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Adapting cognitive processing therapy for child sexual abuse survivors
Abstract and Figures
With the advent of managed care, there is an increasing need for short-term, empirically based treatments. This article presents a cognitive behavioral therapy protocol for the treatment of adult survivors of childhood sexual abuse, Cognitive Processing Therapy for Sexual Abuse (CPT-SA). Based on information processing, developmental and self-trauma theories, this 26-session model combines group and individual therapy over a 17-week period. Clients are asked to write about the trauma, and explore adaptive, schema congruent, and discrepant beliefs that developed during and after the abuse. Focus is placed on beliefs related to safety, trust, power/control, self-esteem, and intimacy, with individual modules for each of these areas. Initial pilot data (N = 15), clinical implications, and two client case studies are also discussed.
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... Similarly, scores on the UCLA PTSD RI indicated the majority of participants experienced a clinically meaningful reduction in the severity of symptoms by 3 months posttreatment, whereas almost three-fourths achieved clinically meaningful reductions in depression severity at 3 months follow-up. These results along with research on the efficacy of group CPT in the United States with similar populations, including child sexual abuse survivors (Chard, 2005;Chard et al., 1997), sexual assault survivors (Resick & Schnicke, 1992;Resick et al., 2012) and adolescents (Matulis et al., 2014), suggest that a modified version of group CPT has preliminary effectiveness in comorbid PTSD and depression symptom reduction. From a clinical perspective, these findings suggest that evidence-based treatments for PTSD like CPT may be modifiable for adolescents living outside the United States and integrated into existing mental health care systems within international NGOs. ...
Research supports the efficacy of cognitive processing therapy (CPT) for reducing Posttraumatic Stress Disorder (PTSD) and comorbid conditions among survivors of sexual assault and other traumas. To date, there are no known studies using CPT with adolescents exposed to commercial sexual exploitation (CSE). The pilot study implemented a modified version of group CPT to determine the preliminary acceptability and feasibility of this intervention with adolescents who experienced CSE. Thirteen participants living in a residential treatment facility in Cambodia received 10 sessions of modified group CPT. Participants were adolescents ranging in age from 14 to 19. Measures of PTSD, depression symptom severity, and suicidal and non-suicidal ideation and behaviors were obtained at baseline, during the intervention, and 1-week and 3 months posttreatment. Group attendance rates and client satisfaction measures of the intervention were obtained. Client satisfaction with the group intervention was high (mean = 27, SD 2.61) and group attendance was good. There was a significant decline in PTSD symptom severity F(7,24) = 2.60, p = .037 and a significant decline in depression symptom severity over time F(7,12) = 9.67, p < .001. There were no occurrences of suicidal or non-suicidal behavior during the study or at follow-up with one participant reporting suicidal ideation after treatment began. The modified CPT intervention appeared to be feasible and received a high acceptability rating.
... Cognitive processing therapy (CPT) is an empirically supported treatment that has demonstrated effectiveness in treating PTSD in civilian (Chard, Weaver, & Resick, 1997;Hall & Henderson, 1996;Kaysen et al., 2013;Resick & Schnicke, 1992;Resick et al., 2008;Resick, Nishith, Weaver, Astin, & Feuer, 2002) and military populations (Forbes et al., 2012;Jeffreys et al., 2014;Lloyd et al., 2014;Monson et al., 2006;Resick et al., 2017;Surís, Link-Malcolm, Chard, Ahn, & North, 2013). CPT has also demonstrated effectiveness in both group and individual formats , as well as outpatient and residential settings (Walter, Dickstein, Barnes, & Chard, 2014). ...
Objective
Cognitive processing therapy is an evidence‐based treatment for posttraumatic stress disorder (PTSD); however, questions remain regarding variability in treatment response.
Method
A total of 123 veterans participated in group‐based cognitive processing therapy (CPT) in residential PTSD treatment. Change over time in PTSD symptoms was modeled as a function of selected demographic and clinical variables.
Results
PTSD checklist (PCL) scores decreased by an average of 1 point per session (standard deviation [SD] = 0.1). Initial PCL scores were predicted by the Beck Depression Inventory‐II (γ01 = 0.25; standard error [SE] = 0.08), Insomnia Severity Index (γ02 = 0.53; SE = 0.15), and Infrequency (F) scale of the Minnesota Multiphasic Personality Inventory‐2 (γ03 = 0.09; SE = 0.04). Rate of change was predicted by the Somatic Complaints (RC1) scale (γ11 = −0.03; SE = 0.01) and the Antisocial Behavior (RC4) scale (γ12 = 0.02; SE = 0.01).
Conclusions
These results provide insight into characteristics that may influence degree of benefit received from group‐based CPT.
... In addition, an adapted version of CPT, CPT-SA, has demonstrated effectiveness in treating survivors of childhood sexual abuse and trauma. 34,79 Although most of the central components of CPT-SA are derived from CPT, additional components are specifically added to address typical trauma responses observed in child abuse survivors; for example, a developmental section focuses on family of origin. ...
Learning objectives:
After participating in this activity, learners should be better able to:• Evaluate psychotherapeutic and pharmacologic approaches to treating patients with posttraumatic stress disorder.
Abstract:
A strong evidence base exists for psychological and pharmacological interventions for the treatment of posttraumatic stress disorder (PTSD). The published literature investigating the effectiveness of these treatments in reducing the symptoms and impairments associated with PTSD has expanded substantially in recent years. This review provides a concise overview of the empirical literature examining these treatment approaches. Evidence-based, trauma-focused therapies are recommended as first-line interventions, with the most support for cognitive- and exposure-based approaches. Prolonged exposure and cognitive processing therapy are the two most cited and rigorously investigated. Various other evidence-supported protocols are discussed. Pharmacotherapies can be used when evidence-based psychotherapies are not available or are ineffective, or on the basis of patient preference. Pharmacotherapy with the most support for PTSD includes selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Evidence supports the implementation of these interventions across genders, populations, and settings. Given that little research directly compares the effectiveness of different PTSD interventions and their mechanisms of action, it remains uncertain how to best select and tailor treatments to optimize individual outcomes. Future directions and novel, ongoing research are discussed.
There is a paucity of research of traditional psychotherapy approaches with individuals of South Asian descent, specifically Pakistani-Americans. In particular, there are very few cases in existing literature highlighting the effectiveness of Cognitive Processing Therapy (CPT) with Pakistani-Americans who have experienced sexual abuse. Due to cultural values, individuals of South Asian descent are less likely to pursue traditional psychotherapy and even far less likely to complete and/or benefit from it. The current case study focused on depression and trauma-related symptoms (e.g., guilt, shame, embarrassment) in the context of repeated sexual abuse for over 20 years. The PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ-9) confirmed qualitative reports and therapist observations of improvement. This case suggests a westernized and protocol-driven treatment can be a viable intervention for individuals of SA descent with a history of sexual trauma. A strong therapeutic relationship and open discussion of diversity considerations were necessary for this treatment to work. This case reflects potential support for CPT as a treatment utilized across cultures for trauma-related symptoms.
This study aimed to investigate predictors of male sexual partner risk among Latinas and Black women in their late thirties. We used multiple regression analysis to examine factors associated with male sexual partner risk among 296 women who participated in two waves of the Harlem Longitudinal Development Study (New York, 2011-2013 and 2014-2016). Women who experienced childhood sexual abuse had higher risk partners than those who did not [b = 0.16, 95% confidence interval (CI) = 0.06, 0.28]. Earlier marijuana use was a risk factor for partner risk in the late thirties (b = 0.12, 95% CI = 0.04, 0.27). Higher levels of ethnic/racial identity commitment mitigated this risk (b = - 0.15, 95% CI = - 0.26, - 0.04). Ethnic/racial identity commitment can be protective against male sexual partner risk among Latina and Black women who use marijuana. Further research should explore the protective role of different dimensions of ethnic/racial identity against sexually transmitted infections, including HIV.
This article reviews the considerations for treating co-occurring eating disorders (EDs) and posttraumatic stress disorder (PTSD) concurrently. EDs are serious psychiatric disorders that interfere with one's physical, mental, and social well-being and require intensive treatment. When a patient presents with co-occurring disorders in addition to an ED, unique treatment considerations must be made. Patients with co-occurring PTSD are likely to use ED behaviors to manage PTSD symptoms. As such, it is important that clinical attention be paid to both disorders. Although a gold standard treatment for the ED/PTSD patient population has not yet been established, there are promising results from emerging research. Of note is the implementation of cognitive processing therapy (CPT), an evidenced-based practice used to treat PTSD in patients with ED/PTSD. CPT can be efficacious in simultaneously treating ED and PTSD symptomology. This article offers a clinical perspective on this issue. [ Psychiatr Ann. 2018;48(10):473–476.]
Einführung: Die Symptome des Herz-Kreislaufsystems gehören zu den häufigsten der internistischen und der Allgemeinpraxis. Bei etwa 40 % aller Patienten mit Herzbeschwerden findet man einen typischen Konflikthintergrund, der in Angst eingebettet ist. Auch bei essentiell Hochdruckkranken sind in der erweiterten Anamnese häufig innerpsychische Spannungs-zustände nachweisbar, die vor dem Entwicklungshintergrund verständlich werden.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To synthesize the literature on psychosocial interventions for CSA survivors compared to control conditions through pair-wise meta-analysis. To assess and compare the effectiveness of different therapeutic interventions in treating adult survivors of child sexual abuse. To determine which interventions are more effective than others in the eligible populations and for specific subgroups of survivors.
A review of 45 studies clearly demonstrated that sexually abused children had more symptoms than nonabused children, with abuse accounting for 15–45% of the variance. Fears, posttraumatic stress disorder, behavior problems, sexualized behaviors, and poor self-esteem occurred most frequently among a long list of symptoms noted, but no one symptom characterized a majority of sexually abused children. Some symptoms were specific to certain ages, and approximately one third of victims had no symptoms. Penetration, the duration and frequency of the abuse, force, the relationship of the perpetrator to the child, and maternal support affected the degree of symptomatology. About two thirds of the victimized children showed recovery during the first 12–18 months. The findings suggest the absence of any specific syndrome in children who have been sexually abused and no single traumatizing process.
This study examines the differential effects of sexual revictimization in a community sample of 248 African-American and White American women, ages 18 to 36. Two classifications of sexual revictimization over the life course were used to assess the effects on later sexual and psychological functioning. The findings suggest that unintended pregnancies and abortions were significantly associated with sexual revictimization. Women who reported more than one incident in both childhood and adulthood were also likely to have multiple partnerships and brief sexual relationships. The findings are discussed within the context of the dynamics of sexual revictimization and its effects. Suggestions are offered for therapeutic strategies with survivors in order to minimize the effects of sexual revictimization.
We randomly assigned 65 women who had been sexually abused by a father, stepfather, or other close relative to 1 of 3 treatment conditions: a 10-week interpersonal transaction (IT) group, a 10-week process group, or a wait list condition. Subjects were evaluated at pretreatment, posttreatment, and (if assigned to a group) a 6-month follow-up on measures of social adjustment, depression, fearfulness, and general distress. Results suggested that both the IT and process group formats were more effective than the wait list condition in reducing depression and in alleviating distress; changes were maintained at follow-up. Subjects in the process group format exhibited improvement in social adjustment, whereas subjects in the wait list condition actually deteriorated.
The incidence and long-term effects of childhood sexual abuse were studied in a clinical sample of 152 adult women. Approximately 44% of female clients presenting to a health center crisis service reported a childhood history of sexual victimization. Prior victimization was associated with increased dissociation, sleep disturbance, tension, sexual problems, and anger on a Crisis Symptom Checklist, as well as greater current use of psychoactive medications, and more frequent histories of suicide attempts, substance addiction, and revictimization. Long-term psychological effects of sexual abuse are interpreted within both a developmental context and in terms of Post Traumatic Stress Disorder. Implications of the current data and related literature for mental health workers are briefly discussed.
By now, it should be apparent that something is happening to behavior therapy. Its “learning theory” basis is being challenged and is being replaced, in part by a cognitive orientation. The conceptual basis of “learning theory” that provided the framework and heuristic background for a variety of behavior therapy procedures is being oppugned on both theoretical grounds (e.g., Bandura, 1974; Breger & McGaugh, 1965; McKeachie, 1974) and empirical grounds (e.g., Brewer, 1974; Mahoney, 1974; Meichenbaum, 1974a). Such time-honored concepts as the automaticity of reinforcement and the continuity assumption between overt and covert events are being seriously questioned. As Bandura stated in his presidential address to the American Psychological Association:
So-called conditioned reactions are largely self-activated on the basis of learned expectations rather than automatically evoked. The critical factor, therefore, is not that events occur together in time, but that people learn to predict them and to summon up appropriate reactions. (1974, p. 860)
Foreword - Lucy Berliner Preface - David Finkelhor Introduction PART ONE: INCIDENCE OF CHILD ABUSE Type and Forms of Child Maltreatment PART TWO: THE LONG-TERM IMPACTS OF CHILD ABUSE: INTEGRATION OF RESEARCH AND THEORY Long-Term Impacts of Child Abuse I Psychological Responses Long-Term Impacts of Child Abuse II Behaviors and Relationships PART THREE: EXPLORING THE SOLUTION: ABUSE-FOCUSED PSYCHOTHERAPY Philosophy of Treatment Parameters of Treatment I Process Issues Parameters of Treatment II Intervention Approaches Special Issues in Abuse-Focused Therapy Summary Appendix The Child Maltreatment Interview Schedule
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific