Resolution of trauma-related guilt following treatment of PTSD in female rape victims: A result of cognitive processing therapy targeting comorbid depression?

Center for Trauma Recovery and Department of Psychology, University of Missouri-St. Louis, St. Louis, MO, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 07/2005; 86(2-3):259-65. DOI: 10.1016/j.jad.2005.02.013
Source: PubMed


Although Resick et al. [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. J. Consult. Clin. Psychol. 70, 867-879.] reported comparable results for treating rape-related posttraumatic stress disorder (PTSD) using either cognitive-processing therapy (CPT) or prolonged exposure (PE), there was some suggestion that CPT resulted in better outcomes than PE for certain aspects of trauma-related guilt. The present study revisited these findings to examine whether this effect was a function of improvement in a subset of participants with both PTSD and major depressive disorder (MDD).
Results indicated that CPT was just as effective in treating "pure" PTSD and PTSD with comorbid MDD in terms of guilt. Clinical significance testing underscored that CPT was more effective in reducing certain trauma-related guilt cognitions than PE.
Findings cannot be generalized to men, and only one measure of guilt was used.
The observed superiority of CPT over PE for treating certain guilt cognitions was not due to participant comorbidity. Further research is recommended to untangle the relationship between guilt, depression and differential response to treatment in PTSD following sexual assault trauma.

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Available from: Patricia A Resick, Jan 05, 2015
    • "CPT was originally developed for use with victims of rape (Resick & Schnicke, 1992, 1993) and was later modified for combat-related trauma as well (Resick, Monson, & Chard, 2007). The main focus of CPT to modify beliefs about the meaning and implications of the traumatic event (Nishith, Nixon, & Resick, 2005; Resick et al., 2008). This involves understanding how the event affected a person's set of beliefs (Sobel, Resick, & Rabalais, 2009). "
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    ABSTRACT: The following case study examines the treatment of a man who presented with ambiguous concerns related to safety. Initially, diagnosis was unclear, and a psychotic disorder was hypothesized. Through the use of functional analysis (FA), it became clear that he met criteria for Posttraumatic Stress Disorder (PTSD) and was subsequently treated using Cognitive Processing Therapy (CPT). He experienced clinically significant change as his score on the PTSD Checklist dropped from 59 to 26. This case demonstrates the utility of FA in the diagnostic process to ensure identification of key treatment targets. Also, visual methods of increasing attentional focus during cognitive restructuring are reviewed.
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    • "Through 10 months of treatment, symptoms of depression improved less in the women with comorbid PTSD than in those with singular depression (Green et al., 2006). Cognitive processing therapy (CPT), which entails 12 sessions (60–90 min) with practice of skills outside of sessions, has been reported to be effective in treating comorbid PTSD and depression among female assault victims (Nishith et al., 2005). Still, nearly all of the literature on treatment for PTSD and comorbid depression has arisen in the past few years (Foa et al., 2009), and integrated treatment is generally recommended. "
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    ABSTRACT: This uncontrolled prospective cohort study evaluated the use of accelerated resolution therapy (ART) for treatment of comorbid symptoms of post-traumatic stress disorder (PTSD) and major depressive disorder. Twenty-eight adult subjects, mean age of 41 years (79% female, 36% Hispanic), received a mean of 3.7 ± 1.1 ART treatment sessions (range 1-5). ART is a new exposure-based psychotherapy that makes use of eye movements. Subjects completed a range of self-report psychological measures before and after treatment with ART including the 17-item PCL-C checklist (symptoms of PTSD) and 20-item Center for Epidemiologic Studies Depression Scale (CES-D). For the PCL-C, the pre-ART mean (±standard deviation) was 62.5 (8.8) with mean reductions of -29.6 (12.5), -30.1 (13.1), and -31.4 (14.04) at post-ART, 2-month, and 4-month follow-up, respectively (p < 0.0001 for comparisons to pre-ART score). Compared to pre-ART status, this corresponded to standardized effect sizes of 2.37, 2.30, and 3.01, respectively. For the CES-D, the pre-ART mean was 35.1 (8.8) with mean reductions of -20.6 (11.0), -18.1 (11.5), and -15.6 (14.4) at post-ART, 2-month, and 4-month follow-up, respectively (p ≤ 0.0001 compared to Pre-ART score). This corresponded to standardized effect sizes of 1.88, 1.58, and 1.09, respectively. Strong correlations were observed at 2-month and 4-month follow-up for post-treatment changes in PTSD and depression symptom scores (r = 0.79, r = 0.76, respectively, p ≤ 0.0002). No serious treatment-related adverse effects were reported. In summary, ART appears to be a promising brief, safe, and effective treatment for adults with clinically significant comorbid symptoms of PTSD and depression. Future controlled and mechanistic studies with this emerging therapy are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints.
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    • "Shame was moderated by specific forms of psychological abuse in its association with PTSD, while guilt was not. Other authors have noted that guilt, although commonly mentioned in the PTSD literature, may be more closely identified with depression (e.g., Bennice, Grubaugh, & Resick, 2001; Nishith et al., 2005). Clearly, we have considerably more to learn concerning negative emotions and PTSD. "
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    ABSTRACT: This study explored the association of shame and guilt with PTSD among women who had experienced intimate partner violence (IPV). Sixty-three women were assessed by a research clinic serving the mental health needs of women IPV survivors. Results indicated that shame, guilt-related distress, and guilt-related cognitions showed significant associations with PTSD but global guilt did not. When shame and guilt were examined in the context of specific forms of psychological abuse, moderation analyses indicated that high levels of both emotional/verbal abuse and dominance/isolation interacted with high levels of shame in their association with PTSD. Neither guilt-related distress nor guilt-related cognitions were moderated by specific forms of psychological abuse in their association with PTSD. These data support the conceptualization of shame, guilt distress, and guilt cognitions as relevant features of PTSD. Results are discussed in light of proposed changes to diagnostic criteria for PTSD.
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