Leah M. Blain

Exploring the role of child sexual abuse and posttraumatic stress disorder symptoms in gay and bisexual men reporting compulsive sexual behavior

OBJECTIVES Compulsive sexual behavior (CSB) is an impairing yet understudied clinical phenomenon. The experience of child sexual abuse (CSA) has been implicated as an etiological factor in the development of some cases of CSB (Kuzma & Black, 2008); however, research regarding the role of CSA and related psychopathology in CSB symptomatology has been limited in the literature. The present study aimed to examine the uniqueness of the association of CSA with CSB as compared to other experiences of child maltreatment; the role of posttraumatic stress disorder (PTSD) symptomatology in CSB symptoms for individuals reporting CSA; and clinical differences between individuals with and without histories of CSA. METHODS Hypotheses were tested using data from a sample of 182 gay and bisexual men reporting CSB symptoms. RESULTS CSA prevalence was high in the tested sample (39%). CSA severity was a unique predictor of CSB symptoms, above child physical and emotional abuse, and poly-victimization status was not significantly related to CSB symptoms. Contrary to hypotheses, PTSD symptoms did not significantly mediate the role of CSA severity, although PTSD symptoms explained additional variance in CSB symptoms, with the final model accounting for over a quarter of the variance in CSB symptoms (27%). Finally, men with a history of CSA reported more CSB, depressive, and anxious symptoms than those without a history of CSA. CONCLUSIONS Findings from the present study support the hypothesis that CSA may be uniquely related to CSB symptoms, above other forms of child maltreatment, and indicate that men with a CSA history are likely to present more severe clinical comorbidities. Clinical implications and future research directions are discussed.

Sex differences in recovery from PTSD in male and female interpersonal assault survivors

Men and women differ in exposure to trauma and the development of posttraumatic stress disorder (PTSD); however, research regarding sex differences in recovery from PTSD has been sparse. This study evaluated the treatment response trajectory for 69 male and female interpersonal assault survivors, using a modified Cognitive Processing Therapy (CPT) protocol that allowed survivors to receive up to18 sessions of CPT, with treatment end determined by therapy progress. Few sex differences were observed in trauma history, baseline PTSD and depressive severity, Axis I comorbidity, anger, guilt and dissociation. Women did report more sexual assault in adulthood and elevated baseline guilt cognitions, whereas men reported more baseline anger directed inward. Attrition and total number of sessions did not differ by sex. Over the course of treatment and follow-up, men and women demonstrated similar rates of change in PTSD and depressive symptoms. However, medium effect sizes on both of these primary outcomes at the 3-month follow-up assessment favored women. Several differences in the slope of change emerged on secondary outcomes such that women evidenced more rapid gains on global guilt, guilt cognitions, anger/irritability, and dissociation. Results suggest that male survivors may warrant additional attention to address these important clinical correlates.

Augmenting cognitive processing therapy to improve sleep impairment in PTSD: A randomized controlled trial

OBJECTIVE Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory after treatment. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy [CPT]). METHOD Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. RESULTS After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. CONCLUSION Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. (PsycINFO Database Record

Non-Paraphilic Compulsive Sexual Behavior and Psychiatric Co-morbidities in Gay and Bisexual Men

This study explored the features of non-paraphilic compulsive sexual behavior (NPCSB) in a community sample of 183 gay and bisexual men in New York City who reported difficulty controlling their sexual behavior. Several diagnostic and face valid measures of NPCSB and Axis I comorbidity were administered. Results indicated that NPCSB is associated with a range of problem behaviors, a fairly coherent pattern of symptoms that can be assessed with good inter-rater reliability, is distinct from other related disorders, and provides a moderate fit to the dependence model but with other unique features. Implications for classification and treatment will be discussed.

Self-Efficacy and Attributions about Change in Persons Attempting to Reduce Compulsive Sexual Behavior with Medication vs. Placebo

Self-efficacy is well-established as an important predictor of long-term health outcomes. There is an emerging literature indicating that taking psychiatric medications without combined behavioral interventions result in poorer long-term outcomes. This is particularly relevant for those using medication for short-term symptom management, including individuals suffering from compulsive sexual behavior (CSB). The purpose of this pilot study was to examine whether post-treatment attributions about change and self-efficacy for future behavior change differed between those taking a placebo or medication for persons attempting to reduce CSB. Participants were 26 gay and bisexual men seeking treatment for CSB who participated in a 12-week double blind placebo controlled trial examining the short-term effectiveness of citalopram. Self-efficacy and attribution assessments were presented to participants after breaking the blind. Participants in the medication group scored significantly lower on post-treatment self-efficacy to change in the future without medication and were more likely to attribute change in CSB to the medication, though no group differences existed on the primary CSB outcome measure. Results suggest that prescription practices for CSB should at minimum include therapeutic techniques that increase confidence to change without medication once it is discontinued.