A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder

A randomized trial was performed in which imaginal exposure (IE) and cognit ive therapy (CT) were compared in the treatment of chronic posttraumatic st ress disorder (PTSD). Patients who continued to meet PTSD caseness at the e nd of a 4-week symptom-monitoring baseline period (n = 72) were randomly al located to either IE or CT. There was a significant improvement in all meas ures over treatment and at follow-up, although there were no significant di fferences between the 2 treatments at any assessment. A significantly great er number of patients who showed worsening over treatment received IE, alth ough this effect was not found at follow-up. Patients who worsened showed a greater tendency to miss treatment sessions, rated therapy as less credibl e, and were rated as less motivated by the therapist. It was concluded that either exposure or a challenge to cognition can result in symptom reductio n, although neither resulted in complete improvement.