Effectiveness of Cognitive, Exposure, and Skills Group Manualized Treatments in Operations Iraqi (OIF)/Operation Enduring Freedom (OEF) Female Veterans
Effectiveness of Cognitive, Exposure, and Skills Group Manualized Treatments in Operations Iraqi (OIF)/Operation Enduring Freedom (OEF) Female Veterans
The purpose of the study is to evaluate the efficacy of a group protocol for the delivery of
 evidence-based therapies in comparison to a wait-list control and evaluate the relative
 contribution of exposure, cognitive, and skills blocks of treatment in a 16-session
 manualized group treatment protocol in a sample of OIF/OEF female PTSD veterans. Hyp1:
 Overall improvement is expected in PTSD symptoms compared to a wait-list control group; and
 Hyp2: the exposure and cognitive components are expected to show greater improvement in PTSD
 symptoms than the skills component. Significant results will establish the efficacy of a
 group format for evidence-based treatments for all veterans with a PTSD diagnosis. An
 ancillary part of the study is to examine initial neuropsychological presentation in this
 population and possible changes that may occur as the result of treatment.
OBJECTIVES: The objectives are to 1) evaluate the effectiveness of exposure, cognitive, and
 skills (assertiveness/relaxation) therapies within a 16-session group; and 2) evaluate the
 relative contribution of each of three treatment components in a manualized treatment group
 in a sample of OIF/OEF female PTSD veterans. HYPOTHESES: Hypothesis 1. Female OIF/OEF PTSD
 veterans will show reductions in PTSD symptoms and improvement in general functioning after
 participation in a structured group treatment compared to a wait-list control group.
 Hypothesis 2. Exposure and cognitive components will show greater improvement in PTSD
 symptoms than the skills component. RESEARCH DESIGN/BACKGROUND: Based on studies with male
 combat veterans, female civilian rape victims, and female veterans, therapies most effective
 for Posttraumatic Stress Disorder (PTSD) are exposure therapy (1,2,3) and cognitive
 restructuring (4), with less improvement found in other treatments, such as relaxation and
 assertiveness training (5). Most examinations of PTSD treatments have been conducted in an
 individual format, but most PTSD treatments offered in Veterans Administration (VA) hospital
 PTSD programs are conducted in a group format (6). It is critical to determine if these
 therapies work in a group setting, as only one study (7) found no differences in exposure
 therapy compared to a support group. In a comprehensive manualized group treatment protocol
 (8) exposure therapy provided in a group was found effective (9). The aim of the present
 study is to establish the effectiveness of exposure therapy, among other evidence-based
 therapies, in a well designed randomized study. METHODOLOGY: Castillo's (8) manualized group
 treatment protocol for female veterans with PTSD will be modified into a 16-week treatment
 group with a five-week exposure, five-week cognitive, and four-week skills treatment blocks.
 Seventy-two subjects will be assessed with structured interviews (SCID and CAPS) and
 questionnaires (Traumatic Life Events and Quality of Life Inventory) and randomized into one
 of two arms: 16-week immediate treatment, or a 16-week wait-list control, the latter of which
 will be reassessed and offered the study treatment. Oversampling will result in 72 subjects
 in the active treatment arm. Subjects will be reassessed upon completion of treatment or
 wait-list, at 3, and 6 months following treatment. All treatment groups will include three
 female OIF/OEF veterans positive for PTSD. The treatment blocks will be varied into six
 possible orders to control for order effects and the PTSD Symptom Checklist will be
 administered after each treatment block. Data will be collected for three years. CLINICAL
 RELATIONSHIPS: Significant results will contribute to the establishment of evidence-based
 treatments in a manualized treatment group for all veterans with a PTSD diagnosis. FINDINGS:
 Present findings from Dr. Castillo's lab suggest the effectiveness of exposure therapy in a
 group setting.
Inclusion Criteria:

 -  Diagnosis of PTSD

 -  Iraq or Afghanistan female Veteran

 -  Psychiatry stability (no suicide, homicide)

 -  One clear memory of a trauma

 -  Stability on psychiatric medications for 1 month

 Exclusion Criteria:

 -  Active substance use/abuse (or in remission less than 3 mo)

 -  Psychotic symptoms or diagnosis

 -  Bipolar disorder diagnosis

 -  Cognitive impairment

 -  Involvement in a violent relationship

 -  Self mutilation within past 6 months