Skip to main content Accessibility help
×
Home

Cognitive Processing Therapy for the Treatment of Acute Stress Disorder Following Sexual Assault: A Randomised Effectiveness Study

  • Reginald D.V. Nixon (a1), Talitha Best (a1), Sarah R. Wilksch (a1), Samantha Angelakis (a1), Lisa J. Beatty (a1) and Nathan Weber (a1)...

Abstract

The effectiveness of individually administered cognitive processing therapy (CPT) when compared with treatment as usual (TAU) in a community sexual assault centre was tested. Trauma survivors with acute stress disorder (ASD) following sexual assault were randomised to either CPT (n = 25) or TAU (n = 22), and assessed at pretreatment, posttreatment, and 3-, 6- and 12-month follow-up. Both groups demonstrated large reductions in PTSD and depression symptoms following treatment, and these gains were maintained over the course of follow-ups (Cohen's ds for PTSD symptom reductions ranging between 0.76 to 1.45). Although smaller and not always consistent, between-group effect sizes typically favoured CPT. Effect sizes (d) ranged between 0.13–0.50 for posttraumatic stress and 0.13–0.41 for depression over the course of follow-ups. Independent assessment of PTSD severity indicated more CPT participants reached good end-state functioning at 12-month follow-up (50%) than TAU (31%). Although both treatments were effective, there were some indications that CPT led to better outcomes relative to therapists delivering their usual therapy. The present study demonstrates that evidence-based, trauma-focused therapy such as CPT can be effective when delivered as an early intervention in a routine mental health setting.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Cognitive Processing Therapy for the Treatment of Acute Stress Disorder Following Sexual Assault: A Randomised Effectiveness Study
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Cognitive Processing Therapy for the Treatment of Acute Stress Disorder Following Sexual Assault: A Randomised Effectiveness Study
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Cognitive Processing Therapy for the Treatment of Acute Stress Disorder Following Sexual Assault: A Randomised Effectiveness Study
      Available formats
      ×

Copyright

Corresponding author

Address for correspondence: Reginald D.V. Nixon, Ph.D., School of Psychology, Flinders University, P.O. Box 2100, Adelaide SA 5001, Australia. Email: reg.nixon@flinders.edu.au

References

Hide All
Australian Centre for Posttraumatic Mental Health (ACPMH). (2013). Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne, Australia: Author.
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Beck Depression Inventory — Second edition: Manual. San Antonio, TX: Psychological Corporation.
Becker, C.B., Zayfert, C., & Anderson, E. (2004). A survey of psychologist's attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research & Therapy, 42, 277292. doi:10.1016/S0005-7967(03)00138-4
Blake, D.D., Weathers, F.W., Nagy, L.M., Kaloupek, D.G., Gusman, F.D., Charney, D.S., & Keane, T.M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 7590. doi:10.1002/jts.2490080106
Benish, S.G., Imel, Z.E., & Wampold, B.E. (2008). The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorder: A meta-analysis of direct comparisons. Clinical Psychology Review, 28, 746758. doi:10.1016/j.cpr.2007.10.005
Bryant, R.A., Harvey, A.G., Dang, S.T., Sackville, T., & Basten, C. (1998). Treatment of acute stress disorder: A comparison of cognitive behavior therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 66, 826866. doi:10.1037/0022-006X.66.5.862
Bryant, R.A., Mastrodomenico, J., Felmingham, K.L., Hopwood, S., Kenny, L., Kandris, E., . . . Creamer, M. (2008). Treatment of acute stress disorder: A randomised controlled trial. Archives of General Psychiatry 65, 659667. doi:10.1001/archpsyc.65.6.659
Bryant, R.A., Moulds, M., Guthrie, R., & Nixon, R.D.V. (2003). Treating acute stress disorder following mild traumatic brain injury. American Journal of Psychiatry, 160, 585587. doi:10.1176/appi.ajp.160.3.585
Bryant, R.A., Moulds, M., Guthrie, R. & Nixon, R.D.V. (2005). The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. Journal of Consulting and Clinical Psychology, 73, 334340. doi:10.1037/0022–006X.73.2.334
Bryant, R.A., Moulds, M.L., & Nixon, R.V.D. (2003). Cognitive behaviour therapy of acute stress disorder: A four-year follow-up. Behaviour Research and Therapy, 41, 489494. doi:10.1016/S0005-7967(02)00179-1
Bryant, R.A., Moulds, M.L., Nixon, R.D., Mastrodomenico, J., Felmingham, K., & Hopwood, S. (2006). Hypnotherapy and cognitive behaviour therapy of acute stress disorder: A 3-year follow-up. Behaviour Research and Therapy, 44, 13311335. doi:10.1016/j.brat.2005.04.007
Bryant, R.A., Sackville, T., Dang, S.T., Moulds, M., & Guthrie, R. (1999). Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. American Journal of Psychiatry, 156, 17801786.
Chard, K.M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 965971. doi:10.1037/0022-006X.73.5.965
Chard, K.M., Ricksecker, E.G., Healy, E.T., Karlin, B.E., & Resick, P.A. (2012). Dissemination and experience with cognitive processing therapy. Journal of Rehabilitation Research & Development, 49, 667678. doi:10.1682/JRRD.2011.10.0198
Chard, K.M., Schumm, J.A., McIlvain, S.M., Bailey, G.W., & Parkinson, R.B. (2011). Exploring the efficacy of a residential treatment program incorporating cognitive processing therapy-cognitive for veterans with PTSD and traumatic brain injury. Journal of Traumatic Stress, 24, 347351. doi:10.1002/jts.20644
Cook, J.M., Dinnen, S., Thompson, R., Simiola, V., & Schnurr, P.P. (2014). Changes in implementation of two evidence-based psychotherapies for PTSD in VA residential treatment programs: A national investigation. Journal of Traumatic Stress, 27, 137143. doi:10.1002/jts.21902
Cumming, G. (2008). Replication and p intervals: p values predict the future only vaguely, but confidence intervals do much better. Perspectives on Psychological Science, 3, 286300. doi:10.1111/j.1745-6924.2008.00079.x
Cumming, G. (2014). The new statistics: Why and how. Psychological Science, 25, 729. doi:10.1177/0956797613504966
deRoon-Cassini, T.A., Mancini, A.D., Rusch, M.D., & Bonanno, G.A. (2010). Psychopathology and resilience following traumatic injury: A latent growth mixture model analysis. Rehabilitation Psychology, 55, 111. doi:10.1037/a0018601
Devilly, G.J., & Borkovec, T.D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31, 7386. doi:10.1016/S0005-7916%2800%2900012-4
Ehlers, A., Bisson, J., Clark, D.M., Creamer, M., Pilling, S., Richards, D., . . . Yule, W. (2010). Do all psychological treatments really work the same in posttraumatic stress disorder? Clinical Psychology Review, 30, 269276. doi:10.1016/j.cpr.2009.12.001
Elklit, A., & Christiansen, D.M. (2010). ASD and PTSD in rape victims. Journal of Interpersonal Violence, 25, 14701488. doi:10.1177/0886260509354587
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 11491160. doi:10.3758/BRM.41.4.1149
Faulkner, C., Fidler, F., & Cumming, G. (2008). The value of RCT evidence depends on the quality of statistical analysis. Behaviour Research and Therapy, 46, 270281. doi:http://dx.doi.org/10.1016/j.brat.2007.12.001
Foa, E.B., Ehlers, A., Clark, D.M., Tolin, D.F., & Orsillo, S.M. (1999). The Posttraumatic Cognitions Inventory (PTCI): Development and validation. Psychological Assessment, 11, 303314. doi:10.1037/1040-3590.11.3.303
Foa, E.B., Hearst-Ikeda, D., & Perry, K.J. (1995). Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. Journal of Consulting and Clinical Psychology, 63, 948955. doi:10.1037/0022-006X.63.6.948
Foa, E.B., Hembree, E.A., Cahill, S.P., Rauch, S.A., Riggs, D.S., Feeny, N.C., . . . Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953964. doi:10.1037/0022-006X.73.5.953
Foa, E.B., Zoellner, L.A., & Feeny, N.C. (2006). An evaluation of three brief programs for facilitating recovery after assault. Journal of Traumatic Stress, 19, 2943. doi:10.1002/jts.20096
Forbes, D., Lloyd, D., Nixon, R.D.V., Elliott, P., Varker, T., Perry, D., . . . Creamer, M. (2012). A multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26, 442452. doi:10.1016/j.janxdis.2012.01.006
Galovski, T.E., Blain, L.M., Mott, J.M., Elwood, L., & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy. Journal of Consulting and Clinical Psychology, 80, 968981. doi:10.1037/a0030600
Gilboa-Schechtman, E., Foa, E.B., Shafran, N., Aderka, I.M., Powers, M.B., Rachamim, L., . . . Apter, A. (2010). Prolonged exposure versus dynamic therapy for adolescent PTSD: A pilot randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 10341042. doi:10.1016/j.jaac.2010.07.014
Kliem, S., & Kröger, C. (2013). Prevention of chronic PTSD with early cognitive behavioral therapy. A meta-analysis using mixed-effects modelling. Behaviour Research and Therapy, 51, 753761. doi:10.1016/j.brat.2013.08.005
Koucky, E.M., Galovski, T.E., & Nixon, R.D.V. (2012). Acute stress disorder: Conceptual issues and treatment outcomes. Cognitive and Behavioral Practice, 19, 437450. doi:10.1016/j.cbpra.2011.07.002
McNally, R.J., Bryant, R.A., & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological Science in the Public Interest, 4, 4579. doi:10.1111/1529-1006.01421
Monson, C.M., Schnurr, P.P., Resick, P.A., Friedman, M.J., Young-Xu, Y., & Stevens, S.P. (2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898907. doi:10.1037/0022-006X.74.5.898
National Institute for Clinical Excellence (NICE). (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London: Gaskell and the British Psychological Society.
Nixon, R.D.V. (2012). Cognitive processing therapy versus supportive counseling for acute stress disorder following assault: A randomized pilot trial. Behavior Therapy, 43, 825836. doi:10.1016/j.beth.2012.05.001
O'Donnell, M.L., Elliot, P., Lau, W., & Creamer, M. (2007). PTSD symptom trajectories: From early to chronic response. Behaviour Research & Therapy, 45, 601606. doi:10.1016/j.brat.2006.03.015
R Development Core Team. (2011). R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.
Raghunathan, T., & Dong, Q. (2013). Analysis of variance from multiply imputed data sets. Unpublished manuscript, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan. Retrieved September 13, 2013, from http://www-personal.umich.edu/~teraghu/Raghunathan-Dong.pdf
Resick, P.A. (1988). Reactions of female and male victims of rape and robbery (A final report; Grant No. 85-IJ-CX-0042). Washington, DC: National Institute of Justice.
Resick, P.A., Galovski, T.E., Uhlmansiek, M.O., Scher, C.D., Clum, G.A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243258. doi:10.1037/0022-006X.76.2.243
Resick, P.A., Monson, C.M., & Chard, K.M. (2007). Cognitive processing therapy: Veteran/military version. Washington, DC: Department of Veterans’ Affairs.
Resick, P.A., Nishith, P., Weaver, T.L., Astin, M.C., & Feuer, C.A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology, 70, 867879. doi:10.1037/0022-006X.74.5.898
Resick, P.A., & Schnicke, M.K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748756. doi:10.1037/0022-006X.60.5.748
Rothbaum, B., Foa, E., Riggs, D., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455475. doi:10.1002/jts.2490050309
Rothbaum, B.O., Kearns, M.C., Price, M., Malcoun, E., Davis, M., Ressler, K.J., . . . Houry, D. (2012). Early intervention may prevent the development of posttraumatic stress disorder: A randomized pilot civilian study with modified prolonged exposure. Biological Psychiatry, 72, 957963. doi:10.1016/j.biopsych.2012.06.002
Russell, M., & Silver, S.M. (2007). Training needs for the treatment of combat-related posttraumatic stress disorder: A survey of department of defense clinicians. Traumatology, 13, 410. doi:10.1177/1534765607305440
Schafer, J.L., & Graham, J.W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7, 147177. doi:10.1037/1082-989X.7.2.147
Schnurr, P.P., Friedman, M.J., Engel, C.C., Foa, E.B., Shea, M.T., Chow, B.K., . . . Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women: A randomized controlled trial. Journal of American Medical Association, 297, 820830. doi:10.1001/jama.297.8.820
Steenkamp, M.M., Dickstein, B.D., Salters-Pedneault, K., Hofmann, S.G., & Litz, B.T. (2012). Trajectories of PTSD symptoms following sexual assault: Is resilience the modal outcome? Journal of Traumatic Stress, 25, 469474. doi:10.1002/jts.21718
Tracey, T.J. & Kokotovic, A.M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207210. doi:10.1037/1040-3590.1.3.207
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45, 167. Retrieved from http://www.jstatsoft.org/v45/i03/
Wampold, B.E., Imel, Z.E., Laska, K.M., Benish, S., Miller, S.D., Flückiger, C., . . . Budge, S. (2010). Determining what works in the treatment of PTSD. Clinical Psychology Review, 30, 923933. doi:10.1016/j.cpr.2010.06.005
Weathers, F., Litz, B., Herman, D., Huska, J., & Keane, T. (1993, October). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX.
Weathers, F.W., Ruscio, A.M., & Keane, T.M. (1999). Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Stress Disorder Scale. Psychological Assessment, 11, 124133. doi:10.1037/1040-3590.11.2.124

Keywords

Type Description Title
PDF
Supplementary materials

Nixon supplementary material
Nixon supplementary material

 PDF (111 KB)
111 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed