The proposed study is composed of two stages: 1) investigation of the etiology of PTDSD in recent rape and female non-sexual crime victims during the three months post assault, and 2) an investigation of the relative efficacy of three treatments and a wait-list control for alleviating the three classes of PTSD symptoms (reexperiencing, avoidance, and arousal) for victims who meet diagnostic criteria for this disorder three months or more following the assault. Rape and female non-sexual crime victims (aggravated and simple assault and robbery) who consent to participate in the etiological study will each be assessed weekly for 12 weeks and compared to one another. Subjects in this study will be 160 female rape victims and 160 female crime victims from the ages of 18 to 65. Measurements will include: structured interviews, questionnaires, and electrodermal and cardiac psychophysiological responses to rape-related images and to neutral stimuli (auditory tones) for a subsample. The effects of prolonged exposure (PE), stress inoculation training (SIT), and a combination of PE and SIT, will be compared to each other and to a wait-list condition in rape and crime victims who meet DSM-III- R diagnosis for PTSD at least three months post-assault. Assessments will be conducted before treatment, after treatment (Session 9), and at follow-up of 3 months, 6 months, and one year. Victims will be randomly assigned to one of the 4 conditions. The dependent variables collected in the treatment will be: 1) standardized measures for PTSD symptoms, general anxiety, depression, social and functioning, coping styles, and controllability/predictability, 2) physiological measures and self- ratings taken during the laboratory procedures, 3) treatment expectancy, and 4) compliance with treatment requirements. The short term goals of the proposed project are to examine hypotheses about the etiology of PTSD in crime victims and its treatment within a unified conceptual framework. The long term goals are to develop a predictive model for PTSD and to identify mechanisms of its treatment. Such understanding will help identify individuals at high risk for developing PTSD so that preventive interventions can be devised.
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