Lisa R. Cohen

Understanding Revictimization Among Childhood Sexual Abuse Survivors: An Interpersonal Schema Approach

Revictimization among women with a history of childhood sexual abuse was investigated within the context of a developmental model of interpersonal schemas. Data from the Interpersonal Schema Questionnaire (ISQ) revealed contrasting schema characteristics among sexually revictimized women (those sexually abused in childhood and sexually assaulted in adulthood) (n = 26), compared to those only abused in childhood (n = 18), and those never abused or assaulted (n = 25). Both revictimized women and never victimized women significantly generalized their predominant parental schemas to current relationships and differed only in the content of the schemas. The generalized parental schema of revictimized women viewed others as hostile and controlling while that of never victimized women viewed others as warm and noncontrolling. Women who had only been abused in childhood held schemas of parents as hostile but not controlling and did not generalize from parental to current schemas. The tendency to generalize observed in the first two groups suggest that “repetition compulsion” is not limited to those who were traumatized and are psychologically distressed. In this article, reasons for the absence of generalization among the childhood abuse only group are explored and implications for the treatment of childhood trauma survivors are discussed.

Combining seeking safety with sertraline for PTSD and alcohol use disorders: A randomized controlled trial.

OBJECTIVEnThe current study marks the first randomized controlled trial to test the benefit of combining Seeking Safety (SS), a present-focused cognitive-behavioral therapy for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), with sertraline, a front-line medication for PTSD shown to also impact drinking outcomes.nnnMETHODnSixty-nine participants (81% female; 59% African American) with primarily childhood sexual (46%) and physical (39%) trauma exposure, and drug dependence in addition to AUD were randomized to receive a partial-dose (12 sessions) of SS with either sertraline (n = 32; M = 7 sessions) or placebo (n = 37; M = 6 sessions). Assessments conducted at baseline, end-of-treatment, 6- and 12-months posttreatment measured PTSD and AUD symptom severity.nnnRESULTSnBoth groups demonstrated significant improvement in PTSD symptoms. The SS plus sertraline group exhibited a significantly greater reduction in PTSD symptoms than the SS plus placebo group at end-of-treatment (M difference = -16.15, p = .04, d = 0.83), which was sustained at 6- and 12-month follow-up (M difference = -13.81, p = .04, d = 0.71, and M difference = -12.72, p = .05, d = 0.65, respectively). Both SS groups improved significantly on AUD severity at all posttreatment time points with no significant differences between SS plus sertraline and SS plus placebo.nnnCONCLUSIONnResults support the combining of a cognitive-behavioral therapy and sertraline for PTSD/AUD. Clinically significant reductions in both PTSD and AUD severity were achieved and sustained through 12-months follow-up, Moreover, greater mean improvement in PTSD symptoms was observed across all follow-up assessments in the SS plus sertraline group. (PsycINFO Database Record

Trauma services for women in substance abuse treatment : an integrated approach

This book is a hands-on guide for clinicians seeking to treat women who suffer from both a history of trauma and the effects of substance abuse. The intertwined nature of trauma and addiction is explored through a review of recent research, with a focus on treatment options for PTSD and addiction that together form the basis for many of the recently developed treatments for trauma and addiction co-morbidity. Vital background material is included that describes the effects of trauma on emotion regulation, interpersonal functioning, parenting, and physical health. Finally, the book addresses the many real-world challenges clinicians will face in implementing trauma-focused therapeutic approaches in community-based substance abuse treatment.The authors have written an essential resource for substance abuse program directors who want to broaden their services to better assist their clients. It will also be helpful for clinicians and social workers who want to better understand the complicated nature of their clients problems, as well as for researchers seeking to expand on the current understanding of addiction and trauma co-morbidity, and for all who seek to further develop integrated treatments to help lead victims to recovery.