Barbara Olasov Rothbaum

Treatment of Posttraumatic Stress Disorder in Rape Victims: A Comparison between Cognitive-Behavioral Procedures and Counseling.

Rape victims with posttraumatic stress disorder (PTSD; N = 45) were randomly assigned to one of four conditions: stress inoculation training (SIT), prolonged exposure (PE), supportive counseling (SC), or wait-list control (WL). Treatments consisted of nine biweekly 90-min individual sessions conducted by a female therapist. Measures of PTSD symptoms, rape-related distress, general anxiety, and depression were administered at pretreatment, posttreatment, and follow-up (M = 3.5 months posttreatment). All conditions produced improvement on all measures immediately post-treatment and at follow-up. However, SIT produced significantly more improvement on PTSD symptoms than did SC and WL immediately following treatment. At follow-up, PE produced superior outcome on PTSD symptoms. The implications of these findings and direction for treatment and future research are discussed.

Behavioral/cognitive conceptualizations of post-traumatic stress disorder

The paper reviews and considers the existing cognitive and behavioral accounts for the acquisition and maintenance of post-traumatic stress disorder. Mowrers two-stage theory as applied to rape victims and Vietnam veterans is critically reviewed. It was concluded that traditional S-R learning theories can adequately account for fear and avoidance consequent to a traumatic event, as well as the greater generalization as compared to simple phobics. However, these theories do not explain the remaining PTSD symptoms. The literature on experimental neurosis predicts that uncontrollable and unpredictable events produce responses that are highly reminiscent of PTSD irrespective of stimulus intensity and complexity. An additional shortcoming of S-R theory is the difficulty in incorporating meaning concepts which are so central to PTSD. Evidence for the necessity of a theory to accommodate meaning concepts is the finding that perceived threat is a better predictor of PTSD than actual threat. Therefore, we have presented a theoretical framework developed by Foa & Kozak (1986) which accommodates meaning concepts in explaining mechanisms of fear reduction and adapted this theory to PTSD.

A Prospective Examination of Symptoms of Posttraumatic Stress Disorder in Victims of Nonsexual Assault

Symptoms of posttraumatic stress disorder (PTSD) were examined prospectively in 84 non-sexual assault victims (53 women, 31 men) beginning shortly after the assault (mean = 18.68 days) and continuing weekly for 3 months. At the initial assessment, 71% of the women and 50% of the men met symptom criteria for PTSD. The incidence of PTSD decreased to 42% of the women and 32% of the men by the fourth assessment, and at the final assessment, 21% of the women but none of the men remained with PTSD. An examination of specific PTSD symptoms indicated that many subjects who were not diagnosed with PTSD at the final assessment retained significant symptoms of PTSD, particularly reexperiencing and arousal symptoms. The severity of PTSD did decrease significantly over the course of the study, but only in those groups who were not diagnosed with the disorder at the final assessment. Women who were diagnosed with PTSD at the final assessment did not show a significant decrease in symptom severity over the course of the study. The results are discussed with regard to implications for understanding the development and persistence of posttrauma pathology, and directions for future research are outlined.

Exposure treatment of PTSD concomitant with conversion mutism: A case study *

A case report of the successful treatment by exposure of a woman diagnosed with post-traumatic stress disorder (PTSD) concomitant with conversion mutism is described. PTSD and conversion disorder are both thought to be caused by emotionally traumatic experiences, but the symptomatology is quite different. Etiological theories of the two disorders are discussed, and mechanisms underlying the successful outcome of exposure treatment are considered.