Sian Thrasher

Social support moderates outcome in a randomized controlled trial of exposure therapy and (or) cognitive restructuring for chronic posttraumatic stress disorder.

Objective: To understand what predicts good outcome in psychiatric treatments, thus creating a pathway to improving efficacy. Method: Our study investigated relations between predictor variables and outcome (on the Clinician Administered Posttraumatic Stress Disorder [PTSD] Scale [CAPS]) at posttreatment for 77 treatment completers in a randomized controlled trial of exposure therapy and (or) cognitive restructuring, compared with relaxation, for chronic PTSD in adults. Results: More social support on the Significant Others Scale significantly predicted better outcome on the CAPS, even after controlling for the effects of treatment group and of pretreatment severity. Importantly, social support was only a significant predictor of outcome for participants receiving cognitive restructuring and (or) exposure therapy and not for participants in the relaxation condition. Conclusions: Better social support is associated with significantly greater gain following cognitive restructuring and (or) exposure therapy for PTSD. Future interventions should consider augmenting social support as an adjunct to treatment.

DO COGNITIVE AND EXPOSURE TREATMENTS IMPROVE VARIOUS PTSD SYMPTOMS DIFFERENTLY? A RANDOMIZED CONTROLLED TRIAL

This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. Seventy-seven PTSD outpatients were randomly allocated to one of four treatments: 1) exposure alone; 2) cognitive restructuring alone; 3) combined exposure and cognitive restructuring; or 4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitive restructuring improved almost all individual symptoms similarly.

Chronic emotional processing in survivors of the Herald of Free Enterprise disaster : the relationship of intrusion and avoidance at 3 years to distress at 5 years

Thirty-seven survivors completed the Impact of Event Scale (IES), a measure of intrusive and avoidant activity, at around 3 yr following the Herald of Free Enterprise disaster. The aim of the present study was to examine the relationship between scores on the IES to scores on the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory (STAI-Y1) at around 5 yr subsequent to the event. Higher scores on the IES were able to predict higher scores on the BDI and the STAI-Y1 over and above scores on the 28-item General Health Questionnaire (GHQ-28) which was also administered at around 3 yr on from the event. Implications for cognitive-behaviour therapy are discussed.

Impulsivity and post-traumatic stress

Abstract Although it has been predicted from the compulsive reexposure hypothesis that PTSD is positively associated with sensation seeking, empirical data do not support this hypothesis but suggest that PTSD may actually be associated with lower sensation seeking. In an attempt to resolve the confusion over the association between sensation seeking and PTSD, we investigated the association between PTSD and scores on the Impulsivity questionnaire (I 7 : Eysenck, Pearson, Easting & Allsopp, 1985) in survivors of the Herald of Free Enterprise disaster. The I 7 makes a distinction between two components of impulsivity: Impulsiveness and Venturesomeness. Impulsiveness is regarded as the pathological aspect of risk taking behaviour. People high on Impulsiveness exhibit less awareness of the future consequences of their activities. Venturesomeness, on the other hand, refers to risk taking behaviour in the knowledge that there is a risk involved. Although no significant difference was found between high and low PTSD symptom survivors on Venturesomeness, high PTSD symptom survivors scored higher on Impulsiveness than low PTSD symptom survivors providing support for the compulsive reexposure hypothesis.

Cognitive Restructuring in the Treatment of Post-Traumatic Stress Disorder—Two Single Cases

Two single cases of chronic Post-Traumatic Stress Disorder following violent assault were successfully treated using cognitive restructuring. The techniques used are outlined, outcome measures reported, and the possible mechanisms of therapeutic change discussed.