Over the past 7 years we have developed and evaluated brief treatments for post-traumatic stress disorder (PTSD) following sexual assault. The proposed study is intended to replicate and extend our treatment studies, and has both practical and theoretical aims. First, Stress Inoculation Training plus Prolonged Exposure (SIT/PE), a successful treatment that we have developed over the last 3 years, will be extended to a community rape crisis center (Women Organized Against Rape [WOAR]). The treatment efficacy at WOAR will be compared with that at our research clinic (Medical College of Pennsylvania), so that its transportability can be ascertained. Second, a new treatment program which is a theoretically and empirically derived refinement of SIT/PE, Cognitive Therapy plus Prolonged Exposure (CT/PE), will also be evaluated in both the research and community settings. Third, the efficacy of 3 additional sessions for partial responders will be examined. The proposed research will also address theoretical issues regarding cognitive processes underlying PTSD and its amelioration by cognitive-behavioral treatment. Specifically, we will examine the relationship of perceptions of the dangerousness of the world, and of one's ability to cope with stress to PTSD and other post- trauma psychopathology. We will also investigate whether the victim's perceptions of aversive events as unpredictable and uncontrollable are associated with PTSD and whether changes in such perceptions via treatment produce improvement. A total of 180 rape victims with PTSD will be randomly assigned to SIT/PE, CT/PE, or a waitlist, half at MCP, and half at WOAR. Assessments will include structured interviews and questionnaires, and will be conducted before treatment, after treatment, and at 3, 6, and 12 months follow-up. Dependent measures will be PTSD symptoms severity and diagnosis, general psychopathology, depression, social function, coping style, cognitive schemas, treatment expectancy, and treatment compliance.
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