title: Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics.
abstract: Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. foa@mail.med.upenn.edu
authors.forename: Edna B
authors.initials: EB
authors.lastname: Foa
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hembree
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Cahill
authors.forename: Sheila A M
authors.initials: SA
authors.lastname: Rauch
authors.forename: David S
authors.initials: DS
authors.lastname: Riggs
authors.forename: Norah C
authors.initials: NC
authors.lastname: Feeny
authors.forename: Elna
authors.initials: E
authors.lastname: Yadin
mesh_terms: D000046:Academic Medical Centers; D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003155:Community Mental Health Centers; D003376:Counseling / Q000379:methods; D019548:Crime Victims / Q000523:psychology*; D005260:Female; D006801:Humans; D012044:Regression Analysis; D012742:Sex Offenses / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000628:therapy*; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists