J Clin Psychol. 2002 Aug;58(8):891-906. Cognitive-behavior therapy for PTSD in rape survivors. Jaycox LH, Zoellner L, Foa EB. Source RAND, Arlington, VA 22202-5050, USA. Jaycox@rand.org Port
Abstract: ...........Terrorism CBT has been found to be effective for PTSD following terrorist attacks, eg, in the survivors of the 9/11 terrorist attack on the World Trade Center,42 the 2005 London bombings,43 and the 1998 bomb explosion in Omagh, Northern Ireland.44 CBT for the victims of the World Trade Center attack was manualized, applied flexibly, in 12–25 sessions, by therapists with no prior training through to extensive training in CBT. There were significant pre-post reductions in symptoms of PTSD and depression.42 The improvement in PTSD in victims of the 2005 London bombings was well maintained at an average of one year later.43 Patients with PTSD secondary to the bomb explosion in Omagh received an average of eight treatment sessions by staff with modest prior training in CBT for PTSD. However, the degree of improvement was comparable with that in reported research trials, in spite of the fact that almost half of the patients (53%) had psychiatric comorbidity.44 War trauma The traumas of war have long been associated with PTSD. In addition, soldiers exposed to combat remain at high risk for developing the disorder.45 Multicomponent CBT showed promise in a group of male combat veterans with severe and chronic PTSD for improving social functioning beyond that provided by exposure therapy alone, particularly by increasing social engagement and interpersonal functioning.46 CBT with brief virtual reality exposure has been found to be beneficial in treating PTSD in war veterans.45 A 12-session integrated treatment using components of cognitive processing therapy for PTSD, and CBT for chronic pain management in veterans with comorbid chronic pain and PTSD, suggested not only the feasibility of this treatment approach but also clinical benefit.47 In recent years, new data have appeared, further suggesting the utility of cognitive-behavioral interventions for posttraumatic stress disorder (PTSD) subsequent to sexual assault. In this article, we present a model of cognitive-behavioral treatment (CBT) for PTSD in rape survivors. Emotional-processing theory, which proposes mechanisms that underlie the development of disturbances following rape, is reviewed. A CBT-based therapy (Prolonged Exposure) is presented that entails education about common reactions to trauma, relaxation training, imaginal reliving of the rape memory, exposure to trauma reminders, and cognitive restructuring. Current research regarding the use of prolonged exposure is discussed. The case example of a young female rape survivor is described in detail, and her prior substance dependence and intense shame are highlighted. The therapy was successful in reducing the client's symptoms of PTSD, as well as her depressive symptoms, and these gains were maintained at a one-year follow-up assessment. Copyright 2002 Wiley Periodicals, Inc.