Comparing Treatments for Post-Traumatic Stress Disorder in Domestic Violence and Women Victims of Rape Essay
The present research will evaluate treatments for Posttraumatic Stress Disorder (PTSD). A group of victims of domestic violence (DV) and rape with persistent PTSD will be recruited and submitted to a 6 month therapy. There will be a 3 X 2 independent groups factorial design where the independent groups are going to be women with PTSD (domestic violence and rape victims) and treatments; one group of Cognitive Behavioral Therapy (CBT), and the second will be issued SSRIs observed under the medicated treatment of Fluoxetine, the third group will be a control condition treatment of self-help literature (VA’s website i. e. Coping with Traumatic Stress Reaction”). There will be 180 participants (90 PTSD-DV and 90 PTSD-Rape victims).
The participants will be randomized and divided into six different groups. All participants will be given the Rosenberg Self-Esteem Scale at the beginning of the therapy and at the end of the therapy to check for the change in self-esteem after treatments. It is hypothesis that the effect of CBT treatment will be more effective in both PTSD-DV and PTSD-Rape victims. Key words: Cognitive Behavioral Therapy (CBT), Posttraumatic Stress Disorder (PTSD), Domestic Violence (DV) and Rape victims, and Rosenberg Self-Esteem Scale.
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Comparing Treatments for Posttraumatic Stress Disorder in Abuse Women: Domestic Violence and Raped Of all crimes, sexual assaults or domestic violence are the ones that results in the most severe psychological aftermath (Billete, Guay, & Marchand, 2008). In contrast to everyday stressful experiences, Post Traumatic Stress Disorder (DSM-TR; American Psychiatric Association, 2000) is linked etiologically to extremely traumatic or catastrophic events that arouse feelings of intense fear, helplessness and horror in exposed individuals.
Posttraumatic Stress Disorder (PTSD) is a normal reaction to abnormal events. The diagnosis occurs most commonly as a stressful reaction to a catastrophic event involving actual or threatened death/injury. Symptoms include increased physiological arousal, persistent re-experiencing of the trauma (intrusive thinking), and trouble sleeping, irritability, trouble concentrating, being watchful, arousal, feeling jumpy, fear, avoidance, hyper vigilance, irritability, and psychic numbing including dissociation (Wilson, Calhoun, & Bernat, 1999).
There is not support of the support for the belief that violence towards women that is perpetrated by their husbands is less traumatizing than violence by others (Cascardi, O’Leary, & Schlee, 1999). PTSD has been shown to be strongly associated with suicidal behaviors (Sanders, 1994). In addition to PTSD, depression, and substance abuse, other mental health problems have been noted in victimized women, such as but not limited too; cognitive difficulties, somatization, anxiety disorders, phobias, sleep disorders, fearfulness of spouse, and obsessive compulsiveness (Stapleton, Taylor, & Asmundson, 2007).
One review of the literature, showed that there was fairly good fit between battered women’s characteristics and the major indicators of PTSD as currently defined (Lang, Kennedy, & Stein, 2002). However, in the most cases the studies reviewed provided only indirect evidence for PTSD indicators. More research with battered women is needed to establish direct evidence of PTSD symptoms using multiple measures of PTSD and related constructs.
In Griffin, Ulhmansiek, Resick, & Mechanic (2004), study compared two groups of battered women on three measures of Posttraumatic Stress and fear questionnaire. At the fear questionnaire was used to explore the possibility of the generalization of trauma effects. One of the groups comprised women who obtained help at domestic violence agencies for shelter and/or counseling. The other group comprised women who obtained help at one or more nondomestic violence programs. Comparisons were also made on the severity of abuse and injures and levels of depression self esteem.
Previous studies on cognitive change have typically employed self-report inventories of cognitive distortions, which limit the response options available to participants and focus on content rather than process. What has not been attempted to date is to asses cognitions in a less-restricted manner and to examine the process of assimilation, accommodation, and overcoomodation. The samples of battered women who are studies are almost exclusively made up of women who came forward and sought help or shelter. These samples are probably not representative of battered or raped women.
They might be the most troubled of battered women or raped women, who sought help because of their distress; or they may be the healthiest of battered women, who still have the resources to seek services. The most distressed may not have requested help because they are immobilized. Depending upon the formulation of which current samples represent, the psychological distress of battering may be over or underestimated (Johnson, & Beight, 2003). There has been minimal investigation of the association with PTSD treatment outcomes in general, or how they might be associated with different types of treatment.
Cognitive Behavior Therapy (CBT) has been established as highly efficacious treatment for PTSD (Monson, Rodriguez, & Warner, 2005), and is perhaps the treatment of choice according to meta-analysis comparing it to drug treatment and a variety of control conditions. The general class of CBT interventions for PTSD has been divided into trauma-focused (e. g. , prolonged exposure, cognitive processing training) therapies (Vogel, & Marshall, 2001). In Vogel & Marshall (2001), there was compelling and consistent evidence demonstrating the efficacy of CBT for the treatment of PTSD.
By safely confronting reminders of the trauma with exposure to memories and situations or discussion of the thoughts and beliefs associated with the trauma, they dysfunctional cognition underlying PTSD is modified (Vogel, & Marshall, 2001). A variety of cognitive behavioral treatment is available, exposure therapy, anxiety management, or cognitive therapy can be used. Exposure therapy is a set of techniques, such as systematic desensitization and flooding that help patients to confront their feared objects, situations, memories, or images in safe circumstances.
Patients subsequently recognize that their fear are unrealistic in programs of anxiety management, by using methods such as relaxation training, controlled breathing, positive self-talk and imagery, social skills training, and distraction techniques, patients are helped to manage their anxiety . The relatively few studies that have investigated interpersonal factors in CBT for PTSD have revealed promising results. In one clinical trial comparing exposure and cognitive interventions for PTSD (Lang, Kennedy, & Stein 2002), patients with high levels of expressed emotion in their families responded poorer to both CBT treatments.
When treating battered women with PTSD, it is important to note that there are factors that can complicate the treatment process. The lives of battered women are often enmeshed in those of their abusive partners through their children, which can result in disordered attachments towards their abusive partners (Griffin, Uhlmansiek, Resick, & Mechanic, 2004). Battered women are at risk for revictimization by subsequent intimate partners (Seedat, Stein, & Carey, 2005). And battered women are very vulnerable to guilt and shame, which PTSD treatments often fail to remedy (Sanders, 1994).
Rothbaum, Kozak, Foa & Whitaker (2001) outlined a cognitive therapy specifically designed for treating battered women with PTSD (i. e. Cognitive Trauma Therapy for Battered Women: CCT-BW). It is a combination of cognitive-behavioral therapy (exposure therapy, cognitive restructuring) with relaxation training and psycho education. Their findings indicated CCT-BW is effective in reducing PTSD symptoms in the short term and at 3-6-month follow-up. They purpose of this study is to further evaluate the treatments rendered to women with persisting PTSD victims of Domestic Violence and Rape.
Our aim is to measure their self-esteem with a Pre-Post Test of the Rosenberg Self-Esteem Scale before and after treatment. Method Participants Participants for this study will be comprised of 90 female victims of domestic violence (DV) and 90 female victims of rape with persistent Posttraumatic Stress Disorder (PTSD) whom met the criteria from the Diagnostic and Statistical Manual of Mental Disorder-Fourth Edition-Tex Revision PTSD-DV victims were on average 30. 0 years, and PTSD-Rape victims were 24. 5 years. In the present study, 56. 0% of participants identified as Hispanic, 36. 0 % as African-American, 8. % identified as Caucasian, and 6. 3% of the total sample identified as Native American, Asian, or “Other. ” Both groups had been victims of Physical and/or sexual abuse by an intimate partner but were no longer involved in an abusive relationship (for at least 4 weeks but no more than 2 years prior to participation). All participants spoke English and could read at or above the 8th grade level. Exclusion criteria included history of neurological illness, head injury involving loss of consciousness greater than 10 min, learning disability, psychosis, or alcohol abuse for a period of greater than 2 years in the past.
Potential participants were also excluded for use of psychotropic medication within 6 weeks prior to participation, oral or intramuscular steroids within the past 5 months, or any illegal substances within the past year. Recruitment took place in the Greater Los Angeles County, California. The same recruitment was used for both groups. Flyers were posted in community service agencies, domestic violence shelters and medical clinics and placed advertisements in local newspapers. A number of additional participants came to us by word of mouth. Women were compensated $250 a week for their participation.
Measures, Materials and Design This is an independent groups design; 3 (treatments) x 2 (PTSD Domestic Violence and Rape victims). The primary measures where by Beck Anxiety and Depression Inventories (Beck, Ward, Mendelson, & Mock, 1961). This inventory consists of 21 items, each item listing a range of severity of symptomatology. The symptoms cover many aspects of depression, including somatic complaints, guilt, pessimism, and indecisiveness. Participants that met the requirements, where then asked to take structured clinical interview for DSM-IV- patient version (SCID: ).
The SCID is frequently used and well-validated diagnostic interview based on the DSM-IV. It’s used to assess for the presence of mood disorders, anxiety and substance abuse/dependence. Then participants were asked to take the Rosenberg Self-Esteem Scale which we will use to measure each group and treatment, this is a commonly used, 10-item measure of self-esteem. Fist developed for use with adolescents (Rosenberg, 1979), it has been widely used with adults, including victims of violence (Myers, Templer, & Brown, 1984). We will use a version with a four-point response format: strongly agree, agree somewhat, disagree omewhat and strongly disagree. All of the recruiting will be done by CSULA graduate research assistants, and paid psychiatrist who will administer the SSRIs and hold the therapy treatments. After the 6 month treatment all participants (n=180) took the Rosenberg Self-Esteem Scale again. Procedures A graduate research assistant conducted the initial screening for the project on the telephone. During the phone screen, information regarding the characteristics of the crime and potential exclusion criteria was gathered. If the participant met the requirements of the study, she was scheduled for an initial assessment.
After complete description of the study to the participants, written informed consent was obtained. This study was conducted with full approval from relevant Institutional Review Boards. The assessments were conducted at the center for research at California State University, Los Angeles (CSULA) campus. Those who passed Beck depression inventory-11 (BDI-11: ) self-report scale were invited to the Clinic Center also at CSULA for an evaluation consisting of the SCID-1, and the Rosenberg Self-Esteem questionnaire (Rosenberg, 1979) (pot-treatment assessment).
Candidates will be randomly assigned to either the proposed PTSD treatments conditioned or a control condition. The Cognitive Behavior Therapy condition will consist of (n=30) PTSD-Domestic Violence victims and (n=30) PTSD-Rape victims, SSRIs-Fluoxetine medicine treatment will consist of (n=30) PTSD-Domestic Violence victims and (n=30) PTSD-Rape victims and the self-help literature (United States Department of Veterans Affairs) control condition will consist of (n= 30) PTSD-DV victims and (n=30) PTSD-Rape victims.
The treatment programs are designed to last 6 months. Those assigned to Cognitive Behavior Therapy will assigned to one session per week, each candidate will complete 26 sessions, one-hour sessions. Therapy meetings will be held at the Clinic Center conference room at CSULA campus and held by psychiatrists trained in dealing with PTSD. Participants assigned to SSRIs-Fluoxetine were prescribed 6 months worth of medication to be taken orally once a day for the duration of the 6 month treatment.
Participants that were assigned to the controlled condition were sent self-help literature (found on the VA’s website) twice a month for the duration of the 6 month treatment. After the 6 month treatments, the Rosenberg Self-Esteem Scale was administered again (follow-up assessment). Results The data will be analyzed using a 3 (Condition: CBT, SSRIs, Control) x 2 (Groups: PTSD-DV, PTSD-Rape Victims) independent groups (ANOVA) at an alpha level of . 05. Anticipated mean change in F-scores between conditions (CBT vs. SSRIs) will be significant, F (1, 180) = 3. 89, p