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The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. Keywords: cognitive processing therapy, posttraumatic stress disorder, interpersonal violence, cognitive behavioral therapy

We followed up over 90% of 57 motor vehicle accident survivors, who completed a controlled comparison of cognitive behavioral therapy (CBT) to supportive psychotherapy (SUPPORT). One-year results showed a continued significant advantage on categorical diagnosis (PTSD or not) and structured interview measures (CAPS) for CBT over SUPPORT. Other measures generally showed the same results. At two years, we were able to follow-up only 75% of one-year completers. Although there continued to be arithmetic differences favoring CBT over SUPPORT, with these attenuated samples only differences on PTSD Checklist and Impact of Event Scale scores and in overall categorical diagnoses were significant. There was very modest improvement from end of treatment to the two-year follow-up. Keywords: Motor vehicle accidents; MVA; Posttraumatic stress disorder; PTSD; Cognitive-behavioral therapy; Follow-up after treatment

Twenty drivers were remanded to our treatment program by the courts following arrests related to serious aggressive driving behaviors. Ten additional drivers entered our program in response to our advertisements thus identifying themselves as aggressive drivers. Psychophysiological assessments were conducted on all 30 drivers and heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), and skin resistance level (SRL) were measured in response to exposure to a mental arithmetic neutral stressor, two idiosyncratic, audio-taped, aggressive driving vignettes (audio 1 and audio 2), and one non-driving related fearful vignette. Fourteen non-aggressive driving controls also completed the assessment. The results indicated that the aggressive drivers (ADs) showed significantly more SBP responsivity during audio 1 and audio 2 and significantly less SBP reactivity during the mental arithmetic stressor than the controls. The aggressive drivers then completed a four-week, group intervention which included relaxation techniques specifically targeting aggressive driving behaviors. The same psychophysiological assessment was conducted at post-treatment. The results showed significant pre- to post-treatment decreases in HR, p < 0.003, SBP, p < 0.01, and DBP, p < 0.02 during audio 1. Similarly, decreases were evident in audio 2 in SBP, p < 0.03 only. No decreases in reactivity occurred during the neutral stressor or fearful situation. Keywords: Aggressive driving; Anger; Aggression; Psychophysiology

We sought to predict posttreatment PTSD symptom scores (Clinician-Administered PTSD Scale scores) among motor vehicle accident (MVA) survivors with PTSD who had received either cognitive behavioral treatment (CBT; n = 30) or supportive psychotherapy (SUPPORT; n = 27) using pretreatment variables. We could account for 43% (CBT) to 70% (SUPPORT) of variance in the measure of PTSD symptoms. The most consistent predictors were pretreatment PTSD symptom scores. Comorbid conditions, especially depression, and degree of initial impairment were also significant predictors.

Seventy-eight motor vehicle accident survivors with chronic (greater than 6 months) PTSD, or severe subsyndromal PTSD, completed a randomized controlled comparison of cognitive behavioral therapy (CBT), supportive psychotherapy (SUPPORT), or a Wait List control condition with two detailed assessments. Scores on the CAPS showed significantly greater improvement for those in CBT in comparison to the Wait List and to the SUPPORT conditions. The SUPPORT condition in turn was superior (p=0.012) to the Wait List. Categorical diagnostic data showed the same results. An analysis of CAPS scores including drop-outs (n=98) also showed CBT to be superior to Wait List and to SUPPORT with a trend for SUPPORT to be superior to Wait List. The CBT condition led to significantly greater reductions in co-morbid major depression and GAD than the other two conditions. Results held up well at a 3-month follow-up on the two active treatment conditions.

This study tested the efficacy of a cognitive-behavioral psychological intervention (CBT) targeting aggressive driving behaviors within both a court-referred (N=20) and a self-referred community (N=8) sample as compared to a symptom monitoring (SM) only control condition. Treatment outcome was assessed through the use of daily driving diaries, standard psychological tests, and a global rating of change scale. The CBT treatment condition improved more than the SM condition as assessed through the daily driving diaries. Although the court-referred and self-referred samples showed equivalent improvement on the driving diaries, the self-referred group improved more on measures of general anger. Standardized measures of driving anger, state anxiety and measures of general anger indicated significant change in the expected direction. Aggressive drivers who met criteria for Intermittent Explosive Disorder (IED) showed a trend to improve less than non-IED aggressive drivers. Treatment gains were maintained at the 2-month follow-up point.

In a population of 71 (57 female, 14 male) IBS patients seeking psychological treatment, we found expected levels of childhood sexual and physical abuse (57.7%) and expected levels of current Axis I psychiatric disorders (54.9%). Moreover, we found those who had been victims of early abuse had higher current Beck Depression Inventory scores. However, contrary to expectations, there were no significant associations between early abuse and current psychiatric disorder in this population, suggesting that those individuals with psychological distress are not exactly the same group with a history of abuse.