Descriptive statistics on criminal victimization, combined with epidemiological studies documenting the mental health problems which may follow criminal victimization, suggest that a high proportion of U.S. population is at risk for developing crime-related Post- traumatic Stress Disorder (PTSD). However, there has been little empirical work on assessing treatment effectiveness for crime-related PTSD. In this study, the extent to which two treatment strategies effectively reduce symptoms of acute PTSD and prevent chronic PTSD in a sample of recent survivors of violent physical assault will be evaluated. Work will proceed in two phases. First, a well-tested family skills training program (Behavioral Family Therapy, BFT) will be modified and piloted to meet the special needs of assault survivors with acute PTSD and their relatives. BFT involves fourteen weekly sessions with the survivor and family members aimed at building communication and problem solving skills so that the family unit can work collaboratively to reduce the social withdrawal and avoidance behaviors characteristic of PTSD. After this piloting and refinement, sixty assault survivors will be randomized to one of three treatment conditions: l) Directed Therapeutic Exposure (DTE), 2) DTE provided in combination with BFT, and 3) three month waiting list control group. DTE involves nine biweekly ninety minute sessions aimed at helping the survivor relieve the anxiety-provoking/intrusive trauma experience. Two primary hypotheses will be tested: Hypothesis l: In comparison to waiting list control subjects, subjects who participate in DTE (with or without subsequent RFT) will experience greater decreases in overall level of PTSD symptoms at end of treatment and follow-up. Hypothesis 2: In comparison to control and DTE only subjects, those in the combined treatment condition (DTE and BFT) will evidence greater decreases in numbing/avoidance PTSD symptoms and specific avoidance behaviors at end of treatment and follow- up. To the best of our knowledge, this pilot study is the first to systematically investigate exposure and family therapy in a rigorously diagnosed sample of recent survivors of violent physical assault with acute PTSD. As such, it should provide useful insights into the effectiveness of exposure and family therapy in the treatment of PTSD and the prevention of chronic PTSD.
