Cognitive-behavioral treatment and theory in posttraumatic stress disorder

Abstract: The present dissertation contains four empirical studies. The first two investigated the efficacy of cognitive-behavioral (CBT) treatments for posttraumatic stress disorder (PTSD) by randomizing patients to two different groups. The last two are experimental studies that tested parts of the cognitive theory of PTSD. The first study examined the preventive efficacy of a CBT intervention in crime victims with acute PTSD. The second study investigated whether CBT is a more effective treatment than exposure therapy (E) for chronic PTSD in refugees. The third study tested whether acute PTSD in crime victims is characterized by attentional and memory biases for threat-related material by using a combined emotional Stroop, implicit memory and explicit memory task. The fourth study investigated whether acute PTSD in crime victims is characterized by a recognition bias for emotional faces in a face recognition task.The results from the first study showed that CBT can be an effective preventive treatment for crime victims with acute PTSD and that a chronic course of this disorder can be hindered. A group that received CBT improved significantly more than a wait-list control group on a broad range of measures including PTSD symptoms, depression, anxiety, quality of life and social adaptation. The second study found no differences between CBT and E in the treatment of chronic PTSD in refugees. However, both treatments led to significant improvements on a broad range of measures including PTSD symptoms, depression, anxiety, quality of life and cognitive schemas. The results from the third study showed that acute PTSD in crime victims is characterized by an attentional and memory bias for threat-related material. A supraliminal Stroop interference and an explicit memory bias were found for trauma words, but no preattentive and implicit memory bias. Methodological limitations of the study preclude definitive conclusions of the results. The fourth study found a recognition bias for faces rated as hostile during an encoding task by crime victims with acute PTSD.In conclusion, the present thesis found that CBT interventions can be effective treatments for acute and chronic PTSD, that CBT is equally effective as E, and that acute PTSD is characterized by a conscious attentional bias towards threat-related material and a memory bias for both verbal and facial threat-related stimuli.