This proposal is for a competing renewal of a treatment outcome study on Posttraumatic Stress Disorder (PTSD). The current study is a clinical trial comparing cognitive processing therapy (CPT) with prolonged exposure and a minimal attention waiting-list condition for the treatment of PTSD among victims of rape. The goal of the proposed study is to examine the individual procedural elements of CPT by using a dismantling design. In addition, a secondary goal is to determine if these elements have differential efficacy in the treatment of primary and secondary emotions that are associated with PTSD. Third, the study will examine the generalization of CPT from the treatment of female rape victims to female victims of physical assault. The study will also examine the efficacy of the three methods on self-reported health status. The study will include 120 female participants who are victims of rape or physical assault and are suffering from PTSD. Participants will be randomly assigned to one of the three treatment conditions: cognitive processing therapy, cognitive therapy, or written exposure therapy. Participants in the study will be administered a battery of interviews and self-report measures of symptoms and cognitions. Guilt and shame will be studied as secondary emotions along with a range of beliefs about oneself and the world. In addition, two different types of physiological assessment (verbal processing and startle) will be used to determine if the individual procedural elements of CPT have a differential effect on verbally or situationally accessed memory. Heart rate, skin conductance response, and EMG will be assessed. Participants will be assessed at pretreatment, posttreatment, and at 6-months follow-up. In addition, the participants will be further assessed on a self-report measure of PTSD every week during treatment. The proposed study should make an important contribution to knowledge about treatment and recovery from PTSD. At a theoretical level, the proposed study will also provide an opportunity to investigate theoretical mechanisms hypothesized to be involved in recovery from PTSD.
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