TREATMENT OF POSTTRAUMATIC-STRESS-DISORDER BY EXPOSURE AND OR COGNITIVE RESTRUCTURING - A CONTROLLED-STUDY/

Background: Unanswered questions from controlled studies of posttrauma tic stress disorder concern the value of cognitive restructuring alone without prolonged exposure therapy and whether its combination with p rolonged exposure is enhancing. Methods: In a controlled study, 87 pat ients with posttraumatic stress disorder of at least 6 months' duratio n were randomly assigned to have 10 sessions of 1 of 4 treatments: pro longed exposure (imaginal and live) alone; cognitive restructuring alo ne; combined prolonged exposure and cognitive restructuring; or relaxa tion without prolonged exposure or cognitive restructuring. Results: I ntegrity of audiotaped treatment sessions was satisfactory when rated by an assessor unaware of the treatment assignment. Seventy-seven pati ents completed treatment. The pattern of results was similar regardles s of rater, statistical method, measure, occasion, and therapist. Expo sure and cognitive restructuring, singly or combined, improved posttra umatic stress disorder markedly on a broad front. Gains continued to 6 -month follow-up and were significantly greater than the moderate impr ovement from relaxation. Conclusion: Both prolonged exposure and cogni tive restructuring were each therapeutic on their own, were not mutual ly enhancing when combined, and were each superior to relaxation.