Avoidant coping and treatment outcome in rape-related posttraumatic stress disorder.
OBJECTIVE
This study investigated the impact of avoidant coping on treatment outcome in rape-related posttraumatic stress disorder (PTSD).


METHODS
Adult women with rape-related PTSD (N = 62) received 9 sessions of prolonged exposure (PE) or eye movement desensitization and reprocessing (EMDR). The mean age for the sample was 34.7 years, and race or ethnicity was reported as 67.7% Caucasian, 25.8% African American, 3.2% Latina, and 3.2% other. PTSD was assessed with the PTSD Symptom Scale-Self-Report (Foa, Riggs, Dancu, & Rothbaum, 1993), and avoidant coping was assessed using the Coping Strategies Inventory-Disengagement subscale (CSI-D; Tobin, Holroyd, Reynolds, & Wigal, 1989).


RESULTS
Pretreatment avoidant coping was negatively associated with posttreatment PTSD symptom severity even when controlling for initial severity of total PTSD symptoms and when removing PTSD avoidance symptoms from the analysis to account for potential overlap between avoidant coping and PTSD avoidance symptoms: ΔR2 = .08, b* = -0.31, 95% CI [-0.17, -0.01], t(60) = -2.27, p = .028. The CSI-D pretreatment mean score of 100 predicted a 96% likelihood of experiencing clinically significant change (CSC) during treatment. A CSI-D pretreatment score of 61 was associated with a 40% likelihood of experiencing CSC.


CONCLUSIONS
PE and EMDR appear to be beneficial for women who frequently engage in avoidant coping responses following rape. A small subset of women with initially low levels of avoidant coping are unlikely to experience a therapeutic response from PE or EMDR.
Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
Amy S
AS
Leiner
Megan C
MC
Kearns
Joan L
JL
Jackson
Millie C
MC
Astin
Barbara O
BO
Rothbaum
D000223:Adaptation, Psychological; D000328:Adult; D057169:Eye Movement Desensitization Reprocessing; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008875:Middle Aged; D011902:Rape / Q000523:psychology*; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome