How well does cognitive-behavioral therapy treat symptoms of complex PTSD? An examination of child sexual abuse survivors within a clinical trial

Abstract

Are brief cognitive-behavioral treatments for posttraumatic stress disorder (PTSD) also effective for the wider range of symptoms conceptualized as complex PTSD? Female rape victims, most of whom had extensive histories of trauma, were randomly assigned to cognitive-processing therapy, prolonged exposure, or a delayed-treatment waiting-list condition. After determining that both types of treatment were equally effective for treating complex PTSD symptoms, we divided the sample of 121 participants into two groups depending upon whether they had a history of child sexual abuse. Both groups improved significantly over the course of treatment with regard to PTSD, depression, and the symptoms of complex PTSD as measured by the Trauma Symptom Inventory. Improvements were maintained for at least 9 months. Although there were group main effects on the Self and Trauma factors, there were no differences between the two groups at posttreatment once pretreatment scores were covaried. These findings indicate that cognitive-behavioral therapies are effective for patients with complex trauma histories and symptoms patterns.

FIGURE 1

Pretreatment, posttreatment, and 9-month follow-up comparison of rape victims with and without a history of CSA on three factors of the Trauma Symptom Inventory: Trauma, Self, and Dysphoria. CSA=child sexual abuse; PreTx=pretreatment; PostTx=posttreatment; 9mo PostTx=9-months follow-up. Resick PA, Nishith P, Griffin MG. CNS Spectr. Vol 8, No 5. 2003.

FIGURE 2

Pretreatment, posttreatment, and 9-month follow-up comparison of rape victims with and without a history of CSA on the 10 subscales of the Trauma Symptom Inventory. CSA=child sexual abuse; Pre=pretreatment; Post=posttreatment; 9Mo=9-months follow-up; AA=anxious arousal; D=depression; AI=anger/irritability; IE=intrusive experiences; DA=defensive avoidance; DIS=dissociation; ISR=impaired self-reference; SC=sexual concerns; DSB=dysfunctional sexual behavior; TRB=tension reduction behavior. Resick PA, Nishith P, Griffin MG. CNS Spectr. Vol 8, No 5. 2003.