Christine D. Scher

A Randomized Clinical Trial to Dismantle Components of Cognitive Processing Therapy for Posttraumatic Stress Disorder in Female Victims of Interpersonal Violence

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.

The childhood trauma questionnaire in a community sample: psychometric properties and normative data.

Interpretation of research on the prevalence and sequelae of childhood trauma has been hindered by the use of assessment instruments with unknown psychometric properties. Thus, we examined the psychometric properties of a new childhood trauma measure, the Childhood Trauma Questionnaire (CTQ). The CTQ has demonstrated strong psychometric properties in clinical samples; limited information exists on its psychometric properties in community samples. Therefore, we explored the factor structure and reliability of the CTQ in a community sample and calculated normative data. Consistent with previous literature, a 5-factor model best described the CTQ, with a hierarchical model also providing excellent fit. Additionally, the CTQ demonstrated acceptable internal consistency. Overall, our findings suggest that the CTQ is appropriate for use in a community sample.

Developmental antecedents of anxiety sensitivity.

Anxiety sensitivity (AS) has been implicated in the etiology of anxiety and depressive disorders. Nonetheless, little is known about the developmental antecedents of AS or about its role as a mediator of emotional distress. To investigate these issues, 249 university students completed a battery of self-report measures. Regression analyses and partial correlations were used to evaluate hypotheses. Analyses revealed that exposure to parental threatening, hostile, and rejecting behaviors (1) predicted overall AS and (2) appeared differentially related to AS factors. Additionally, AS acted as a mediator between parenting and both current emotional distress and history of emotional disorder symptoms. These data support the notion that parental behaviors hypothesized as etiologic in the development of emotional disorders may also be etiologic in the development of AS and that AS may serve as a mediator between childhood experience and emotional distress.

Cognitive mediation of childhood maltreatment and adult depression in recent crime victims

Childhood maltreatment has been linked to adult depressive disorders. However, few studies have examined mechanisms through which childhood maltreatment may contribute to adult depression. Thus, we examined the role of one potential mechanism of this relationship, maladaptive cognitions, in a recently traumatized sample. Participants were adult women who had been recently raped (n = 133) or physically assaulted (n = 73). We examined whether maladaptive self-and other-cognitions mediated relationships between childhood sexual, physical, and emotional abuse and current depression. Relationships between childhood sexual abuse and both current depression symptoms and diagnosis were mediated by maladaptive cognitions about self. Relationships between both childhood sexual abuse and childhood physical abuse and adult depressive symptoms were mediated by maladaptive cognitions about others.

Factor structure and reliability of the childhood trauma questionnaire and prevalence estimates of trauma for male and female street youth.

This study examines the psychometric properties of the Childhood Trauma Questionnaire short form (CTQ-SF) with street youth who have run away or been expelled from their homes (N = 397). Internal reliability coefficients for the five clinical scales ranged from .65 to .95. Confirmatory Factor Analysis (CFA) was used to test the five-factor structure of the scales yielding acceptable fit for the total sample. Additional multigroup analyses were performed to consider items by gender. Results provided only evidence of weak factorial invariance. Constrained models showed invariance in configuration, factor loadings, and factor covariances but failed for equality of intercepts. Mean trauma scores for street youth tended to fall in the moderate to severe range on all abuse/neglect clinical scales. Females reported higher levels of abuse and neglect. Prevalence of child maltreatment of individual forms was very high with 98% of street youth reporting one or more forms; 27.4% of males and 48.9% of females reported all five forms. Results of this study support the viability of the CTQ-SF for screening maltreatment in a highly vulnerable street population. Caution is recommended when comparing prevalence estimates for male and female street youth given the failure of the strong factorial multigroup model.

The structure of post-traumatic stress disorder symptoms in three female trauma samples: A comparison of interview and self-report measures

Empirical research increasingly suggests that post-traumatic stress disorder (PTSD) is comprised of four factors: re-experiencing, avoidance, numbing, and hyperarousal. Nonetheless, there remains some inconsistency in the findings of factor analyses that form the bulk of this empirical literature. One source of such inconsistency may be assessment measure idiosyncrasies. To examine this issue, we conducted confirmatory factor analyses of interview and self-report data across three trauma samples. Analyses of the interview data indicated a good fit for a four-factor model across all samples; analyses of the self-report data indicated an adequate fit in two of three samples. Overall, findings suggest that measure idiosyncrasies may account for some of the inconsistency in previous factor analyses of PTSD symptoms.

Cultural sensitivity in screening adults for a history of childhood abuse: evidence from a community sample

BackgroundA number of practice guidelines and recommendations call for the assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening questions, however, has not been examined.ObjectiveTo assess whether questions that inquire about childhood abuse history function differently for black and white patients.DesignCross-sectional telephone surveys in 1997 and 2003.SubjectsRandomly sampled adults from Memphis, Tenn (1997, N = 832; 2003, N = 967).MeasurementsPhysical, emotional, and sexual abuse scales of the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Standardized mean difference technique for differential item functioning to assess for possible bias in CTQ-SF items.ResultsControlling for total physical abuse scale scores, black respondents were significantly (P < .01) more likely than white respondents to report that they had been punished with a hard object during their childhood, but less likely to report having being hit so hard that it left marks, have been hit so hard that someone noticed, or to believe they had been physically abused.ConclusionsInquiries that do not explicitly differentiate physical punishment from physical abuse may not be useful for black respondents because they tend to identify black respondents who report fewer clearly abusive experiences than comparable white respondents. Although untested in this study, one possible explanation is that physical discipline may be used more frequently and may play a different role among black families than among white families. These results underline the importance of attending to cultural factors in clinical history taking about childhood abuse histories.

Hopelessness as a risk factor for post-traumatic stress disorder symptoms among interpersonal violence survivors

Post‐traumatic stress disorder often co‐occurs with depression, and they may share common risk factors. One possible common cognitive risk factor is hopelessness. Thus, we examined whether hopelessness was related to symptoms of post‐traumatic stress disorder. Participants were 202 female survivors of interpersonal violence. Relationships between self‐reported and interviewer‐rated measures of hopelessness gathered at 2 weeks post‐trauma and self‐reported and interviewer‐rated symptoms of post‐traumatic stress disorder gathered at 2 weeks and 3 months post‐trauma were examined. Hierarchical, simultaneous regression analyses that co‐varied trauma type revealed that hopelessness was related to self‐reported symptoms of post‐traumatic stress disorder, both concurrently and prospectively. Follow‐up analyses revealed that relationships between hopelessness and symptoms of post‐traumatic stress disorder were due almost entirely to shared variance with depression. No relationships were found between hopelessness and interviewer‐rated symptoms of post‐traumatic stress disorder.

Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder.

Objectives: This study examined (a) relationships between trauma-related cognitions and posttraumatic stress disorder (PTSD) symptoms from pretreatment through a long-term period after cognitive–behavioral therapy (CBT) for PTSD and (b) whether these relationships were impacted by treatment type. Method: Participants were 171 women randomized into treatment for PTSD after rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pretreatment, posttreatment, and 3-month, 9-month, and 5–10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure). Results: Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With 1 minor exception, relationships between beliefs and symptoms were not moderated by treatment type. Conclusions: These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains after CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism.

Fire-related cognitions moderate the impact of risk factors on adjustment following wildfire disaster

This study builds upon current understanding of risk and protective factors for post-disaster adjustment by examining relationships between disaster-related cognitions, three empirically supported risk factors for poorer adjustment (i.e., greater disaster impact, female gender, and racial/ethnic minority status), and three common post-disaster outcomes (i.e., depression, anxiety, and somatic complaints). Participants were 200 students exposed to wildfire disaster. Simultaneous hierarchical regression analyses revealed that, during the acute stress period: (1) disaster-related cognitions in interaction with fire impact and minority status, as well as gender, were related to anxiety symptoms, (2) cognitions were related to depression symptoms, and (3) cognitions in interaction with minority status, as well as fire impact, were related to somatic symptoms. No examined variables predicted symptom change.