Study 1
Foa and colleagues (1999) assessed the effects of several treatment conditions on women victims of assault (both sexual and nonsexual) and presenting with chronic posttraumatic stress disorder (PTSD). The sample was randomized into four treatment conditions through a pretest screening and followed by a posttest and three follow-up measurements at 3, 6, and 12 months. The four treatment conditions were Prolonged Exposure (PE) Therapy (n = 25), Stress Inoculation Training (SIT) (n = 26), a mixture of PE and SIT (n = 30) and a waiting list (WL) condition to act as a control group (n = 15). After 5 weeks, participants in the WL group were offered treatment. The CrimeSolutions review of this study focused on the comparisons between the PE Therapy treatment group and the WL control group. There were no significant differences among the four groups on demographics and pretreatment measures of psychopathology. However, some differences were found among groups in relation to employment status.
Participants were not eligible if, during intake, they presented with current schizophrenia, bipolar disorder, organic mental disorder, alcohol or drug dependence, or severe suicidal ideation, or if they were in a current intimate relationship with their assailant. Of the 96 participants in the final sample, 63 percent were white, 36 percent were African American, and their average age was 34.9 years. Ten percent of the sample did not finish high school, 18 percent had high school diplomas, 41 percent had some college, and the remainder had a bachelor’s degree or higher. Roughly a third of the sample had a household income below $10,000, while 38 percent had an income greater than $30,000. Forty-eight percent of the sample reported at least one incident of childhood physical or sexual abuse.
The PE treatment group received nine biweekly sessions: the first two were 120-minute sessions; the next seven each lasted 90 minutes. The instruments used to measure outcomes were the PTSD Symptom Scale—Interview, the Social Adjustment Scale, and two self-report measures: the Beck Depression Inventory and the State—Trait Anxiety Inventory. At pretreatment intake, a Structured Clinical Interview for DSM–III–R Disorders with Psychotic Screen was also conducted to determine eligibility.
Results were analyzed by group mean comparisons (analysis of covariance [ANCOVA] and multivariate analysis of covariance [MANCOVA]) as well as intent-to-treat analysis. It should be noted, however, that sample sizes in this study were small. The study authors did not conduct subgroup analyses.
Study 2
Foa and colleagues (2005) assessed two treatment conditions compared with a waiting list (WL) control group (n = 26). The first treatment group received Prolonged Exposure (PE) Therapy (n = 79), while the second treatment group received PE Therapy and Cognitive Restructuring (CR) [n = 74]. After 9 weeks, participants in the WL group were offered treatment. The CrimeSolutions review of this program focused on the comparisons between the PE Therapy treatment group and the WL control group.
The participants were women diagnosed with PTSD as a result of adult rape, nonsexual assault, or childhood sex abuse. The participants were referred by police departments, victims groups, and other professionals. Enrollment was done through the Center for the Treatment and Study of Anxiety and the Women Organized Against Rape, a Philadelphia, Pa., community clinic for victims of sexual assault. Women were excluded from the study if they were in an abusive relationship; currently diagnosed with an organic mental disorder, schizophrenia, or psychotic disorder; were at high risk of suicide; had recent history of serious self-harm; had unmedicated bipolar disorder; were substance dependent; or were illiterate in English. The average sample age was 31 years, and the average number of years since the trauma was 9. Sixty-nine percent of the sample listed sexual assault as their trauma. The majority (62 percent) of women were single, 49 percent were white, and 44 percent were African American. Forty percent of the participants were in full-time employment, 44 percent had some college, and 47 percent reported an income below or equal to $15,000.
The study used the PTSD Symptom Scale—Interview, the Beck Depression Inventory, the Social Adjustment Scale, and the PTSD Symptom Scale—Self-Report. Measurements were taken pretest, posttest, and then at 3, 6, and 12 months following the intervention. The Structural Clinical Interview for DSM–IV Axis I Disorders with Psychotic Screen was used at pretest to diagnose participants and assess their eligibility.
In addition to intent-to-treat analysis using ANOVA and independent sample t–tests, the study employed repeated analysis on a completer-only subsample (n = 52 for PE only, and n = 44 for PE/CR).
All PE treatment participants received eight weekly sessions between 90 and 120 minutes. At the eighth session, their PTSD Symptom Scale—Self-Report score was compared with their pretest score. Participants showing a 70 percent reduction received only one more (a ninth) session. Others continued to a maximum of 12 sessions. After the 9-week period, the WL group was offered treatment. They were not included in follow-ups. The study authors conducted subgroup analyses on the completer-only subsample (52 for PE only).
Study 3
Resick and colleagues (2002) compared the effects of Prolonged Exposure (PE) Therapy and Cognitive–Processing Therapy (CPT) to a Minimal Attention (MA) waiting list control condition for chronic PTSD in female rape victims. An intent-to-treat sample (n = 171) was randomized into the three conditions (121 were completers). There were 41 women in the CPT group, 40 women in the PE group, and 40 women in the MA group. The MA group was offered treatment after 6 weeks. The CrimeSolutions review of this study focused on the comparisons between the PE Therapy treatment group and the MA control group.
The participants were excluded if they presented current psychosis, developmental disabilities, suicidal intent, drug or alcohol dependence, or illiteracy, and if they were in an abusive relationship or being stalked. Participants needed to be at least 3 months posttrauma. Overall, the average sample age was 32, with an average of 14.3 years of education, and 76 percent of the sample had never been married or were divorced or separated. The sample was 71 percent white and 25 percent African American. Thirty-one percent of the sample was taking psychotropic medication. The average time since the rape was 8.5 years, and 48 percent of the sample reported at least one rape other than the indexed trauma. Forty-one percent reported childhood sexual abuse.
The study used several instruments to measure posttrauma effects: the Clinician-Administered PTSD Scale, Structured Interview for DSM–IV—Patient Version, Standardized Trauma Interview, PTSD Symptom Scale, Beck Depression Inventory, Trauma-Related Guilt Inventory, and Expectancy of Therapeutic Outcome. PE participants (and CPT participants) received nine sessions of 60 to 90 minutes, with one session a week. The MA group was offered treatment after 6 weeks. Assessment was made at pretreatment, posttreatment, at 3 months, and at 9 months.
This study used intent-to-treat analysis with last observations carried forward (LOCF) as well as random effects regression. This allowed for a more complete picture of the results and was chosen because of missing data due to drop outs. The completer subsample was analyzed separately using MANOVA for the three groups at pretreatment and posttreatment and then for the two treatment groups across the four assessment periods. The authors conducted subgroup analyses on the completer-only subsample (121 were completers).
