated a trend for elevated heart rate during the experiment compared with LD participants, but both groups displayed comparable skin-conductance levels. Curve estimation analysis indicated that the two groups had a similar pattern of physiological responding during the trauma narratives. These findings challenge the notion that dissociative reactions are associated with reduced psychophysiological arousal after trauma.

This evidence suggests that response to CBT may be enhanced in PTSD patients by preparing them with emotion regulation skills. High attrition of participants during the study limits conclusions from this study.