A cognitive-behavioral therapy (CBT) program for PTSD was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared to treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than clients in TAU at blinded post-treatment and 3-and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. Keywordsposttraumatic stress disorder; severe mental illness; cognitive behavioral therapy; mood disorder; schizophrenia People with severe mental illnesses such as schizophrenia, bipolar disorder, and treatmentrefractory major depression are more likely to have experienced adverse events in childhood such as sexual and physical abuse, and to be victimized in adulthood, compared to the general population (Bebbington et al., 2004;Goodman, Rosenberg, Mueser, & Drake, 1997;Shevlin, Dorahy, & Adamson, 2007). As a presumed result of this high vulnerability to trauma, surveys of posttraumatic stress disorder (PTSD) in treatment samples of people with prolonged and severe mental illness have reported rates of current PTSD ranging between 29% and 48% (Calhoun et al., 2007;Cascardi, Mueser, DeGiralomo, & Murrin, 1996;Craine, Henson, Colliver, & MacLean, 1988;Howgego et al., 2005;Mueser et al., 1998;Mueser et al., 2001;Mueser et al., 2004c;Switzer et al., 1999). These rates far exceed the prevalence of PTSD in the general population, estimated to be 3.5% over 12-months (Kessler, Chiu, Demler, & Walters, 2005b) and 7 to 12% over the lifetime (Breslau, Davis, Andreski, & Peterson, 1991;Breslau, Peterson, Poisson, Schultz, & Lucia, 2004;Kessler et al., 2005a;Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995;Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993).Persons with severe mental illness may experience psychotic distortions or delusions with themes involving sexual or physical abuse (Coverdale & Grunebaum, 1998), raising questions about the reliability and validity of self-reports of trauma and PTSD in this population. However, research addressing this question supports the validity of self-reports (Read, van Os, Morrison, & Ross, 2005). Self-reports of trauma in clients with severe mental illness are reliable over ...

The findings extend research in the general population by suggesting that adverse childhood experiences contribute to worse mental and physical health and functional outcomes among adults with severe mood disorders.

This study investigated the effect of posttraumatic stress disorder (PTSD) on help-seeking for physical problems. Merging two large data sets resulted in a sample of 1773 male Vietnam veterans from white, black, Hispanic, Native Hawaiian, and Japanese American ethnic groups. Predictors of utilization included PTSD, other axis I disorders, and substance abuse. In analyses that adjusted only for age, PTSD was related to greater utilization of recent and lifetime VA medical services, and with recent inpatient care from all sources. Further analysis showed that the increased utilization associated with PTSD was not merely due to the high comorbidity between PTSD and other axis I disorders. The uniqueness of the association between PTSD and medical utilization is discussed in terms of somatization and physical illness.

Exposure to trauma, particularly violent victimization, is endemic among clients with severe mental illness. Multiple psychiatric and behavioral problems are associated with trauma, but posttraumatic stress disorder (PTSD) is the most common and best-defined consequence of trauma. Mental health consumers and providers have expressed concerns about several trauma-related issues, including possible underdiagnosis of PTSD, misdiagnosis of other psychiatric disorders among trauma survivors, incidents of retraumatization in the mental health treatment system, and inadequate treatment for trauma-related disorders. Despite consensus that trauma and PTSD symptoms should be routinely evaluated, valid assessment techniques are not generally used by mental health care providers. PTSD is often untreated among clients with serious mental illness, or it is treated with untested interventions. It is important that policy makers, service system administrators, and providers recognize the prevalence and impact of trauma in the lives of people with severe mental illness. The development of effective treatments for this population requires a rational, orderly process, beginning with the testing of theoretically grounded interventions in controlled clinical trials.

The present study examined the psychological impact of dating violence and the relationship between methods of coping with dating violence and psychological adjustment in a nonclinical female student population. Analyses revealed that women who experienced dating violence were at significantly greater risk than a comparison group for experiencing psychological distress. More symptoms of psychological distress were observed even after controlling for differences between the groups in histories of sexual aggression since age 16 and violence experiences in childhood including physical abuse, sexual abuse, and witnessing physical conflict between one’s parents. The dating violence group was also more prone to use disengagement methods of coping to deal with nondating violence stressful life events than was the comparison group. In addition, disengagement methods of coping with the dating violence per se accounted for unique variance in psychological adjustment even after controlling for characteristics of the dating violence and methods of coping with other stressors.