EXCEED THE SPACE PROVIDED. There is growing recognition that while treatment outcome research conducted in expert clinics is necessary in order to determine the internal validity of the outcome of specific treatments,'new approaches are needed for research that will translate informationfrom clinical treatmentresearch into studies that demonstrate the effectiveness and utility of treatments in community practice' (Norquist et al., 1999, p. 4). This competingrenewal application responds to this need for establishing the external validity of treatments by proposing two studies to evaluate the effectiveness of an empiricallyvalidated treatment for posttraumaticstress disorder (PTSD), Prolonged Exposure (PE) a brief cognitive behavioral therapy, in each of two community-based agencies. Over the past 6 years, we have conducted an NIMH funded study to evaluatethe extent to which PE can be successfully implemented by counselors of a community-based agency dedicated to providing services for sexual assault victims,Women Organized Against Rape (WOAR). The results revealed that WOAR counselors were as successful as the PE experts of the Center for the Treatment and Study of Anxiety (CTSA). This Phase I effectiveness study involved intensive initialtraining of the WOAR counselors, continued weekly supervision by CTSA experts, and bi-annual 'booster' training-sessions. Such continued intensive expert-involvementis not a practical model for long-term clinical practices in a community-based clinic. Thus, the goal of the proposed Study1 (N ~ 110),which we view as Phase II of our evaluation of the effectiveness of PE for PTSD, is to examinewhether counselors at WOAR can maintaintheir success with PE with reduced CTSA expert involvement. Another aim of Study 1 is to compare the outcome of PE to that of group treatment as usual at WOAR (TUGT). Participants will be assessed before and after treatment. Follow-up assessments are scheduled for 3, 6, 12, and 24 months post-treatment. In the second study (N = 110), we propose to replicate the trainingprocedures utilizedat WOAR withcounselors at Joseph J. Peters (JJP), another communitybased agency that provides services for sexual assault victims to further examine the effectiveness of PE for PTSD and the generalizability of our trainingprocedures. The efficacy of PE will be compared to that of Supportive Counseling (SC), a treatment that mimics treatment as usual in rape crisis center. As in Study 1,the participants will be assessed before and after treatment and long-term follow-upat 3, 6,12, and 24 months post-treatment. The proposed research also aims to develop methods for examining the cost effectiveness of treatment delivery to sexual assault victims with PTSD. Thus, we will use cutting edge methods to address a highly critical issue in treatment research, namely the evaluation of interventions that have been found efficacious in 'laboratory conditions' under 'real world' conditions of service delivery. PERFORMANCE SITE ========================================Section End===========================================

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH042178-20
Application #
6938512
Study Section
Special Emphasis Panel (ZMH1-ITV-D (01))
Program Officer
Street, Linda L
Project Start
1994-09-01
Project End
2008-08-31
Budget Start
2005-09-01
Budget End
2008-08-31
Support Year
20
Fiscal Year
2005
Total Cost
$614,377
Indirect Cost
Name
University of Pennsylvania
Department
Psychiatry
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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Jayawickreme, Nuwan; Cahill, Shawn P; Riggs, David S et al. (2014) Primum non nocere (first do no harm): symptom worsening and improvement in female assault victims after prolonged exposure for PTSD. Depress Anxiety 31:412-9
Zoellner, Lori A; Feeny, Norah C; Eftekhari, Afsoon et al. (2011) Changes in negative beliefs following three brief programs for facilitating recovery after assault. Depress Anxiety 28:532-40
Moser, Jason S; Cahill, Shawn P; Foa, Edna B (2010) Evidence for poorer outcome in patients with severe negative trauma-related cognitions receiving prolonged exposure plus cognitive restructuring: implications for treatment matching in posttraumatic stress disorder. J Nerv Ment Dis 198:72-5
Rauch, Sheila A M; Grunfeld, Tania E E; Yadin, Elna et al. (2009) Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder. Depress Anxiety 26:732-8
Tolin, David F; Foa, Edna B (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959-92
Foa, Edna B; Hembree, Elizabeth A; Cahill, Shawn P et al. (2005) Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics. J Consult Clin Psychol 73:953-64
Hembree, Elizabeth A; Street, Gordon P; Riggs, David S et al. (2004) Do assault-related variables predict response to cognitive behavioral treatment for PTSD? J Consult Clin Psychol 72:531-4
Feeny, Norah C; Zoellner, Lori A; Foa, Edna B (2002) Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: a preliminary examination. J Pers Disord 16:30-40
Gilboa-Schechtman, E; Foa, E B (2001) Patterns of recovery from trauma: the use of intraindividual analysis. J Abnorm Psychol 110:392-400

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