HelpingVulnerablePopulations:AComprehensiveReviewofthe...

Helping Vulnerable Populations: A Comprehensive Review of theTreatment Outcome Literature on Substance Use Disorder and PTSD

Lisa M. Najavits1 and Denise Hien2

1Veterans Affairs Boston Healthcare System / Boston University School of Medicine2City College of New York

We review treatment studies for comorbid substance use disorder (SUD) and posttraumatic stressdisorder (PTSD). Results show positive outcomes on multiple domains. Most models had more effecton PTSD than SUD, suggesting SUD is harder to treat. Seeking Safety (SS) is the most studied model.It shows positive outcomes, and is the only treatment outperforming a control on both PTSD andSUD. Partial-dose SS had more mixed results than the full dose. This first-generation of PTSD/SUD re-search addresses complex samples excluded from “gold standard” PTSD-alone literature. Treatmentsfor PTSD/SUD are generally longer than PTSD-alone treatments and present-focused, emphasizingstabilization and coping. The few models with past-focused (exposure-based) components also incor-porated present-focused approaches for these vulnerable clients. We discuss public health perspectivesto advance the field. C© 2013 Wiley Periodicals, Inc. J. Clin. Psychol: In Session 69:433–479, 2013.

Complex trauma, posttraumatic stress disorder (PTSD), and substance use disorder (SUD) arelike parts of a prism—different lenses from which to see into clients’ often-tragic past. Thoughthey may have formal diagnostic representations that lead us to view them as separate entities,they are highly related in the day-to-day experience of clients’ lives. Yet it is only quite recentlythat attention has been directed toward linkages between these domains. Splits between mentalhealth and SUD treatment are well known, as is the fact that most clinicians never receive formaltraining in both. Clients have been left to try to integrate what our field historically has not.

Thus, it is heartening that the past several years have seen the emergence of new therapiesto address comorbidity and research to evaluate those therapies. This article is an attempt tosummarize where we are at this point: What models have been developed and tested? Whatthemes can we draw from the research on them? What next new directions are needed?

A major aspect that we hope to portray is that the data have many “stories to tell.” Withinthe framework of empirical studies, different details and ideas can be brought out. Our goal isto address topics that are meaningful to both clinicians and researchers. For example, for eachstudy we list how many hours of treatment were delivered, how the sample addressed complextrauma, the rate of minority representation, the types of clients who were excluded from thestudies (which is just as important as who was included), whether the clinicians conducting themodel were native to the setting (which bodes for stronger replication), and whether any negativeoutcomes occurred. We also apply uniform descriptors across studies so that one can comparea consistent set of standards across studies. Because of space limitations, a more detailed, fullyacademic version of this article is available from the first author, which provides a complete reference

This article was researched and written by the first author. The second author provided editorial feedbackand reported on her studies in the paper. Special thanks are extended to Martha Schmitz, PhD, for inspiringconversations related to themes in this article, and each of the authors’ research, clinical, and training teams,whose daily efforts toward improving the lives of complex PTSD/SUD clients is the backbone of our workand has been a large part of our attempt to contribute to this area. The first author names Gabriella Grant,Kay Johnson, Kevin Reeder, Martha Schmitz, Brenda Underhill, and Joni Utley. The second author namesAimee Campbell, Lisa Cohen, Lisa Litt, Gloria Miele, and Lesia Ruglass. This work was supported by theDepartment of Veterans Affairs, Clinical Sciences Research and Development.

Please address correspondence to: Lisa M. Najavits, VA Boston Healthcare System, 150 South HuntingtonAve., 116-B, Boston, MA 02130 617-299-1610. E-mail: [email protected]

JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 69(5), 433–479 (2013) C© 2013 Wiley Periodicals, Inc.Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.21980

434 Journal of Clinical Psychology: In Session, May 2013

section, footnotes to explain technical points, and identification of methodological and statisticalissues in studies.

Method

This review includes all studies that address (a) a PTSD/SUD treatment model (one designed forthe comorbidity) or (b) a PTSD/SUD population, even if the treatment model was not designedfor the comorbidity. Exclusion criteria for studies are as follows: if they did not attempt to treatboth disorders and instead offer a posthoc analysis of their outcomes (e.g., Rotunda, O’Farrell,Murphy & Babey, 2008); had no SUD outcome (e.g., Bragdon & Lombardo, 2012); are solelya case study (Batten & Hayes, 2005) or case series without aggregated data (e.g., Berenz, Rowe,Schumacher, Stasiewicz & Coffey, 2012); are prevention rather than treatment (e.g., Danielsen,McCart, Walsh, de Arellano, White & Resnick, 2012; Zatzick et al., 2004); use a nonmanualizedtreatment (Steindl, Young, Creamer & Compton, 2003); evaluate a multicomponent intensivetreatment program rather than primarily a manualized model per se (Donovan, Padin-Rivera &Kowaliw, 2001); or take a model that has been studied for PTSD/SUD but is being applied toa sample that does not have SUD (e.g., Ford, Steinberg & Zhang, 2011).

In sum, our focus is on comprehensively summarizing the PTSD/SUD comorbidity treatmentliterature. Studies were obtained through existing literature reviews, online searches, referencelists of articles, and colleagues. Throughout, we use the term “PTSD” to broadly refer to thefull range of trauma-related symptoms, and SUD to refer to the full spectrum of both substanceabuse and dependence, unless otherwise indicated.

However, there are also topics we do not address, such as level of treatment attendance.Attendance is defined inconsistently in studies, sometimes with no clear denominator (howmany sessions were available to clients), sometimes reported only for those attending a certainamount of the study treatment, and sometimes not reported. Similarly, we do not report effectsizes, which are a metric of how much change occurred on an outcome. Many studies do notreport effect sizes or use different statistical methods for them, so they are beyond the scopeof this article. Finally, the treatment models themselves are not described, but that informationcan be obtained online or through the reference list from the first author. Regarding statistics,results are reported only for the standard .05 significance level (no trends). Finally, there werea few instances where, either for accuracy or to make equivalent comparisons across studies, aresult reported in Table 2 (see Appendix) may differ from that in the paper on the publishedstudy. Such discrepancies are documented in detail in the full academic version of this paperavailable from the first author.

Results

A description of each study (see Table 1 in Appendix) is organized by treatment model, and Table2 provides results of each study in relation to PTSD, SUD, and other outcomes. In a narrativesense, Table 1 represents “before and during” treatment and Table 2 is “after.” Several majorthemes are identified below that apply across studies, followed by a section related to specificmodels.

Key Themes

All of the Studies Address Complex Trauma/PTSD

The studies did not use a definition of complex trauma or complex PTSD as an inclusionarycriterion (identifier of who is to be included in the study), as there is as yet no formal definitionof these terms. Yet each study in fact did address a complex trauma/PTSD sample. Table 1,columns C, D, and E, indicate how each study relates to complex trauma/PTSD, in any or allof the following ways.

A multiply-traumatized sample and the presence of current trauma-related symptoms. Symptomswere in the form of PTSD (full or subthreshold), elevated trauma symptoms, or a positive screenfor major trauma history and/or symptoms. Most studies used well-validated assessments toidentify these.

Review of Treatments 435

Comorbidity. To be included in this review, each study had to include comorbidity inthe form of a SUD sample, which was either defined through formal assessment of SUD orby virtue of being in a SUD treatment setting. The SUD in these studies was generally severe(usually dependence, not just abuse), chronic, often involved multiple substances, and includedboth alcohol and drugs (the latter being typically harder to treat). Further, although the studiesin this review do not provide a full diagnostic picture, any studies that did assess for additionaldiagnoses or symptoms found notable rates of them, such as major depression, Axis II disorders,or severe and persistent mental illness.

Childhood-based and/or repeated trauma. The clients in these studies often hadchildhood-based sexual and/or physical trauma, typically repeated, and interpersonally-based.

Multiple life burdens. A defining characteristic of complex trauma populations is thepresence of multiple life problems, in addition to formally diagnosed disorders. In these studies,per column D, these were clearly multiply-burdened samples, including homelessness, unemploy-ment, criminal justice involvement, multiple prior treatment episodes, low education, domesticviolence, suicidality, and violence.

Just reading some of the descriptors of these samples in Table 1 (column D) is heart-wrenching:“All had childhood-based PTSD; average of near-daily substance use; most had active suici-dal ideation and/or plan; all had substance dependence, primarily drug rather than alcohol”(Najavits, Schmitz, Gotthardt & Weiss, 2005); “Most were violent offenders with serious mentalillness, including bipolar/psychotic; child sexual abuse; average of 15 life stressors; in minimum,medium, or maximum security” (Wolff, Frueh, Shi, & Schumann, 2012); “Primarily unmarriedmothers, 35% with parental rights terminated by legal system, due primarily to SUD; 69% hadproblems with multiple substances, and substantial percentage used substance(s) daily; 77% hadprior SUD treatment; 35% had major depression, 19% bipolar I or II” (Young et al., 2004).

Minimal exclusionary criteria. The studies generally have low or at most moderateexclusions (see Table 1, column E), in contrast to the relatively high level of exclusions in theliterature on PTSD-alone (Bradley, Greene, Russ, Dutra, & Westen, 2005). Moreover, whenmajor exclusions are present, they are usually due to the study requiring a high level of care forthese vulnerable clients (studies #10, 22, 25, 33).

Finally, all but one of the treatment models themselves were explicitly designed for com-plex trauma/PTSD in terms of the above-mentioned characteristics: Concurrent Treatmentof PTSD and Cocaine Dependence (CTPTCD), later named Concurrent Prolonged Exposure(COPE); Creating Change (CC); Helping Women Recover/Beyond Trauma (HWR/BT); Inte-grated CBT for PTSD and SUD (ICBT); Seeking Safety (SS); Substance Dependence PTSDTherapy (SDPT); Trauma Adaptive Recovery Group Education and Therapy (TARGET); andTrauma Recovery Empowerment Model (TREM). All of these models were conceptualized fromthe start to address the multiple comorbidities and life problems of PTSD/SUD or complextrauma clients. In contrast, one additional model, Exposure Therapy plus SUD coping skillstreatment (EXP), used a PTSD-alone model in a PTSD/SUD sample.

The Studies’ Clinical Implementation Speaks to the Needs of the Population

There is much to be gleaned from Table 1, column B. For example, although the current researchculture focuses on short-term treatment models, notice how long the treatments were in thesestudies. They are wide-ranging but often were delivered in about 30–40 hours and sometimesquite a lot more. The study treatments were also added on to what were often quite high levelsof care (See Table 1, column C).

Column B also shows that the majority of studies used a group rather than individual modality,and within the group studies many used open rather than closed groups. Finally, many of thestudies used frontline clinicians who were native to the setting, often without advanced degreesor high levels of formal training. One study (#22) used a creative method of training its clinicians,


who were in recovery themselves, by having them go through the model as participants prior toleading sessions. Another study used peer-led treatment (#9).

In sum, Column B provides a window into the needs of frontline settings that work with thesehighly complex populations. Aspects such as the number of hours of treatment, the use of groupover individual modality, and the use of a less highly trained workforce speak to the realities ofthese environments, where a good deal of complex trauma treatment is delivered. This picture isalso discrepant from many PTSD-alone treatment trials. (We are using the term “PTSD-alone”to differentiate the standard PTSD treatment literature from this review on comorbid PTSD-SUD.) Overall, the PTSD-alone literature has focused more on efficacy rather than effectivenessstudies. The former represents more pure academic research designed to have stricter control andmore rigorous scientific standards; the latter addresses real-world outcomes in regular practice.For example, PTSD-alone studies have focused largely on individual rather than group therapies;closed groups if they do use group modality; clinicians who are costly (highly trained, often withadvanced degrees, and receiving many hours of consultation and training as part of the studies;Karlin et al., 2010).

PTSD-alone studies have also consistently excluded more vulnerable populations such asthose who have problems with homelessness, domestic violence, suicidality, violence, seriousand persistent mental illness, and SUD (particularly substance dependence and drug disordersrather than alcohol). The PTSD treatment field does produce positive outcomes with short-termmodels of 12–20 sessions (Institute of Medicine, 2007), but not generally on these types of highlycomplex clients. And, even with its successes, it is also true that a substantial subset of clientsremains symptomatic, and go through repeated episodes of these and other treatments.

All Studies Using a Past-Focused (Exposure) Approach Combined it With aPresent-Focused (Coping) Approach

A major current discussion in the field is the relative merit of present-focused versus past-focusedapproaches to PTSD treatment. Broadly speaking, models that focus on exposure-based or otheremotionally intense exploration of the trauma narrative are termed here past-focused, in contrastto models that focus on current coping skills and psychoeducation, which are present-focused(Najavits, 2013).

A note on terms: The term trauma-focused is sometimes used to refer to exposure-basedmodels. However, we view that as a misnomer as all present-focused PTSD models, includingthose covered in this review, directly and strongly “focus on trauma.” The difference is how theyapproach it. Exposure-based models focus primarily on the past by exploring trauma memoriesand associated feelings, thoughts, and body sensations. Present-focused PTSD models explicitlyomit detailed exploration of the past, typically in the service of helping stabilize the client,and instead focus primarily on coping skills and psychoeducation. We observe too that theterm “nontrauma-focused treatment” to refer to these present-focused PTSD models is alsoproblematic as it labels them solely by what they are not; it is equivalent to referring to womenas “non-men” or children as “non-adults.” Present-focused approaches have a rich content ofcoping skills and psychoeducation that is better captured by a meaningful label.

Terminology aside, in recent years, there has been growing interest in applying past-focusedPTSD models to SUD, which historically was always viewed as outside the purview of suchmodels. The phrase, “get clean and sober first, and then work on PTSD” was the predominantmessage for most of the 20th century (Najavits, 2002). In part, this perspective was based ondocumented cases (Pittman et al., 1990) and other reports of increased substance use or otheriatrogenesis from trying to move clients into emotionally intense trauma narratives before theywere stable enough to tolerate it, sometimes called “opening Pandora’s box” (Hien, Litt, Cohen,Miele & Campbell, 2009). It has also been based on differences in workforce, culture, resources,and modality of treatment in mental health versus SUD treatment settings (Najavits, 2013).The stage-based approach to PTSD treatment, in which present-focused stabilization occursfirst before moving into past-focused exposure, has been an important historical framework(Herman, 1992), and remains one that is still widely endorsed by PTSD experts (Cloitre, Courtois,Charuvasta, Carapezza, Stolbach & Green, 2011).


However, in recent years there has been a new development of trying to evaluate whetherpast-focused approaches can be used safely with complex PTSD/SUD populations. (To see theshift in enthusiasm for applying past-focused models to PTSD/SUD, compare, for exampleFoa, 2000, to Riggs and Foa, 2008). Six studies in this review have attempted this, using fourdifferent models: CTPCD (#30), later reworked as COPE (#34); Exposure (EXP; #33); SS-plus-Exposure-Therapy-Revised (#31), later reworked as CC (#35); and SDTP (#32). Severalimportant lessons can be gleaned from these studies, albeit based on an early stage of literatureat this point. First, it is possible to use exposure-based models with these complex clientswhen using the modifications used in these studies. The latter is emphasized because all six studiesmarkedly changed classic exposure for PTSD. Two models, COPE and SDTP, took the approachof combining an existing empirically validated model already developed for PTSD (such as PE)and SUD (such as relapse prevention). Another, CC, was developed as a companion to present-focused SS, and has extensive preparation and decision-making tools for deciding whether aclient is ready for exposure, as well as broadening exposure to a gentler version. Finally, the EXPstudy required all clients to be in highly intensive SUD treatment and to verify abstinence priorto starting. That study was primarily a laboratory experiment rather than a treatment trial, butdoes report outcome results and so is included.

With such extensive modification to classic exposure, all six studies found some positive out-comes and no notably negative outcomes, which is an important take-home message. However,two of the three randomized controlled trials (RCTs) conducted thus far (SDTP and COPE)did not outperform standard SUD treatment to any notable degree. In the SDTP study (#32)there was no difference between it and 12-Step Facilitation therapy on any outcome. And COPE(#34) did not outperform the control (SUD treatment-as-usual) on any substance use variablein the study at any timepoint, and only outperformed on PTSD at 9-month follow-up, not atthe end of treatment point for COPE (Najavits, 2012). The EXP study (#33) did outperformthe control, but only on PTSD (SUD and other variables were not reported), and only in thecontext of mandatory SUD treatment and major exclusions for complex clients (see Table 1,column E).

Finally, Table 1 indicates that all six studies that included a past-focused component weredelivered in individual modality rather than group, and most tended to restrict to a morenarrow sample than the present-focused studies, in keeping with the PTSD-alone literature.It is also evident that the CTPCD and EXP (#30, 33) studies only report outcomes on aminority of their sample, and SDTP is unclear on the percentage it reported on (see Table 2,column A).

The Studies Have Variable Methodological Rigor and Clearly More Research is Needed

Also evident from the tables is that the mantra of research—“more research is needed”—holdsvery true in this area of work. There are relatively few RCTs compared with pilots and controlledtrials. Moreover, there were some consistent methodological weaknesses in the studies. Thesecan be useful for clinicians to keep in mind when considering adoption of treatments and whenreading outcome articles, as well as for improving future research in this area.

Absence of end-of-treatment outcomes. Per Table 2, a surprising number of studiesreport no data at the end of treatment, but instead only at follow-up points. One study, forexample, has a treatment that ends at 4 months, but there are no outcome data until 12 months(#13). Yet from baseline to end of treatment is the most rigorous timeframe from which tounderstand the effect of a treatment model, and end of treatment to follow-up to understandwhether clients maintained gains. One study collected data at what appears to be the end oftreatment, but did not compare it separately to either baseline or follow-up (#25). There arecertainly interesting questions, from a health services perspective, that can be addressed byfollow-ups months after the study treatment has ended, but the “black box” of the follow-upperiod, during which clients may be receiving all sorts of unknown treatments, makes it lessuseful for understanding how to improve treatment models.


Omission of key information. Also notable was the large amount of missing informa-tion. Published reports typically lacked some of the following details: attendance data and effectsizes (mentioned earlier); whether any negative outcomes occurred; clear reporting on timing(i.e., when the study treatment ended, how much study treatment was delivered); the amountof training and supervision clinicians had to undergo in the study treatment; treatments clientswere engaged in aside from the study treatment; sample sizes at each stage of the researchand in all statistical reporting; and full-intent-to-treat analyses (reporting on all clients whoentered the study, rather than just those who completed treatment as in #22 and #33). And,although not standard at this point, a wish-list for additional information would include uri-nalysis/breathalyzer to verify substance use self-reports, scales to measure complex trauma andintergenerational trauma, treatment satisfaction by both clients and clinicians (the latter is virtu-ally never reported, the cost of the treatment (even in some basic form), the treatment developer’slevel of involvement in the research, and use of only psychometrically valid instruments for keyconstructs. Such details matter, in terms of both being able to interpret the results of studies andalso for later implementation of models in practice.

Questionable aspects. Occasionally, there was some reporting that was puzzling. Someexamples are as follows: A study treatment that had 52% more clients randomized to it thanto the control condition, with no reason given (#25); report of a “decrease in substance use”without adequate data or a statistical test to support that (#22); covarying out a set of variablesthat were not statistically different between treatment conditions at baseline, resulting in positiveoutcomes for the study treatment that otherwise did not exist (#23); mention of a treatmentbeing “superior” to another based on a trend on one variable and no other significant differenceon primary outcomes between study conditions (#26); stating a difference existed at a 6-monthtimepoint that was not there (#28); stating that a study had adequate sample size though itobtained 26% less than was required by the power analysis listed in the paper (#18); reportingfollow-up results when just 13% (#30) or 27% (#14) of the study treatment sample was stillavailable. Thus, one should always read beyond the study abstracts as sometimes they are rosierthan actual verifiable results in the text, and may omit findings that do not put the study treatmentin a positive light.

Yet it is clear that many of the studies were conducted under less than optimal conditions andsome were unfunded, and the teams were sometimes not academics but rather more clinicallyoriented. The remarkable big picture point is that the studies were done on complex populationsthat heretofore have been largely unstudied in the treatment outcome field. Thus, the weaknessesof these studies, as reflected in their methodological and reporting flaws, are noted here so asnot to imply that the literature is further along than it is. Although it is a dramatic improvementover the virtual absence of such studies a decade ago, the hope is that the next decade will seeincreasing rigor.

Summary of Results on Models

About Table 2

Table 2 provides a wealth of information. To better understand results listed there, the followingpoints may be helpful.

The goal of the table is to provide comprehensive data on all models and all variables,addressing both the end of treatment and follow-up results. In other words, do clients improvefrom baseline to end of treatment (columns C, D, E)? And do they improve at follow-up, i.e., atsome timepoint months after the end of the treatment (column F)? Within each of these centralquestions, results are organized into three types of outcomes: (a) trauma/PTSD, (b) SUD, and(c) “other variables,” which refers to all other outcomes studied.

Throughout, results are reported only for psychometrically valid measures. Also, given theearly stage of literature and the often small sample sizes (resulting in statistical lack of power),only significant outcomes are listed.


All controlled studies and RCTs are, by their design, comparing the study treatment to acontrol such as another treatment or treatment-as-usual. For such studies, results are listed asfollows. If the study treatment outperforms the control, the result is shown in boldface andunderline (regardless of whether the control also improves, as our primary goal is to identifywhether there is any added benefit for the study treatment). If the study treatment does notoutperform the control, and both conditions improve, the result is underlined only. This is usefulbecause it gets away from just the “horse race” results reported in many reviews, which indicateonly whether one treatment outperformed another. From a public health standpoint, a morerelevant question is, “In what ways does the study treatment outperform the control, and inwhat ways do both improve?” Thus, Table 2 is constructed to help the reader see the full bodyof evidence so as to be able to identify overarching patterns.

Column A provides the percentage of the original sample that the investigators sought toreport on in their outcomes. This is important because (as is evident from looking down columnA) some investigators aim to report outcomes for the entire initial sample, which is consideredthe gold standard known as “full intent to treat” reporting. It is the least biased because it asks,“How did everyone do who enrolled in the trial?” Other studies have some smaller proportion,which is also legitimate but addresses a different question, such as in a pilot study where thegoal may be: “How did clients do if they attended at least one session [or four sessions, etc.] ofthe treatment?” In Column A, studies that have less than the full intent to treat (100%) data arelisted by their percentage. In most studies, the majority of participants were reported on. But ina few studies, it is a minority percentage, and thus limits the generalizability of the results. Anystudies with a minority of the original sample being reported on are noted with this symbol toindicate absence of sufficient sample and thus caution needed in interpreting the study results: ♦.

Findings Across Models

The following points become clear when looking across Table 2.

The models generally show positive outcomes. Notice the many “yes” results acrossthe table, each indicating a positive outcome. This is good news because it means that clientsimproved over time when given these manualized models of treatment that were designed totarget their problems. They improved, depending on the study, in many different domainsincluding trauma/PTSD, SUD, and areas such as psychopathology, functioning, cognitions,self-compassion, and coping skills. There were few negative outcomes (worsening over time),and treatment satisfaction was generally strong in studies that addressed it. However, it is alsoimportant to keep in mind the context of these studies. Clients were almost always in additionaltreatments while receiving the study treatment, and those additional treatments were rarelyidentified in terms of amount, type, or quantity. Additional treatments included psychiatricmedication, other psychotherapies, 12-step, intensive partial program, and methadone mainte-nance, for example. Thus, future research is needed to help address the interaction between studytreatments and additional treatments. Also, other questions would be needed for a full under-standing: Are there different subgroups of clients who improve more than others in treatment?How do clinicians differ in delivering the treatment (as therapist factors are one of the mostpowerful influences on outcomes; Najavits & Weiss, 1994)? How much treatment is needed toproduce positive outcomes?

There are some findings for treatments outperforming the control. This is the “horserace” question, asking whether the study treatment did better than what it was being comparedto (the design of all studies in Table 2 listed as “controlled trial” or “RCT”). The table indicatesthat there were various findings for the models outperforming the control, although not always,and not for all models. (Look for the findings that are both in boldface and underlined, notunderlined alone, to locate the ones that did occur). Those that showed any difference were asfollows: SS (#13, 14, 15, 16, 17, 18, 19, 20, 21); ICBT (#25); TREM (#27, 29) and BCM/TREM(#28); EXP/SUD (#33); and COPE (#34). A few models showed no significant differences fromthe control (SDPT, TARGET, GRT). Even the models that did show a difference sometimes


only showed it for one variable or scale, so it is important to recognize that at this early stageof work, it is not yet clear what the future holds in terms of range, degree, and sustainability ofchanges produced by any one model.

It is also important to recognize that treatments differed in how long they were delivered(e.g., they varied extensively in number of hours of treatment, per Table 1 and, by implication,likely cost). There are also many other relevant contextual factors (see the paragraph above). Itis also notable that there were no instances of the control outperforming the study treatment.(The only ones reported was for GRT, #23, on one variable and only in the overtime, notbetween-conditions analysis, and for SS, #21, on one secondary analysis variable [alcohol useby stimulant users]). Finally, it is just as important to notice how often both the study treatmentand the control showed improvement, without a difference between them (see all instances inthe table of the underlined, but not boldface, results). This happened quite frequently acrossthe table, indicating that the study treatment was not more helpful than the control on thosevariables.

Overall, then, it is evident that there were some positive findings for some of the studytreatments outperforming the controls. Among the models that did evidence outperforming acontrol, there were also differences in the number and range of findings achieved, per Table 2.And there were also quite a few instances where both the study treatment and the control showedimprovement, with no difference between them.

When there were differences between conditions, they were more on PTSD or othermental health variables, and less often on SUD. This is important as it may indicate thatin these complex comorbid clients, the PTSD and mental health issues may be easier to treator sustain over time than SUD outcomes. That remains a question for future research but doesfit clinicians’ perceptions (Back et al., 2009). It also fits the larger body of work wherein PTSDis typically conceptualized as amenable to short-term treatment and resolution, whereas SUD(dependence in particular) is conceptualized as a chronic relapsing disorder (Arria & McLellan,2012). The pattern seen in Table 2 may also reflect that clients were typically in SUD treatmentswhile in the study treatment. In terms of specific models in Table 2, study treatments that showedthis pattern of outperforming the control on PTSD but not SUD occurred for ICBT (#), BCM(#28), and COPE (#34). The only models in which the study treatment outperformed the controlon SUD were SS (e.g., #16,17, 18) and TREM (#29). The only model thus far that outperformedthe control on both PTSD and SUD was SS (see next section).

SS

We will summarize results on SS here, as it has been the subject of the majority of studies.

SS is the most rigorously studied treatment thus far for PTSD/SUD. It has beenstudied in 22 of the 35 studies in this review: 13 pilots, three controlled studies, and six RCTs(one a hybrid RCT). It is also the model with the most number of independent studies, which,as noted earlier, are less subject to positive bias. Consistent with all the studies in this review,clients in SS studies were consistently in the realm of complex trauma/PTSD, with comorbidity,high severity and chronicity, and multiple life problems. Various studies had strong minorityrepresentation. There were relatively few exclusionary criteria for clients, and in many studiesclinicians were native to the setting. SS has been studied primarily in group modality (18 of the22 studies), with most of these open rather than closed groups, and usually singly led rather thanco-led. Overall, these characteristics are representative of frontline SUD treatment settings.

Some studies are partial-dose SS only. Six of the studies are partial-dose SS studies,using 24% to 48% of the model (#10–12, 19–21), including the largest investigation of SS to date,the National Institute on Drug Abuse Clinical Trials Network (CTN) study, which used 48% ofthe model in 6 weeks (#21). “Partial-dose” refers to the number of SS topics used. The CTNstudy, for example, used 12 of the 25 SS topics. Partial-dose does not refer to a total numberof hours conducted per se as SS does not have a defined dose in that sense (per the SS manual


sessions can vary in duration of session and timing of sessions, based on the needs of the clientand clinician). Partial-dose studies address a different question than full dose SS studies. Theyask, “How well does SS work when only a segment of the content is delivered?” which in all sixpartial-dose studies thus far was less than half of its content. (Thus far, all reviews that includeSS omit this important point, e.g., Bernardy et al., 2013; Torchalla, Nosen, Rostam & Allen,et al. 2012, van Dam, Vedel, Ehring & Emmelkamp et al., 2011.)

SS has shown positive outcomes across studies generally. Across studies SS has hadnumerous positive outcomes on PTSD, SUD, and other variables (the many “yes” results inTable 2). In the controlled trials and RCTs, SS outperformed the control on PTSD but notSUD in some studies (#13, 14, 15, 20); on SUD but not PTSD in another (#18); and in somestudies, on both PTSD and SUD (#16, 17) and on both PTSD and SUD among more severeSUD patients (#21, on secondary analyses of subgroups). Most also found SS outperformed thecontrol on other variables, such as psychopathology, cognitions, and coping. Thus, in keepingwith the finding noted for other models, it appears to be easier to obtain results for PTSD andmental health outcomes than for SUD, although SS has shown demonstrable results on SUD insome studies as well.

Also, consistent with our earlier summary of Table 2, there are various instances of bothSS and the control improving. Studies of partial-dose SS have had mixed results, with somefinding stronger results than others (see studies #10–12, 18–20). In the partial-dose CTN study,secondary analyses on subgroups found SS to outperform the control in various results (andespecially with more severe SUD clients), and in only one instance found the control outper-forming SS (#21). When treatment satisfaction has been studied it has consistently been strong.Also, greater dosage has been shown to positively affect outcomes (#13, #19), and in two studiesSS obtained higher attendance than the control (#18, 21). SS has achieved various positiveoutcomes even with delivery by case managers (#14), by peers (#9), and with client who havepathological gambling disorder (#8). Thus far, there appear to be no discernable patterns ofdifference in studies based on factors such as individual versus group delivery, level of minor-ity representation, or type of clinicians delivering it, but formal comparative studies would beneeded to address these topics.

Finally, the model has been found to be very safe (Killeen et al., 2008), with no regular orfrequent pattern of worsening, though an occasional finding has occurred per Table 2 on asingle variable. SS is listed as having strong research support by various professional entities,based on their criteria sets, including Level A by the International Society for Traumatic StressStudies, and “strong research support” by Divisions 12 and 50 of the American PsychologicalAssociation.

Summary and Discussion

In the pages above, we explored the topic of treatment outcome studies for complex PTSD/SUD.Below is a recap of some of the key findings, although this is clearly an early stage literature withfar more research needed to draw firm conclusions.

The majority of treatments developed for these complex PTSD/SUD clients are present-focused approaches, emphasizing stabilization, coping skills, and psychoeducation, and, bydesign, not including past-focused (e.g., exposure-based) emotionally intense components. Thesemodels, all of which have had one or more empirical studies, are HWR/BT, ICBT, SS, TARGET,and TREM.

In recent years, a few models have also been developed or studied that include a past-focusedcomponent: CTPCD, later named COPE, CC, and SDPT. Each of these represents majoradaptations of classic exposure-based models to make them safe and effective for PTSD/SUDpopulations, who are perceived as more vulnerable and challenging to treat than PTSD-alone.Each of the resulting models is a present-focused plus past-focused combination, not a past-focused intervention delivered alone.

Overall, the studies in this review represent a more complex clientele than has been studiedin most of the gold standard PTSD-alone outcome literature thus far. A typical description


comes from study #13: “In addition to co-occurring SUD/psychiatric disorders, most had expe-rienced child abuse, been homeless, served jail time, and suffered interpersonal abuse in the past6 months; SUD was primarily drugs rather than alcohol (with methamphetamine common).”

Thirty-five studies are described (Table 1) and their outcomes listed (Table 2). Overall, resultsshow numerous positive outcomes across the domains of PTSD, SUD, and other variables,including psychopathology, cognitions, and coping. However, it also appears that SUD is harderto treat than PTSD (most models having more effect on the PTSD than SUD when studied incontrolled or randomized trials). The “controls” in these trials have almost uniformly beenSUD treatments, whether as treatment-as-usual SUD treatments or formal manualized SUDtreatments (e.g., relapse prevention or individual drug counseling). Thus, it may be the casethat the PTSD/SUD treatments were duplicating the effort already being focused on SUD.However, it may also be the case that SUD is simply harder to treat. The conceptualizationof SUD (especially substance dependence) as a “chronic relapsing illness,” much like diabetes,rather than a resolvable acute syndrome (as PTSD is currently conceptualized in gold standardPTSD-alone treatments currently), may be useful to keep in mind in future research.

All treatments studied showed a positive effect in pilot studies. In controlled trials or RCTs,most treatments evidenced at least one variable or scale in which it was superior to the control,although some did not. Also, both the study treatment and the control showed improvementon various outcomes in various studies, highlighting the point that it is not always differentialoutcomes that are important, but also looking at ways in which both show effects.

SS is the most studied model, with 22 of the 35 studies. It is the only treatment thus far thathad an effect on both PTSD and SUD relative to a control (in controlled trials or RCTs). Insome studies it shows a superior effect on PTSD and in one study it is superior just on SUD.Six of the SS studies, including the large CTN study (#21), were partial-dose studies with lessthan 50% of the SS content delivered, a fact omitted in prior literature reviews that covered SS.Overall, various positive SS outcomes are listed in Table 2 across a diverse range of studies. Twostudies have found that greater dosage has been shown to positively affect outcomes (#13, #19),and in two studies SS obtained higher attendance than the control (#18, 21). A few isolatednegative outcomes were found on single variables; but overall research shows it to be a highlysafe model. SS studies have largely been group modality studies, typically open groups, withclinicians native to the setting, and by independent investigators. As such, the literature on itlargely represents effectiveness rather than efficacy studies, and evidences its ability to producepositive outcomes in real-world conditions. However, more studies are clearly needed.

Several important aspects were beyond the scope of this review: comparison of attendancepatterns, effect sizes (degree of change), and statistical meta-analysis. However, given the currentstate of the literature (see the next point), meta-analysis appears premature.

The studies reviewed are impressive in being the first generation of research to focus on thecomplex PTSD/SUD clientele that have consistently been excluded from most prior outcomeresearch. However, the studies contain notable weaknesses in both design and reporting. Theyoften lack end-of-treatment outcomes (which are the most relevant to understand the effectof models and to improve them). In addition, they are typically pilot studies conducted inconjunction with variable amounts of other treatments that are unspecified, generally do notreport on the full array of comorbid conditions in their samples, and tend not to use urinalysisto verify SUD self-reports.

A Public Health Perspective

Beyond the above findings, it is useful to address the treatment needs of these clients froma broader public health lens. There is no model yet in existence nor is there one likely to bedeveloped that can resolve quickly what for many of these clients are decades of abuse, neglect,violence, substance use, and the host of associated life problems that co-occur with these, such ashomelessness, criminal justice involvement, job problems, poverty, discrimination, and physicalhealth problems. They are a multiply burdened segment of the population with high chronicity(Brown, Huba, & Melchior, 1995). They often have the least resources for care and receive


treatment from some of the least trained clinical staff. They often end up in public healthsystems of care.

Thus, some important questions for the next generation of research include the following, interms of behavioral treatments.

What length of treatment is actually needed for these clients? As shown in Table 1, treatmentsin this study had wide-ranging length, but few treatments were actually very brief, suggestingthat for complex PTSD/SUD clients, longer treatment is perceived as necessary. In keeping withthis, Dialectical Behavior Therapy, one of the most widely adopted treatments for complex pop-ulations, is designed as one year of approximately 182 hours of group and individual treatment(see Landes, Garovoy & Burkman, this issue). Various PTSD-alone gold standard treatmentshave been identified as short-term models of 12–20 sessions, but they are gold standard only fora narrow segment of PTSD clients, and certainly not as yet gold standard, much less empiricallyvalidated, for the types of high complexity clients covered in this review. (There have been a fewinitial studies in which past-focused models have been tried with complex PTSD/SUD clientsper Tables 1 and 2. But they have always been combined with present-focused models and madeinto longer treatments, as described earlier.)

What is consistently missing from the outcome literature is a clear picture of treatments thatclients had prior to the study treatment and after the study treatment. Many if not most ofthese clients are “repeat customers” who cycle through many rounds of treatment, yet this is notcaptured in the current zeitgeist of how models are studied. It is as if we are watching just themiddle few minutes of a movie and have missed the much larger story before and after. Evenstudies with follow-up periods rarely report on what treatments client received during that timein type, amount, and level of helpfulness.

Complex comorbid clients at the severe end of the spectrum may need models that provideongoing support rather than a time-limited course. Certainly for less severe, less complex clients,treatment may work as envisioned in manuals with a limited number of sessions. But others mayneed support for a long time. This is reflected in the wisdom of 12-step approaches that provideongoing, free, continuous support to help maintain abstinence from substances and that grewup as a grass-roots model developed by addicts themselves. In the PTSD field and mental healthbroadly, there is currently no widespread supportive resource of this type. Findings consistentlyshow that SUD clients, including those with PTSD, who attend 12-step groups are more likely tosustain positive outcomes. For clients in the severe end of the spectrum, SUD may be more of adisorder like diabetes that requires long-term management. Becoming creative about developingresources for complex clients (beyond 12-step groups) may be an important public health goal.Some of the models identified in this review can perhaps be used in such ways.

It is crucial to focus more on which treatments, and what about those treatments, are mostappealing, easy to implement, and low cost for clinicians and clients in public health systems ofcare, in relation to a given unit of outcome. “Horse race” comparisons (which rarely evidencepowerful or consistent differences between well-developed models) are increasingly less relevantthan determining which models clients want to engage in and which their workforce can deliver,within the realities of the setting. Major reviews and several decades of research indicate thatwell-crafted models do not typically outperform each other (Benish, Imel & Wampold, 2007;Bradley et al., 2005; Garfield & Bergin, 1998; Imel, Wampold, Miller & Fleming, 2008; Powers,Halpern, Ferenschak, Gillihan & Foa, 2010). However, they may differ in other important waysin terms of these other aspects (appeal, ease of implementation, and cost). A model that hasslightly less effect on outcome but is much stronger on these factors may be a good public healthchoice. Thus far, such aspects have not been researched in the PTSD/SUD field in relation totreatment models.

It is also essential to attend more to the clinicians treating these clients, many of whomhave substantial histories of trauma and/or addiction themselves. They typically manage largecaseloads of complex clients, often without sufficient support or training. There is little empiricalresearch on how to best select and retain them, and to support them in their work. The adventof evidence-based manuals is important, but their workforce needs go beyond manuals.

Overall, as this review shows, there have been creative and strongly humanitarian attempts tocreate various treatment manuals that are sensitive to the trauma, comorbidity, and widespread


suffering endured by complex PTSD/SUD clients. Manualized models can bring a high levelof innovation and inspiration to clinical work. The hope is that in the decades ahead, empiricalefforts will continue to expand our understanding of how to best help the broadest range ofthese clients.

Selected References and Readings

Amaro, H., Dai, J., Arevalo, S., Acevedo, A., Matsumoto, A., Nieves, R., & Prado, G. (2007a). Effects ofintegrated trauma treatment on outcomes in a racially/ethnically diverse sample of women in urbancommunity-based substance abuse treatment. Journal of Urban Health, 84, 508–522. [Note: Amaroet al., 2007b is listed in the fully referenced version of this paper available from the first author.]

Benton, D. M., Deering, D. E. A., & Adamson, S. J. (2012). Treating co-occurring posttraumatic stressdisorder and substance use disorders in an outpatient setting in New Zealand. New Zealand Journal ofPsychology, 41, 30–37.

Boden, M. T., Kimerling, R., Jacobs-Lentz, J., Bowman, D., Weaver, C., Carney, D., . . . Trafton, D. A. (2012).Seeking Safety treatment for male veterans with a substance use disorder and PTSD symptomatology.Addiction, 107, 578–586.

Brady, K. T., Dansky, B. S., Back, S. E., Foa, E. B., & Carroll, K. M. (2001). Exposure therapy in thetreatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of SubstanceAbuse Treatment, 21, 47–54.

Coffey, S. F., Stasiewicz, P. R., Hughes, P. M., & Brimo, M. L. (2006). Trauma-focused imaginal exposure forindividuals with comorbid posttraumatic stress disorder and alcohol dependence: revealing mechanismsof alcohol craving in a cue reactivity paradigm. Psychology of Addictive Behaviors, 20, 425–435.

Cook, J. M., Walser, R. D., Kane, V., Ruzek, J. I., & Woody, G. (2006). Dissemination and feasibility ofa cognitive-behavioral treatment for substance use disorders and posttraumatic stress disorder in theVeterans Administration. Journal of Psychoactive Drugs, 38, 89–92.

Covington, S., Burke, C., Keaton, S., & Norcott, C. (2008). Evaluation of a Trauma-Informed and Gender-Responsive Intervention for Women in Drug Treatment. Journal of Psychoactive Drugs (SARC Supple-ment), 5, 387–398.

Daoust, J.-P., Renaud, M., Bruyere, B., Lemieux, V., Fleury, G., & Najavits, L. M. (2012). Posttraumaticstress disorder and substance use disorder: Evaluation of the effectiveness of a specialized clinic forFrench-Canadians based in a teaching hospital. Manuscript submitted for publication.

Desai, R. A., Harpaz-Rotem, I., Najavits, L. M., & Rosenheck, R. A. (2009). Seeking Safety therapy:Clarification of results. Psychiatric Services, 60, 125.

Desai, R. A., Harpaz-Rotem, I., Rosenheck, R. A., & Najavits, L. M. (2008). Effectiveness of treatment forhomeless female veterans with psychiatric and substance abuse disorders: Impact of “Seeking Safety”on one-year clinical outcomes. Psychiatric Services, 59, 996–1003.

Fallot, R. D., McHugo, G. J., Harris, M., & Xie, H. (2011). The Trauma Recovery and EmpowermentModel: A quasi-experimental effectiveness study. Journal of Dual Diagnosis, 7, 74–89.

Frisman, L., Ford, J., Hsui-Ju, L., Mallon, S., & Chang, R. (2008). Outcomes of trauma treatment using theTARGET model. Journal of Groups in Addiction & Recovery, 3, 285–303.

Gatz, M., Brown, V., Hennigan, K., Rechberger, E., O’Keefe, M., Rose, T., & Bjelajac, P. (2007). Effectivenessof an integrated, trauma-informed approach to treating women with co-occurring disorders and historiesof trauma: The Los Angeles site experience. Journal of Community Psychology, 35, 863–878.

Ghee, A. C., Bolling, L. C., & Johnson, C. S. (2009). The efficacy of a condensed Seeking Safety interventionfor women in residential chemical dependence treatment at 30 days posttreatment. Journal of Child SexAbuse, 18, 475–488.

Hien, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for womenwith comorbid PTSD and substance use disorders. American Journal of Psychiatry, 16, 1426–1432.

Hien, D. A., Wells, E. A., Jiang, H., Suarez-Morales, L., Campbell, A. N., Cohen, L. R., . . . Nunes, E. V.(2009). Multisite randomized trial of behavioral interventions for women with co-occurring PTSD andsubstance use disorders. Journal of Consulting and Clinical Psychology, 77, 607–619. [Note: citationsfor secondary analyses of this study are in the fully referenced version of this paper available from thefirst author.]

Lynch, S., Heath, N. M., Matthews, K. C., & Cepeda, G. J. (2011). Seeking Safety: An intervention fortrauma exposed incarcerated women? Journal of Trauma and Dissociation, 9, 301–319.


McGovern, M. P., Lambert-Harris, C., Acquilano, S., Xie, H., Alterman, A. I., & Weiss, R. D. (2009). Acognitive behavioral therapy for co-occurring substance use and posttraumatic stress disorders. AddictiveBehaviors, 34, 892–897.

McGovern, M. P., Lambert-Harris, C., Alterman, A. I., Xie, H., & Meier, A. (2011). Behavioral therapyversus individual addiction counseling for co-occurring substance use and posttraumatic stress disorders.Journal of Dual Diagnosis, 7, 207–227.

Messina, N. P., Calhoun, S., & Warda, U. (2012). Gender-responsive drug court treatment:A randomized controlled trial. Criminal Justice and Behavior, online version 10/2/2012doi:10.1177/0093854812453913

Mills, K. L., Teesson, M., Back, S. E., Brady, K. T., Baker, A. L., Hopwood, S., . . . Ewer, P. L. (2012). Inte-grated exposure-based therapy for co-occurring posttraumatic stress disorder and substance dependence:a randomized controlled trial. Journal of the American Medical Association, 308, 690–699.

Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking Safety therapy for adolescent girls with PTSDand substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services& Research, 33, 453–463.

Najavits, L. M., Hamilton, N., Miller, N., Doherty, J., Welsh, T., & Vargo, M. Peer-led Seeking Safety:Results of a pilot outcome study with relevance to public health. Manuscript submitted for publication.

Najavits, L. M., & Johnson, K. M. Pilot study of Creating Change, a new past-focused model for PTSDand substance abuse. Manuscript submitted for publication.

Najavits, L. M., Schmitz, M., Gotthardt, S., & Weiss, R. D. (2005). Seeking Safety plus Exposure Therapy:An outcome study on dual diagnosis men. Journal of Psychoactive Drugs, 37, 425–435.

Najavits, L. M., Smylie, D., Johnson, K., Lung, J., Gallop, R., & Classen, C. (in press). Seeking Safetytherapy for pathological gambling and PTSD: A pilot outcome study. Journal of Psychoactive Drugs.

Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). “Seeking Safety”: Outcome of anew cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substancedependence. Journal of Traumatic Stress, 11, 437–456.

Norman, S. B., Wilkins, K. C., Tapert, S. F., Lang, A. J., & Najavits, L. M. (2010). A pilot study of seekingsafety therapy with OEF/OIF veterans. Journal of Psychoactive Drugs, 42, 83–87.

Patitz, B., & Najavits, L. M. Seeking Safety for women with PTSD and substance use disorder: An outcomestudy. Manuscript submitted for publication.

Searcy, V., & Lipps, A. (2012). The Effectiveness of Seeking Safety on reducing PTSD symptoms in clientsreceiving substance dependence treatment. Alcoholism Treatment Quarterly, 30, 238.

Toussaint, D. W., VanDeMark, N. R., Bornemann, A., & Graeber, C. J. (2007). Modifications to the TraumaRecovery and Empowerment Model (TREM) for substance-abusing women with histories of violence:Outcomes and lessons learned at a Colorado Substance Abuse Treatment Center. Journal of CommunityPsychology, 35, 879–894.

Triffleman, E. (2000). Gender differences in a controlled pilot study of psychosocial treatments in substancedependent patients with post-traumatic stress disorder: Design considerations and outcomes. AlcoholismTreatment Quarterly, 18, 113–126.

Wolff, N., Frueh, B. C., Shi, J., & Schumann, B. E. (2012). Effectiveness of cognitive-behavioral traumatreatment for incarcerated women with mental illnesses and substance abuse disorders. Journal of AnxietyDisorders, 26, 703–710.

Young, M. S., Hills, H. A., Rugs, D., Peters, R., Moore, K., Woods-Brown, L., & Pape, L. (2004, July).Integrating Seeking Safety into substance abuse treatment programs. Paper presented at the 112th annualmeeting of the American Psychological Association, Honolulu, HI.

Zlotnick, C., Johnson, J., & Najavits, L. M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. BehaviorTherapy, 40, 325–336.

Zlotnick, C., Najavits, L. M., & Rohsenow, D. J. (2003). A cognitive-behavioral treatment for incarceratedwomen with substance use disorder and posttraumatic stress disorder: Findings from a pilot study.Journal of Substance Abuse Treatment, 25, 99–105.


App

endi

x

Tab

le1

Des

crip

tion

ofS

tudi

es

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(1)

See

king

Saf

ety

Pilo

tN

ajav

its

etal

.,19

98

Ope

ngr

oup

24se

ssio

ns×

1.5

hour

s.=

36ho

urs

in3

mon

ths.

27ou

tpat

ient

wom

enw

ith

curr

ent

PT

SD+

curr

ent

subs

tanc

ede

pend

ence

(plu

sha

dto

beac

tive

subs

tanc

eus

erin

prio

r30

days

);12

%m

inor

ity.

Yes

Seve

reon

PT

SD,S

UD

,soc

ial

func

tion

ing,

child

hood

trau

ma.

Mos

tun

empl

oyed

,wit

hA

xis

IIdi

sord

ers.

All

subs

tanc

ede

pend

ent,

mos

tdr

ugde

pend

ent.

Min

imal

His

tory

ofsc

hizo

phre

nia,

orga

nic

men

tal

diso

rder

;cur

rent

lyon

met

hado

nem

aint

enan

ceor

man

date

dto

trea

tmen

t.

(2)

See

king

Saf

ety

Pilo

tZ

lotn

ick

etal

.,20

03

Ope

ngr

oup

25se

ssio

ns×

1.5

hour

s.=

37.5

hour

sin

3m

onth

s).

17in

carc

erat

edw

omen

wit

hcu

rren

tP

TSD

,and

subs

tanc

ede

pend

ence

30da

yspr

ior

topr

ison

;33%

min

orit

y.

Yes

Maj

orit

yw

ere

repe

atof

fend

ers;

allh

adsu

bsta

nce

depe

nden

ce,

prim

arily

coca

ine;

mos

tne

ver

grad

uate

dhi

ghsc

hool

;all

had

child

hood

trau

ma,

repe

ated

trau

ma,

maj

orit

yph

ysic

alan

dse

xual

abus

e.

Min

imal

Act

ivel

yps

ycho

tic,

diag

nose

dor

gani

cbr

ain

impa

irm

ent.

(3)

See

king

Saf

ety

Pilo

tY

oung

etal

.,20

03

Gro

up(o

pen

atco

mm

unit

ysi

tes;

clos

edat

jail

site

s).

Com

mun

ity

sett

ings

wer

e25

sess

ion

×1.

5ho

urs

in6

mon

ths;

jail

was

25se

ssio

ns×

1.5

hour

sin

6w

eeks

=37

.5ho

urs.

220

wom

enin

SU

Dtr

eatm

ent,

wit

hva

stm

ajor

ity

havi

ngex

peri

ence

dtr

aum

a;53

%m

inor

ity.

Yes

Pri

mar

ilyun

mar

ried

mot

hers

,35

%w

ith

pare

ntal

righ

tste

rmin

ated

byle

gals

yste

m,d

uepr

imar

ilyto

SUD

;69%

had

prob

lem

sw

ith

mul

tipl

esu

bsta

nces

,an

dsu

bsta

ntia

lper

cent

age

used

subs

tanc

e(s)

daily

;77%

had

prio

rSU

Dtr

eatm

ent;

35%

had

maj

orde

pres

sion

,19%

bipo

lar

Ior

II.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(4)

See

king

Saf

ety

Pilo

tC

ook

etal

.,20

06

Gro

up25

sess

ions

;len

gth

and

tim

ing

not

spec

ified

;ass

ume

25ho

urs.

25m

ean

and

wom

enve

tera

nsw

ith

curr

ent?

PT

SDan

dSU

Dat

Vet

eran

sA

ffai

rs(V

A)

subs

tanc

eab

use

outp

atie

ntcl

inic

;eth

nici

tyno

tre

port

ed.

Yes

(alc

ohol

,coc

aine

,and

hero

inus

edi

sord

ers;

olde

rve

tera

nco

hort

,mea

nag

eof

50).

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

(5)

See

king

Saf

ety

Pilo

tP

atit

zet

al.,

unde

rre

view

Clo

sed

grou

p25

sess

ions

×2

hour

s=

37.5

hour

sin

12w

eeks

.

24ou

tpat

ient

rura

lwom

enw

ith

SUD

(ver

ified

byA

SIpl

usin

take

hist

ory)

and

trau

ma

sym

ptom

s(v

erifi

edby

the

TSI

);0%

min

orit

y.

Yes

Rur

al,l

ow-i

ncom

e,al

lhad

com

plex

trau

ma,

unab

leto

succ

eed

inSU

Dre

cove

ryus

ing

12-s

tep

orot

her

addi

ctio

nm

odel

s,us

edva

riou

ssu

bsta

nces

(alc

ohol

,met

ham

phet

amin

em

ost

com

mon

).

Min

imal

Act

ive

psyc

hoti

csy

mpt

oms,

e.g.

,del

usio

ns,

hallu

cina

tion

s.

(6)

See

king

Saf

ety

Pilo

tD

aous

tet

al.,

2011

Ope

ngr

oup

28se

ssio

nsus

ing

Fre

nch

tran

slat

ion

ofSS

×3

hour

s=

84ho

urs.

18m

enan

dw

omen

hosp

ital

outp

atie

nts

wit

hcu

rren

tP

TSD

and

curr

ent

SUD

;1%

min

orit

y.

Yes

Pri

mar

ilyph

ysic

al,s

exua

l,an

d/or

child

hood

trau

ma

(lat

ter

78%

);22

%in

pris

onin

thei

rlif

etim

e.P

rim

ary

subs

tanc

es:a

lcoh

ol,o

piat

es,

cann

abis

,coc

aine

.

Min

imal

Psy

chos

is,n

ope

rman

ent

resi

denc

y,or

bein

gac

tive

lyin

volv

edin

crim

inal

acti

viti

es.

(7)

See

king

Saf

ety

Pilo

tW

olff

etal

.,20

12

Clo

sed

grou

p28

sess

ions

×1.

5ho

urs=

42ho

urs

in14

wee

ks(u

sed

23of

the

25SS

topi

cs).

74in

carc

erat

edw

omen

wit

hm

enta

lilln

ess

inad

diti

onto

PT

SD(8

8%fu

ll,12

%su

bthr

esho

ld);

SUD

;64%

min

orit

y.

Yes

Mos

tw

ere

viol

ent

offe

nder

sw

ith

seri

ous

men

tali

llnes

s,in

clud

ing

bipo

lar/

psyc

hoti

c;ch

ildse

xual

abus

e;av

erag

eof

15lif

est

ress

ors;

inm

inim

um,

med

ium

,or

max

imum

secu

rity

.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(8)

See

king

Saf

ety

Pilo

tN

ajav

its

etal

.,20

13

Indi

vidu

al25

wee

kly

sess

ions

×50

min

utes

=25

hour

sin

6m

onth

s.

7m

enan

dw

omen

outp

atie

nts

wit

hcu

rren

tP

TSD

and

curr

ent

path

olog

ical

gam

blin

gdi

sord

er;

29%

min

orit

y.

Yes

Chi

ldho

odon

set

ofP

TSD

;al

lexp

erie

nced

phys

ical

,sex

ual,

and

othe

rtr

aum

aty

pes;

low

-inc

ome,

chro

nic

and

seve

re.

Min

imal

His

tory

ofdi

agno

sed

and

veri

fied

bipo

lar

1di

sord

eror

psyc

hoti

cdi

sord

er;

inst

itut

iona

lized

<3

wee

ksin

prio

r3

mon

ths

(“ou

tpat

ient

”).

(9)

Peer

-led

See

king

Saf

ety

Pilo

tN

ajav

its

etal

.und

erre

view

Clo

sed

grou

p25

sess

ions

×1

hour

=25

hour

s.18

wom

enin

resi

dent

ialS

UD

prog

ram

for

mot

hers

and

thei

rch

ildre

n;22

%m

inor

ity.

Yes

All

wit

hm

ulti

ple

trau

mas

,pr

edom

inan

tly

child

hood

repe

ated

phys

ical

and/

orse

xual

abus

e;su

bsta

nce

depe

nden

ce(o

nin

take

toth

efa

cilit

y);a

ndlo

w-

inco

me.

Maj

orH

adto

bein

the

resi

dent

ialp

rogr

amfo

r90

days

,an

dpl

anne

dto

rem

ain

for

atle

ast

6m

onth

s(t

oco

mpl

ete

the

proj

ect)

.

(10)

Part

ial-

dose

(40%

)S

eeki

ngS

afet

yP

ilot

Nor

man

etal

.201

0

Ope

ngr

oup

10w

eekl

yse

ssio

ns×

1.5

hour

s=15

hour

sin

10w

eeks

.

9m

enve

tera

nsw

ith

curr

ent

PT

SDan

dSU

Dat

aV

Aho

spit

al;3

6%m

inor

ity.

Yes

Seve

reon

both

PT

SDan

dde

pres

sion

mea

sure

sat

base

line.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

(11)

Part

ial-

dose

(32%

)S

eeki

ngS

afet

yP

ilot

Sear

cy&

Lip

ps,2

012

Ope

ngr

oup

Tw

ice

per

wee

k×

1ho

urdu

ring

28-d

ayst

ay=

8ho

urs.

40m

enan

dw

omen

in28

-day

SU

Dre

side

ntia

lpro

gram

wit

hsu

bsta

nce

depe

nden

cean

dP

TSD

sym

ptom

s;10

%m

inor

ity.

Yes

Maj

orit

yun

empl

oyed

,wit

hpa

stor

pres

ent

lega

lpro

blem

s,22

%at

tem

pted

suic

ide

inpa

st;

both

drug

san

dal

coho

lpr

omin

ent

(pre

dom

inan

tly

stim

ulan

ts,a

lcoh

ol,o

piat

es).

Non

eA

llcl

ient

sin

the

prog

ram

wer

eof

fere

dth

eop

tion

topa

rtic

ipat

e;no

excl

usio

nary

crit

eria

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(12)

Unc

lear

dose

See

king

Saf

ety

Pilo

tB

ento

net

al.,

2011

,201

2

Clo

sed

grou

pW

eekl

yse

ssio

nsof

1.5

hour

sov

er3

mon

ths

(but

noat

tend

ance

data

repo

rted

,nor

whi

chto

pics

from

SS)=

19.5

hour

s(a

ssum

e13

wee

ks).

20ou

tpat

ient

wom

enin

aS

UD

clin

ic,w

ith

curr

ent

PT

SDan

dcu

rren

tSU

D,a

llof

who

mha

dal

read

yco

mpl

eted

the

clin

ic’s

8-w

eek

SUD

IOP

(up

tosi

xm

onth

spr

ior)

;50%

had

PT

SDat

base

line;

30%

min

orit

y.

Yes

Maj

orit

yun

empl

oyed

,and

“hig

hpr

opor

tion

ofch

ildho

odse

xual

abus

e”.

Min

imal

His

tory

ofsc

hizo

phre

nia,

acti

vebi

pola

rdi

sord

er,i

mpe

ndin

gin

carc

erat

ion,

orlif

e-th

reat

enin

g/un

stab

lem

edic

alill

ness

.

(13)

See

king

Saf

ety

Con

trol

led

tria

l(o

nesi

teof

WC

DV

Scst

udy)

Gat

zet

al.,

2007

Gro

up31

sess

ions

×1.

5ho

urs=

46.5

hour

s;se

ssio

nsw

ere

held

twic

epe

rw

eek.

313

wom

enin

resi

dent

ial

trea

tmen

twit

hSU

Dan

dco

-occ

urri

ngm

enta

lhea

lth

diso

rder

(bot

hin

past

5ye

ars,

and

atle

ast

one

inpa

st30

days

),ex

peri

ence

dph

ysic

alor

sexu

alab

use;

had

atle

ast

two

prio

rtr

eatm

ent

epis

odes

.Sa

mpl

ew

asn

=13

6in

SSvs

.n

=17

7co

mpa

riso

nw

omen

;all

rece

ived

trau

ma-

info

rmed

,in

tegr

ated

SUD

/men

talh

ealt

hse

rvic

es;6

3%m

inor

ity.

Yes

Inad

diti

onto

co-o

ccur

ring

SUD

/psy

chia

tric

diso

rder

s,m

ost

had

expe

rien

ced

child

abus

e,be

enho

mel

ess,

serv

edja

ilti

me,

suff

ered

inte

rper

sona

lab

use

inpa

st6

mon

ths;

SUD

prim

arily

drug

sra

ther

than

alco

hol

(met

ham

phet

amin

eco

mm

on).

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

450 Journal of Clinical Psychology: In Session, May 2013T

able

1C

onti

nued

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(14)

See

king

Saf

ety

(del

iver

edby

case

man

ager

s)C

ontr

olle

dtr

ial

Des

aiet

al.,

2008

,200

9

Gro

upor

indi

vidu

al(c

linic

ians

coul

dco

nduc

tei

ther

mod

alit

y)25

wee

kly

sess

ions

over

6m

onth

s;as

sum

e1

hour

per

sess

ion

(len

gth

not

spec

ified

)=

25ho

urs.

450

hom

eles

sw

omen

vete

rans

wit

had

dict

ion

and/

orps

ychi

atri

cpr

oble

ms,

all

rece

ivin

gin

tens

ive

case

man

agem

ent

(IC

M).

Tw

oco

hort

s:n

=35

9in

ICM

,fo

llow

edby

91in

SSpl

usIC

M;

65%

min

orit

y.

Yes

Hom

eles

s,pl

ushi

ghlif

etim

etr

aum

ara

tes

(ave

rage

of9)

;68%

had

been

rape

d;35

%re

port

edtr

aum

are

late

dto

pros

titu

tion

.

Non

e/M

inim

al“U

nsta

ble

topa

rtic

ipat

e”as

deci

ded

byth

est

udy

inve

stig

ator

.

(15)

See

king

Saf

ety

Con

trol

led

tria

lL

ynch

etal

.,20

12

Ope

ngr

oup

24se

ssio

ns×

2ho

urs=

48ho

urs

in12

wee

ks.

114

inca

rcer

ated

wom

enw

ith

mod

erat

eor

high

erP

TSD

sym

ptom

s(≥

30on

PC

L),

hist

ory

ofSU

D;1

6%m

inor

ity.

Yes

Mos

tre

peat

offe

nder

s,vi

ctim

sof

mul

tipl

evi

olen

tcr

imes

and

sexu

alas

saul

t;m

ajor

ity

had

seve

re,≥

50P

CL

sym

ptom

s,an

dde

pres

sion

;pr

imar

ydr

ugw

asm

etha

mph

etam

ine.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

(16)

See

king

Saf

ety

RC

T(h

ybri

d)H

ien,

Coh

enet

al.,

2004

Indi

vidu

al12

twic

ew

eekl

yse

ssio

ns×

1ho

ur=

24ho

urs

in3

mon

ths.

107

com

mun

ity

outp

atie

ntw

omen

wit

hcu

rren

tP

TSD

(88%

full;

12%

subt

hres

hold

)+

curr

ent

SUD

;had

tobe

acti

vesu

bsta

nce

user

inpr

ior

30da

ys);

75.6

%m

inor

ity.

Yes

Seve

reon

PT

SD,m

ost

wit

hch

ildho

odtr

aum

a;al

lwit

hsu

bsta

nce

depe

nden

ce,m

ost

wit

hdr

ugde

pend

ence

;mos

tun

empl

oyed

wit

hlo

wso

cial

func

tion

ing.

Min

imal

Act

ivel

yps

ycho

tic,

orga

nic

men

tald

isor

der;

sign

ifica

ntsu

icid

alor

hom

icid

alin

tent

.

(17)

See

king

Saf

ety

RC

TN

ajav

its

etal

.,20

06

Indi

vidu

al25

sess

ions

of50

min

utes

=21

hour

sin

3m

onth

s(t

wic

e-w

eekl

yse

ssio

ns).

33ou

tpat

ient

adol

esce

nts

wit

hcu

rren

tP

TSD

and

curr

ent

SUD

(94%

wit

hsu

bsta

nce

depe

nden

ce),

plus

acti

vesu

bsta

nce

use

inpr

ior

60da

ys;

n=

18in

SSpl

usT

AU

vers

usn

=15

TA

Uon

ly;2

1%m

inor

ity.

Yes

Chi

ldho

odP

TSD

;mos

tha

dse

xual

and

phys

ical

abus

e;m

ost

had

drug

rath

erth

anal

coho

ldep

ende

nce.

Min

imal

His

tory

ofbi

pola

rI

diso

rder

(man

ia),

psyc

hoti

cdi

sord

er;c

urre

ntly

man

date

dto

trea

tmen

t.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(18)

See

king

Saf

ety

RC

TB

oden

etal

.,20

12

Ope

ngr

oup

24se

ssio

nsin

3m

onth

s;se

ssio

nle

ngth

uncl

ear,

assu

me

1.15

hour

s=

30ho

urs.

117

men

outp

atie

ntve

tera

nsw

ith

curr

ent

SUD

and

curr

ent

PT

SD(a

llfu

llP

TSD

,exc

ept

n=

9su

bthr

esho

ld);

81%

min

orit

y.

Yes

Maj

orit

yun

empl

oyed

,wit

hbo

thdr

ugan

dal

coho

lpr

oble

ms,

olde

rve

tera

nco

hort

(mea

nag

eov

er50

),40

%ho

mel

ess;

“tre

atm

ent-

resi

stan

t”.

Min

imal

Acu

teps

ycho

sis,

man

ia,d

emen

tia,

orsu

icid

alin

tent

.

(19)

Part

ial-

dose

(%va

ried

)S

eeki

ngS

afet

yR

CT

Zlo

tnic

ket

al.,

2009

Ope

ngr

oup

90m

inut

esw

hile

inpr

ison

,va

ryin

gdo

sage

;ave

rage

was

15.6

sess

ions

=23

.4ho

urs

tota

lin

6–8

wee

ks.

49in

carc

erat

edw

omen

wit

hcu

rren

tP

TSD

(ful

l,83

.5%

,or

subt

hres

hold

,16.

5%)

and

curr

ent

SUD

(88%

depe

nden

ce);

n=

27in

SSpl

usT

AU

vers

us22

inT

AU

alon

e.T

AU

was

man

dato

ryin

the

pris

onan

dhi

gh-d

ose

(180

–240

trea

tmen

thou

rs);

53%

min

orit

y.

Yes

Rep

eat

offe

nder

s;ch

ildho

odP

TSD

,maj

orit

yw

ith

sexu

al/p

hysi

calr

epea

ted

trau

ma,

child

hood

SUD

,ch

roni

c,bo

thal

coho

land

drug

depe

nden

ce.

Min

imal

Act

ivel

yps

ycho

tic

atti

me

ofre

crui

tmen

t;or

gani

cbr

ain

impa

irm

ent

diag

nosi

s.

(20)

Part

ial-

dose

(24%

)S

eeki

ngS

afet

yR

CT

Ghe

eet

al.,

2009

Gro

up6

sess

ions

;eac

hse

ssio

n1.

5ho

urs=

9ho

urs

(hel

dov

er3–

4w

eeks

).

104

wom

enin

resi

dent

ialS

UD

trea

tmen

t(51

SSpl

usT

AU

vs.

52T

AU

);49

%m

inor

ity.

Yes

“His

tori

esof

inte

rgen

erat

iona

lsub

stan

ceab

use,

untr

eate

dhi

stor

ies

ofse

xual

abus

e,se

vere

phys

ical

abus

e,or

conc

omit

ant

men

tal

heal

thne

eds;

”98

%of

stud

ysa

mpl

eun

empl

oyed

;mos

tlo

win

com

e;m

any

low

educ

atio

n.

Min

imal

No

acti

veps

ycho

sis

orse

vere

med

ical

(phy

sica

l)co

ndit

ion.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(21)

Part

ial-

dose

(48%

)S

eeki

ngS

afet

yR

CT

Hie

net

al.,

2009

Ope

ngr

oup

6tw

ice

wee

kly

sess

ions

×1.

5ho

urs=

18ho

urs

in1.

5m

onth

s.

353

outp

atie

ntw

omen

wit

hcu

rren

tP

TSD

(80%

full;

20%

subt

hres

hold

)+

curr

ent

abus

eor

depe

nden

ce(p

lus

coul

dha

vesu

bthr

esho

ldP

TSD

(DSM

-IV

Cri

teri

onA

,B,F

and

eith

erC

orD

);ha

dto

beac

tive

subs

tanc

eus

erin

prio

r6

mon

ths)

;54.

4%m

inor

ity.

Yes

Seve

reon

PT

SD,S

UD

,so

cial

func

tion

ing,

child

hood

trau

ma.

Mos

tun

empl

oyed

.All

subs

tanc

ede

pend

ent,

mos

twit

hdr

ugde

pend

ence

.

Min

imal

Act

ivel

yps

ycho

tic,

orga

nic

men

tald

isor

der;

sign

ifica

ntsu

icid

alor

hom

icid

alin

tent

,lit

igat

ion

reP

TSD

.

(22)

Hel

ping

Wom

enR

ecov

er(H

WR

)pl

usB

eyon

dT

raum

a(B

T),

calle

dW

omen

’sIn

tegr

ated

Tre

atm

ent(

WIT

)P

ilot

Cov

ingt

onet

al.,

2008

Gro

uppl

usvi

deo

Unc

lear

:ass

ume

atle

ast

28ho

urs

(BT

and

HW

Rto

tal

28se

ssio

ns),

but

nolis

ting

ofdo

se,d

urat

ion,

tim

ing,

leng

thof

sess

ion,

whe

ther

grou

psw

ere

open

orcl

osed

,att

enda

nce

atW

IT,o

rho

wvi

deo

was

used

.T

here

side

ntia

lSU

Dpr

ogra

mis

liste

das

12m

onth

s.

202

wom

enin

resi

dent

ialS

UD

trea

tmen

twho

had

alre

ady

com

plet

ed45

days

inth

ere

side

ntia

lSU

Dpr

ogra

m(“

stab

iliza

tion

”);5

9%m

inor

ity.

Yes

Maj

orit

yha

dm

ulti

ple

trau

mas

,cri

min

alhi

stor

y(e

.g.,

prio

rar

rest

),la

cked

stab

leho

usin

gpr

ior

topr

ison

,had

met

ham

phet

amin

eas

thei

rpr

imar

ydr

ugpr

oble

m;h

adpr

oble

ms

wit

h2

orm

ore

subs

tanc

es;a

nav

erag

eof

10ye

ars

subs

tanc

epr

oble

ms;

28%

had

atte

mpt

edsu

icid

e.

Maj

orC

ompl

etio

nof

45da

ysre

side

ntia

lSU

Dpr

ogra

mst

abili

zati

on.O

ther

than

that

,no

stat

emen

tof

incl

usio

nary

/ex

clus

iona

rycr

iter

ia.

Hal

fth

esa

mpl

em

anda

ted

totr

eatm

ent.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(23)

Hel

ping

Wom

enR

ecov

er(H

WR

)pl

usB

eyon

dT

raum

a(B

T),

calle

dG

ende

rR

espo

nsiv

eT

reat

men

t(G

RT

)R

CT

Mes

sina

etal

.,20

10

Unc

lear

ifgr

oup,

indi

vidu

alor

both

(app

ears

tobe

latt

er).

Dos

age

“app

roxi

mat

ely”

20ho

urs

per

wee

kfo

r“a

ppro

xim

atel

y”6

mon

ths”

=52

0ho

urs

[sam

eas

for

TA

U].

Len

gth

ofse

ssio

nsan

ddo

seof

HW

Rve

rsus

BT

(the

yar

ese

para

tem

anua

ls)

not

repo

rted

;att

enda

nce

data

not

repo

rted

for

GR

Tor

TA

U.

115

wom

enm

anda

ted

topr

ison

-bas

edS

UD

trea

tmen

t,w

hich

was

eith

erG

RT

orSU

Dth

erap

euti

cco

mm

unit

y;60

inG

RT

vers

us55

inT

AU

.At

base

line,

95%

ofth

efu

llsa

mpl

eha

dSU

D;2

6%ha

dP

TSD

;52%

min

orit

y.

Yes

Maj

orit

yun

empl

oyed

prio

rto

pris

on,h

adm

etha

mph

etam

ine

aspr

imar

ydr

ugpr

oble

mpr

ior

topr

ison

,ha

dhi

stor

ies

ofse

xual

and

phys

ical

abus

e,an

dha

dbe

enin

carc

erat

edan

aver

age

of4.

7ye

ars

lifet

ime.

Min

imal

/uns

peci

fied

Mem

bers

hip

inpr

ison

gang

;se

greg

ated

for

viol

ence

orw

eapo

nsch

arge

sin

past

year

;or

inpr

ison

due

tofe

lony

orim

mig

rati

on(a

llel

igib

ility

wit

hin

the

pris

onpr

ogam

);bu

tno

excl

usio

nary

crit

eria

repo

rted

for

the

stud

yit

self.

Clie

nts

wer

em

anda

ted

toG

RT

.

(24)

Inte

grat

edC

BT

for

PT

SD

and

SU

D(I

CB

T)

plus

SU

Din

tens

ive

outp

atie

ntpr

ogra

mP

ilot

McG

over

net

al.,

2009

Indi

vidu

alU

ncle

ardo

sage

:met

hods

sect

ion

stat

es8–

12se

ssio

nsar

ene

eded

;Fig

ure

2in

dica

tes

upto

14se

ssio

nsco

nduc

ted.

Len

gth

and

tim

ing

ofse

ssio

nsno

tst

ated

.Ass

ume

14se

ssio

n×

1ho

ur=

14ho

urs.

11m

enan

dw

omen

inS

UD

inte

nsiv

eou

tpat

ient

prog

ram

,w

ith

curr

ent

PT

SD;0

%m

inor

ity.

Yes

Maj

orit

yha

dch

ildse

xual

assa

ult;

seve

reP

TSD

(bas

edon

init

ialC

AP

Ssc

ore)

.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(25)

Inte

grat

edC

BT

for

PT

SD

and

SU

D(I

CB

T)

plus

SU

DIO

Por

met

hado

nem

aint

enan

cetr

eatm

ent

RC

TM

cGov

ern

etal

.,20

11

Indi

vidu

alIC

BT

was

8m

odul

esde

liver

edw

eekl

yov

er“a

ppro

xim

atel

y”12

-14

sess

ions

(pg.

212)

but

uncl

ear

asla

ter

isst

ated

as8-

12w

eeks

ofw

eekl

yse

ssio

ns(p

g.21

4);s

essi

ons

wer

e50

min

utes

=11

.67

hour

s[a

ssum

ing

14se

ssio

ns×

50m

inut

es].

IAC

(com

pari

son

cond

itio

n)ap

pear

sto

belo

wer

dose

:“10

-12

wee

kly

sess

ions

”de

liver

edov

er8–

12w

eeks

(pg.

214)

=10

sess

ions

[ass

umin

g12

50-m

inut

ese

ssio

ns].

53m

enan

dw

omen

inS

UD

inte

nsiv

eou

tpat

ient

orm

etha

done

mai

nten

ance

trea

tmen

t,w

ith

curr

ent

PT

SD(a

ndC

AP

Ssc

ore

≥44

);32

inIC

BT

vers

us21

inIn

divi

dual

Add

icti

onC

ouns

elin

g(I

AC

,am

anua

lized

addi

ctio

n-on

lym

odel

);9%

min

orit

y.

Yes

Maj

orit

yha

dch

ildho

odse

xual

assa

ult;

seve

reP

TSD

(bas

edon

init

ialC

AP

Ssc

ore)

.

Maj

orA

llha

dto

beac

tive

inSU

Din

tens

ive

outp

atie

nttr

eatm

ent

orm

etha

done

mai

nten

ance

;no

acut

eps

ycho

tic

sym

ptom

s;no

suic

ide

atte

mpt

orps

ychi

atri

cho

spit

aliz

atio

nin

past

mon

th(u

nles

sla

tter

dire

ctly

rela

ted

tosu

bsta

nce

into

xica

tion

orde

toxi

ficat

ion

and

curr

entl

yst

able

);an

dm

edic

alan

dle

gal

situ

atio

nsw

ere

stab

le.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(26)

Tra

uma

Ada

ptiv

eR

ecov

ery

Gro

upE

duca

tion

and

The

rapy

(TA

RG

ET

)R

CT

Fri

sman

etal

.,20

08

Gro

up8

or9

wee

kly

sess

ions

;len

gth

uncl

ear;

assu

me

1.15

hour

s=

11.2

5ho

urs.

213

outp

atie

ntm

enan

dw

omen

inS

UD

trea

tmen

t,w

hoex

peri

ence

da

trau

ma

(lif

etim

e),

plus

met

eith

er(a

)P

TSD

(b)

DE

SNO

Spl

usat

leas

ton

eor

mor

eA

xis

Idi

sord

ers

or(c

)m

ajor

depr

essi

vedi

sord

er,

dyst

hym

icdi

sord

er,o

rdi

ssoc

iati

vedi

sord

er.A

ssig

ned

toT

AR

GE

T(n

=14

1)or

Tra

uma-

Sens

itiv

eC

are

asU

sual

(TSU

)n

=72

;44%

min

orit

y.

Yes

Low

inco

me,

mos

tun

empl

oyed

,had

expe

rien

ced

hom

eles

snes

s(l

ifet

ime)

,had

been

arre

sted

atso

me

poin

t.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

Smal

linc

enti

ves

rela

ted

toT

AR

GE

T(e

.g.,

keyc

hain

,pen

)ha

nded

out

atth

ree

sess

ions

;an

dcl

inic

ians

peri

odic

ally

brou

ght

refr

eshm

ents

togr

oup.

(27)

Tra

uma

Rec

over

yan

dE

mpo

wer

men

tMod

el(T

RE

M),

mod

ified

and

part

ial-

dose

vers

ion,

plus

Cop

elan

d’s

trau

ma

self

-hel

pbo

okC

ontr

olle

dtr

ial

(one

WC

DV

Sst

udy

site

)c

Tous

sain

tet

al.,

2007

Gro

upan

din

divi

dual

24gr

oup

TR

EM

sess

ions

(16

sess

ions

twic

e/w

eek

for

8w

eeks

;the

n8

sess

ions

/wee

k);

plus

upto

24in

divi

dual

sess

ions

wit

ha

coun

selo

rto

revi

ewth

eT

RE

Mw

orkb

ook

mat

eria

l;le

ngth

ofgr

oup

and

indi

vidu

alse

ssio

nsno

tsp

ecifi

ed.

Ass

umin

g1.

25ho

urpe

rgr

oup

sess

ion

(per

Fal

lot

&H

arri

s,20

00),

and

1ho

urin

divi

dual

sess

ion

tota

l=30

-54

hour

s.

170

wom

enin

resi

dent

ial

trea

tmen

tmee

ting

WC

DV

Scr

iter

ia(s

eest

udy

#14

);ha

dat

leas

ttw

opr

ior

trea

tmen

tep

isod

es.S

ampl

ew

asn

=64

inT

RE

Mvs

.n=

106

com

pari

son

wom

en;a

llw

omen

inth

est

udy

rece

ived

trau

ma-

info

rmed

,in

tegr

ated

SUD

/men

talh

ealt

hse

rvic

es;4

7%m

inor

ity.

Yes

All

wit

hcu

rren

tsu

bsta

nce

depe

nden

ce,a

ndm

othe

rsof

child

ren

unde

rag

e13

;mos

tun

empl

oyed

.All,

per

the

WC

DV

Sst

udy,

had

SUD

and

co-o

ccur

ring

men

talh

ealt

hdi

sord

er,e

xper

ienc

edph

ysic

alor

sexu

alab

use;

and

atle

ast

two

prio

rtr

eatm

ent

epis

odes

.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(28)

Tra

uma

Rec

over

yE

mpo

wer

men

tMod

el(T

RE

M)

aspa

rtof

Bos

ton

Con

sort

ium

Mod

el(B

CM

)C

ontr

olle

dtr

ial(

one

WC

DV

Sst

udy

site

)c

Am

aro

etal

.,20

07a,

2007

b

Gro

uppl

usin

divi

dual

case

man

agem

ent

BC

Mgr

oup

is10

1.25

grou

pho

urs

com

pris

ing

5m

anua

lized

mod

ules

:(1)

25T

RE

Mse

ssio

nsm

odifi

edto

incl

ude

3se

ssio

nsfo

rH

IV/A

IDS

prev

enti

on)

[31.

25ho

urs]

;(2)

3se

ssio

nsof

wom

en’s

lead

ersh

iptr

aini

ng[1

5ho

urs]

;(3)

8se

ssio

nsof

econ

omic

succ

ess

inre

cove

ry[1

6ho

urs]

;(4)

10se

ssio

nsof

Pat

hway

sto

Fam

ilyR

euni

ficat

ion

and

Rec

over

y[1

5ho

urs]

;(5)

12se

ssio

nsof

Nur

turi

ngP

rogr

amfo

rF

amili

es[2

4ho

urs]

,plu

san

unsp

ecifi

edam

ount

ofin

divi

dual

case

man

agem

ent.

342

wom

enin

resi

dent

ial,

outp

atie

nt,o

rm

etha

done

prog

ram

;n=

181

wom

enin

BC

Mpl

usT

AU

vers

us16

1w

omen

inT

AU

alon

e.(T

AU

was

wee

kly

grou

pan

d/or

indi

vidu

altr

eatm

ent

last

ing

6-12

mon

ths)

.All

met

WC

DV

Scr

iter

ia(s

eest

udy

#14

);65

.5%

min

orit

y.

Yes

Mos

tw

ith

less

than

high

scho

oled

ucat

ion,

unem

ploy

ed;

allw

ith

SUD

and

co-o

ccur

ring

men

talh

ealt

hdi

sord

er,

expe

rien

ced

phys

ical

orse

xual

abus

e;ha

dat

leas

ttw

opr

ior

trea

tmen

tep

isod

es.

Unc

lear

/Min

imal

Bas

edon

clin

icia

nad

vice

,exc

lude

dw

omen

“in

anes

peci

ally

sens

itiv

est

ate,

that

is,t

hose

who

may

not

have

been

able

togi

vere

ason

able

answ

ers

toth

ein

terv

iew

and

thos

efo

rw

hom

the

inte

rvie

wco

uld

have

trig

gere

dth

ere

expe

rien

ceof

trau

mat

icev

ents

.”


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(29)

Tra

uma

Rec

over

yan

dE

mpo

wer

men

tMod

el(T

RE

M)

plus

indi

vidu

alin

tegr

ated

trau

ma

serv

ices

.C

ontr

olle

dtr

ial

(one

WC

DV

Sst

udy

site

)c

Fal

lot

etal

.,20

11

Gro

up(o

pen

init

ially

then

clos

ed)p

lus

indi

vidu

altr

aum

ase

rvic

esT

RE

Mgr

oup

was

33w

eekl

yse

ssio

ns×

1.25

hour

s=

41.2

5to

talg

roup

hour

sin

8m

onth

s;2-

3co

-lea

ders

per

grou

p;pl

usin

divi

dual

sess

ions

ofun

spec

ified

dura

tion

and

freq

uenc

y(i

nteg

rate

dtr

aum

ase

rvic

eco

unse

ling)

.

251

wom

enre

crui

ted

from

com

mun

ity

agen

cies

;un

spec

ified

asto

leve

lof

care

(i.e

.,un

clea

rif

outp

atie

nt,d

aypr

ogra

m,o

rre

side

ntia

l);1

53in

TR

EM

+T

AU

+in

tegr

ated

trau

ma

serv

ices

vers

us98

inT

AU

[sam

ein

clus

ion

crit

eria

asst

udy

#28

];85

%m

inor

ity.

Yes

Mos

tun

empl

oyed

,wit

hhi

stor

yof

both

child

and

adul

tse

xual

and

phys

ical

abus

e;av

erag

eof

5pr

ior

hosp

ital

izat

ions

.

Unc

lear

/Non

eE

xclu

sion

ary

crit

eria

not

repo

rted

.

(30)

Con

curr

entT

reat

men

tof

PT

SD

and

Coc

aine

Dep

ende

nce

(CT

PC

D)j

Pre

sent

-an

dpa

st-f

ocus

edP

ilot

Bra

dyet

al.,

2001

Indi

vidu

al16

sess

ions

×1.

5ho

urs=

24ho

urs,

cond

ucte

dat

vary

ing

pace

(1–2

sess

ions

per

wee

k).

39m

enan

dw

omen

outp

atie

nts

wit

hcu

rren

tP

TSD

and

curr

ent

coca

ine

depe

nden

ce,p

lus

had

toat

tend

atle

ast

1se

ssio

nof

the

stud

yth

erap

y;51

%m

inor

ity.

Yes

All

had

subs

tanc

ede

pend

ence

;maj

orit

yha

dco

-occ

urri

ngaf

fect

ive

diso

rder

,an

dha

dex

peri

ence

dra

pe.

Mod

erat

eSu

icid

alor

hom

icid

alid

eati

on,p

sych

osis

,dis

soci

ativ

eid

enti

tydi

sord

er,d

emen

tia,

illit

erac

y,or

med

ical

inst

abili

ty.

Pai

dfo

rse

ssio

nat

tend

ance

.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(31)

See

king

Saf

ety

plus

Exp

osur

eT

hera

pyR

evis

edP

rese

nt-

and

past

focu

sed

Pilo

tN

ajav

its

etal

.,20

05

Indi

vidu

al30

sess

ions

×1

hour

=30

hour

sin

5m

onth

s.

5ou

tpat

ient

men

wit

hcu

rren

tP

TSD

and

curr

ent

subs

tanc

ede

pend

ence

(plu

sac

tive

subs

tanc

eus

ein

prio

r60

days

);0%

min

orit

y.

Yes

All

had

child

hood

-bas

edP

TSD

;ave

rage

ofne

ar-d

aily

subs

tanc

eus

e;m

ost

had

acti

vesu

icid

alid

eati

onan

d/or

plan

;al

lhad

subs

tanc

ede

pend

ence

,pr

imar

ilydr

ugra

ther

than

alco

hol;

chro

nic

and

seve

re).

Min

imal

His

tory

ofbi

pola

rI

diso

rder

(man

ia),

psyc

hoti

cdi

sord

er;c

urre

ntly

man

date

dto

trea

tmen

t.

(32)

Sub

stan

ceD

epen

denc

eP

TS

DT

hera

py(S

DP

T)

Pre

sent

-an

dpa

st-f

ocus

edR

CT

Tri

fflem

an,2

000

Indi

vidu

al20

sess

ions

2ti

mes

per

wee

k×

1ho

ur=

40ho

urs.

19m

enan

dw

omen

outp

atie

nts

wit

ha

lifet

ime

diag

nosi

sof

subs

tanc

ede

pend

ence

,at

leas

tcu

rren

tpa

rtia

lPT

SD(2

/3of

sym

ptom

s),a

ndat

tend

edat

leas

ton

ese

ssio

nof

stud

ytr

eatm

ent.

Par

tici

pant

sw

ere

rand

omiz

edto

SDT

P(n

=10

)or

12-S

tep

Fac

ilita

tion

(n=

9);3

7%m

inor

ity.

Yes

Mos

tun

empl

oyed

;SU

Dhi

stor

yw

aspr

imar

ilydr

ugs

rath

erth

anal

coho

l;hi

ghle

vel

ofim

pair

men

ton

num

erou

sba

selin

eva

riab

les.

Mod

erat

eSe

vere

maj

orde

pres

sion

,evi

denc

eof

diss

ocia

tive

iden

tity

diso

rder

,un

trea

ted

man

ia,a

cute

psyc

hosi

s,ac

ute

suic

idal

ity

orho

mic

idal

ity

requ

irin

gco

ntin

uing

invo

lvem

ent

inot

her

ongo

ing

psyc

hoth

erap

yor

hosp

ital

izat

ion.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(33)

PT

SD

expo

sure

ther

apy

inco

ntex

tofS

UD

copi

ngsk

ills

trea

tmen

t.P

ast-

focu

sed

inco

ntex

tof

requ

ired

pres

ent-

focu

sed

RC

TC

offe

yet

al.,

2006

Indi

vidu

al1

educ

atio

nals

essi

onan

dth

en6

PT

SDex

posu

rese

ssio

ns×

1ho

ur=

7ho

urs

[pre

cede

dan

dfo

llow

edby

ala

bora

tory

cue

expo

sure

],pr

ovid

edin

cont

ext

ofre

quir

edSU

Dco

ping

skill

str

eatm

ent

(see

deta

ilsin

colu

mn

E).

43m

enan

dw

omen

outp

atie

nts

wit

hcu

rren

tP

TSD

and

curr

ent

alco

hold

epen

denc

e;pl

usal

coho

luse

inpr

ior

60da

ys;

rand

omiz

edto

expo

sure

(n=

X)

vers

usre

laxa

tion

trai

ning

,wit

hbo

thst

udy

cond

itio

nsin

cont

ext

ofre

quir

edpr

esen

t-fo

cuse

dSU

Dco

ping

skill

str

eatm

ent)

;35%

min

orit

y.

Yes

Maj

orit

yw

ith

child

hood

-bas

edP

TSD

,poo

r,dr

ugde

pend

ence

inad

diti

onto

alco

hold

epen

denc

e,m

ulti

ple

prio

rin

pati

ent

trea

tmen

ts.

Maj

orR

equi

red

topa

rtic

ipat

ein

SUD

trea

tmen

t(3

x/w

eek

grou

pco

ping

skill

sth

erap

ypl

us1

indi

vidu

alse

ssio

nev

ery

1–2

wee

ks),

and

drop

ped

from

the

stud

yif

they

ende

dth

eSU

Dtr

eatm

ent;

plus

requ

ired

abst

inen

cefr

omal

lsub

stan

ces

for

4da

yspr

ior

toth

ein

itia

lla

bora

tory

sess

ion,

veri

fied

byur

inal

ysis

;sev

ere

maj

orde

pres

sion

(i.e

.,se

vera

lsy

mpt

oms

inex

cess

ofD

SM

–IV

maj

orde

pres

sion

and

sym

ptom

sm

arke

dly

inte

rfer

ing

wit

hda

ilyliv

ing)

.Als

o,ex

clud

edif

PT

SDdi

agno

sis

was

from

com

bat

orif

they

wer

eno

wor

had

ever

enga

ged

inP

TSD

expo

sure

trea

tmen

t;cu

rren

tps

ycho

tic

diso

rder

;or

man

icep

isod

e.


Tab

le1

Con

tinu

ed

(b)

Stud

ytr

eatm

ent:

mod

alit

y,do

sage

,tot

alho

urs

(d)

Com

plex

sam

ple

(a)

Mod

el/

Stud

yty

pe/

(and

ince

ntiv

esfo

r(s

ever

e,ch

roni

c,hi

ghly

Stud

yau

thor

atte

ndin

gse

ssio

ns,i

fan

y)(c

)Sa

mpl

eaco

mor

bid,

etc.

)(e

)E

xclu

sion

sfr

omst

udyb

(34)

Con

curr

entP

rolo

nged

Exp

osur

eC

OP

EP

rese

ntan

dpa

st-f

ocus

edR

CT

Mill

set

al.,

2012

Indi

vidu

al13

sess

ions

wee

kly

[but

toim

prov

eat

tend

ance

,sch

edul

ing

exte

nded

upto

9m

onth

s]×

1.5

hour

s=

19.5

hour

s.

103

men

and

wom

enou

tpat

ient

sw

ith

curr

ent

PT

SDan

dSU

D(s

ubst

ance

depe

nden

ce);

n=

55in

CO

PE

plus

TA

Uve

rsus

n-48

inT

AU

;min

orit

yun

clea

r(6

%lis

ted

asA

bori

gina

lbut

othe

ret

hnic

itie

sno

tre

port

ed).

Yes

Had

subs

tanc

ede

pend

ence

;m

ost

had

poly

subs

tanc

eus

ean

dhi

stor

yof

inje

ctio

ndr

ugus

e,ha

dex

peri

ence

dse

xual

assa

ult,

had

child

hood

and

repe

ated

trau

ma;

had

atte

mpt

edsu

icid

e(l

ifet

ime)

;an

dw

ere

unem

ploy

ed;c

hron

ican

dse

vere

.

Mod

erat

eSe

lf-h

arm

inpa

st6

mon

ths;

curr

entl

ysu

icid

al(i

deat

ion

plus

plan

and

inte

nt);

curr

ent

psyc

hoti

csy

mpt

oms;

cogn

itiv

eim

pair

men

tth

atm

ight

impe

detr

eatm

ent.

(35)

Cre

atin

gC

hang

eP

ast-

focu

sed

Pilo

tN

ajav

its

&Jo

hnso

n,un

der

revi

ew

Indi

vidu

al17

sess

ions

×1

hour

=17

hour

s ,co

nduc

ted

over

a6

mon

thti

mef

ram

e(t

ypic

ally

wee

kly,

but

allo

win

gfo

rsc

hedu

ling

issu

es).

7m

enan

dw

omen

outp

atie

nts

wit

hcu

rren

tP

TSD

and

curr

ent

SUD

,and

acti

vesu

bsta

nce

use

inpr

ior

30da

ys;7

1%m

inor

ity.

Yes

All

expe

rien

ced

sexu

alab

use;

aver

age

age

offir

sttr

aum

aw

as5;

chro

nic

PT

SDan

dSU

D(e

.g.,

aver

age

ofov

er20

year

sof

mor

eth

anon

esu

bsta

nce

per

day)

.

Min

imal

Cur

rent

bipo

lar

Idi

sord

er(i

.e.,

full

man

ia)

unco

ntro

lled

bym

edic

atio

n;or

curr

ent

psyc

hosi

s.

Not

e.St

udie

sar

elis

ted

inth

efo

llow

ing

orde

r:by

mod

elst

arti

ngw

ith

Seek

ing

Safe

ty,a

sth

atha

sth

em

ajor

ity

ofst

udie

s,an

dal

phab

etic

alby

mod

elaf

ter

that

;all

orga

nize

dfr

ompi

lots

thro

ugh

rand

omiz

edco

ntro

lled

tria

ls,f

ulld

ose

befo

repa

rtia

l-do

se,a

ndby

date

.aA

llre

crui

ted

from

com

mun

ity

unle

ssno

ted

othe

rwis

e;sa

mpl

esi

zeis

atba

selin

e;nu

mbe

rsat

end-

of-t

reat

men

tor

used

for

anal

ysis

may

belo

wer

.bM

inim

alex

clus

ions

defin

edas

:no

excl

usio

ndu

eto

suic

idal

idea

tion

,sel

f-ha

rm,s

ubst

ance

depe

nden

ceno

ran

yot

her

maj

orlim

its.

c WC

DV

S=

Wom

enC

o-O

ccur

ring

Dis

orde

rsan

dV

iole

nce

Stud

y(C

ocoz

zaet

al.,

2005

;Mor

isse

yet

al.,

2006

).


Tab

le2

Stu

dyR

esul

ts

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(1)

SSpi

lot

Naj

avit

set

al.,

1998

Maj

orit

y(6

3%)o

fth

ose

enro

lled

(of

n=

27re

crui

ted,

the

n=

17w

hoco

mpl

eted

the

min

imum

dose

of>

6se

ssio

ns).

No

•Yes

ondr

ugus

e(A

SIco

mpo

site

),ab

stin

ence

(SU

I,ve

rifie

dby

urin

alys

is)

and

cogn

itio

ns(B

ASU

mea

n).

•Yes

onsu

icid

alth

ough

tsan

dri

sk(S

BQ

item

s),s

ocia

lad

just

men

t(S

AS

tota

lan

dsu

bsca

leex

tend

edfa

mily

role

),co

ping

(CSI

prob

lem

-sol

ving

subs

cale

).

3m

onth

sfr

omen

d-of

-tre

atm

ent;

anal

ysis

from

base

line

(lis

ted

as“3

mon

ths”

)•Y

eson

SU

D:d

rugs

(ASI

com

posi

te),

cogn

itio

ns(B

ASU

mea

n),a

ndal

coho

lfro

men

dof

trea

tmen

tto

follo

w-u

p(A

SIco

mpo

site

).•Y

eson

PT

SD

:(T

SC-4

0to

tala

ndde

pres

sion

subs

cale

).•N

egat

ive

outc

ome:

Incr

ease

inso

mat

izat

ion

(BSI

subs

cale

)at

end

oftr

eatm

ent

and

follo

w-u

p.

•Str

ong

trea

tmen

tsa

tisf

acti

on.

(2)

SSpi

lot

Zlo

tnic

ket

al.,

2003

100%

ofen

rolle

d(f

ull

inte

ntto

trea

t).

•Yes

leve

lof

PT

SDsy

mpt

oms

and

maj

orit

yno

long

erm

etP

TSD

diag

nosi

s(C

AP

S).

Not

asse

ssed

(due

topr

ison

envi

ronm

ent)

.N

otas

sess

ed(n

oot

her

outc

ome

vari

able

s).

•S

tron

gtr

eatm

ent

sati

sfac

tion

.

Bas

elin

eto

6w

eeks

and

3m

onth

s(b

oth

tim

edfr

omre

leas

efr

ompr

ison

);un

clea

rw

hen

rele

ase

was

inre

lati

onto

end

oftr

eatm

ent;

All

anal

yses

base

line

tofo

llow

-ups

;(lis

ted

as“6

wee

ks”

and

“3m

onth

s”)

•Yes

onS

UD

:at

both

6w

eeks

and

3m

onth

s,on

drug

and

alco

hol

seve

rity

,and

also

maj

orit

yno

tus

ing

subs

tanc

es(S

CID

,ver

ified

byur

inal

ysis

).•

Yes

onP

TS

D:a

tbo

th6

wee

ksan

d3

mon

ths,

onle

velo

fsy

mpt

oms

(CA

PS)

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(3)

SSpi

lot

You

nget

al.,

2003

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(TSC

-40

tota

lsca

lean

d5

of6

subs

cale

s);

and

rate

ofP

TSD

diag

nosi

sde

crea

sed.

Not

asse

ssed

.•Y

eson

psyc

hopa

thol

ogy

(BSI

tota

land

6of

9su

bsca

les.

)

Not

asse

ssed

.

(4)

SSpi

lot

Maj

orit

y(7

2%)o

fen

rolle

d(o

fth

e25

.•Y

eson

sym

ptom

s(P

CL

).•Y

eson

abst

inen

ce(v

erifi

edby

•Yes

onQ

ualit

yof

Lif

eIn

vent

ory.

Not

asse

ssed

.

Coo

ket

al.,

2006

enro

lled,

n=

18w

hoat

tend

edat

leas

t14

sess

ions

ofSS

and

wer

est

illco

min

gat

the

end

ofth

erap

y).

urin

alys

is).

•Str

ong

trea

tmen

tsa

tisf

acti

on.

(5)

SSpi

lot

Pat

itz

etal

.,un

der

revi

ew

Maj

orit

y(9

6%)o

fsa

mpl

e(n

=23

of24

enro

lled)

.

•Yes

onsy

mpt

oms

(all

10su

bsca

les

ofT

SI).

Not

asse

ssed

.N

otas

sess

ed.

Sati

sfac

tion

not

form

ally

asse

ssed

.

Not

asse

ssed

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(6)

SSpi

lot

Dao

ust

etal

.,20

11

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(PC

Lar

ousa

lsu

bsca

le;T

SC-4

0to

tal

scor

e,an

dsu

bsca

les

diss

ocia

tion

,and

sexu

alab

use

trau

ma

inde

x).

•Yes

onsc

reen

edsy

mpt

oms

(MA

STan

dD

AST

).

•Yes

onfu

ncti

onin

g(B

ASI

S-32

subs

cale

daily

role

).•S

tron

gtr

eatm

ent

sati

sfac

tion

.

Not

asse

ssed

.

(7)

SSpi

lot

Wol

ffet

al.,

2012

Maj

orit

y(6

7%)o

fth

en

=11

1en

rolle

d(n

=74

who

com

plet

edSS

,i.e

.,w

ere

enro

lled

atth

ebe

ginn

ing

and

end

ofSS

,and

nom

ore

than

2un

excu

sed

abse

nces

per

pris

onpo

licy)

.

•Yes

onsy

mpt

oms

(PC

Lfo

rfu

llsa

mpl

ean

dsu

bgro

ups

such

asSM

I,vi

olen

tof

fend

ers,

low

ered

ucat

ion,

etc.

).A

lso

maj

orit

yw

ith

PT

SDat

star

tno

long

erha

dP

TSD

aten

d(P

CL

).

Not

asse

ssed

due

topr

ison

sett

ing.

•Yes

onps

ycho

path

olog

y(B

SIG

loba

lSev

erit

yIn

dex)

.•S

tron

gtr

eatm

ent

sati

sfac

tion

.

Not

asse

ssed

.

464 Journal of Clinical Psychology: In Session, May 2013T

able

2C

onti

nued

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(8)

SSpi

lot

Naj

avit

set

al.,

2013

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(PC

Lin

trus

ion

subs

cale

;TSI

mea

nan

dsu

bsca

les

anxi

ety,

diss

ocia

tion

,sex

ual

abus

etr

aum

ain

dex,

sex

prob

lem

s)an

dco

gnit

ions

(WA

Sbe

nevo

lenc

esu

bsca

le).

•Yes

onco

gnit

ions

(Gam

bler

sB

elie

fsQ

uest

ionn

aire

mea

nan

dsu

bsca

leill

usio

nof

cont

rol)

.

•Yes

onfu

ncti

onin

g(B

asis

-32

mea

nan

dde

pres

sion

/anx

iety

subs

cale

),ps

ycho

path

olog

y(B

SIm

ean

and

subs

cale

san

xiet

yan

dde

pres

sion

;ASI

psyc

hiat

ric

com

posi

te);

self

-com

pass

ion

(SC

Sm

ean

and

subs

cale

sis

olat

ion,

over

-ide

ntifi

ed,

self

-jud

gmen

t).

Not

asse

ssed

.

•Neg

ativ

eou

tcom

e:em

ploy

men

t(A

SIco

mpo

site

).S

tron

gtr

eatm

ent

sati

sfac

tion

.

(9)

Pee

r-le

dSS

pilo

tN

ajav

its

etal

.und

erre

view

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(TSC

-40

tota

land

all

6su

bsca

les)

.

Not

asse

ssed

(due

tore

side

ntia

lnat

ure

ofth

epr

ogra

m).

•Yes

onps

ycho

path

olog

y(B

SIto

tala

nd6

of9

subs

cale

s);a

ndSC

S(s

ubsc

ales

self

-jud

gmen

t,is

olat

ion,

and

over

-ide

ntifi

ed).

Not

asse

ssed

.

Str

ong

trea

tmen

tsa

tisf

acti

on.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(10)

Par

tial

-dos

e(4

0%)

SSpi

lot

Nor

man

etal

.,20

10

Maj

orit

y(6

4%)o

fth

e14

enro

lled

(n=

9w

hoco

mpl

eted

trea

tmen

tand

the

end

oftr

eatm

ent

asse

ssm

ent)

.

•Yes

onsy

mpt

oms

(PC

L).

•Yes

onal

coho

l(n

umbe

rof

drin

king

days

,dri

nks

per

epis

ode)

.

•Yes

onde

pres

sion

(BD

I).S

atis

fact

ion

not

form

ally

asse

ssed

.

3an

d6

mon

ths

(app

ears

tobe

tim

edfr

omen

dof

trea

tmen

t).

•Yes

onP

TS

D:(

PC

L).

Unc

lear

onSU

D(l

owas

sess

men

tco

mpl

etio

n).

(11)

Par

tial

-dos

e(3

2%)

SSpi

lot

Sear

cy&

Lip

ps,

2012

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(TSC

-40

tota

land

all

6su

bsca

les)

.

Not

asse

ssed

(due

tore

side

ntia

lnat

ure

ofth

epr

ogra

m).

Not

asse

ssed

Tre

atm

ent

sati

sfac

tion

was

not

form

ally

asse

ssed

.

Not

asse

ssed

.

(12)

Unc

lear

dose

SSpi

lot

Ben

ton

etal

.,20

11,2

012

♦U

ncle

arR

esul

tsre

port

edon

lyfo

rth

ose

who

com

plet

edat

leas

ton

ese

ssio

n.N

oda

taon

how

man

ydi

dno

tat

tend

atle

ast

one

sess

ion.

♦N

oon

PT

SD(M

PSS

R;T

SC-4

0).

♦N

oon

SUD

(AD

OM

,i.e

.,nu

mbe

rof

days

usin

gsu

bsta

nces

inpa

stm

onth

,but

mos

tw

ere

abst

inen

tat

base

line,

per

clin

icpo

licy

and

com

plet

ion

ofSU

DIO

Ppr

ior

toSS

).

♦N

oon

othe

rva

riab

les:

func

tion

ing

(BA

SIS-

32to

tal,

subs

cale

s).

Str

ong

trea

tmen

tsa

tisf

acti

on.

6-m

onth

follo

w-u

pfr

omen

dof

trea

tmen

t;an

alys

isfr

omba

selin

efo

ral

lva

riab

les,

plus

end

oftr

eatm

entt

ofo

llow

-up

for

AD

OM

and

BA

SIS

-32

slee

psu

bsca

leon

ly;(

liste

das

“6m

onth

s”)

•Yes

onP

TS

Dsy

mpt

oms

and

diag

nosi

s(M

PSS

Rdi

agno

stic

cuto

ff,

tota

l,an

dsu

bsca

les

re-e

xper

ienc

ing

and

arou

sal;

TSC

-40

depr

essi

onan

dsl

eep

subs

cale

s,w

ith

the

latt

eral

sosi

gnifi

cant

from

end

oftr

eatm

ent

tofo

llow

-up)

.•N

oon

SU

D.

•Yes

onot

her

vari

able

s:fu

ncti

onin

g(B

ASI

S-32

subs

cale

sre

lati

onto

self

and

othe

rs,a

ndps

ycho

sis)

.•N

egat

ive

outc

ome:

end

oftr

eatm

ent

tofo

llow

-up

ther

ew

asan

incr

ease

inal

coho

luse

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(13)

SS cont

rolle

dtr

ial

Gat

zet

al.,

2007

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.S

tron

gtr

eatm

ent

sati

sfac

tion

(per

Bro

wn

etal

.,20

07).

8m

onth

sfr

omen

dof

trea

tmen

t;an

alys

isfr

omba

selin

e(l

iste

das

“12

mon

ths”

)Y

eson

PT

SD

:•S

Sou

tper

form

edth

eco

ntro

lon

sym

ptom

s(P

SS).

Yes

onS

UD

:•B

oth

cond

itio

nsim

prov

edon

drug

and

alco

hol(

ASI

com

posi

tes)

.Y

eson

othe

rva

riab

les:

•SS

outp

erfo

rmed

the

cont

rolo

ntr

eatm

ent

atte

ndan

ce.

•Bot

hco

ndit

ions

impr

oved

onps

ycho

path

olog

y(B

SIG

loba

lSe

veri

tyIn

dex)

.

(14)

(del

iver

edby

case

man

ager

s)SS co

ntro

lled

tria

lD

esai

etal

.,20

08,2

009

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

sym

ptom

s(P

CL

tota

l,an

dav

oida

nce

subs

cale

).•B

oth

SSan

dth

eco

ntro

lim

prov

edon

PC

Lsu

bsca

lehy

perv

igila

nce.

Yes • B

oth

SSan

dth

eco

ntro

lim

prov

edon

drug

and

alco

hol(

ASI

com

posi

tes)

.

Yes •S

Sou

tper

form

edth

eco

ntro

lon

soci

alsu

ppor

t.•B

oth

SSan

dth

eco

ntro

lim

prov

edon

psyc

hopa

thol

ogy

(SC

L,A

SIps

ychi

atri

cco

mpo

site

),da

ysho

mel

ess,

self

-est

eem

,an

dhe

alth

(SF

-12

med

ical

scor

e).

Tre

atm

ent

sati

sfac

tion

was

not

form

ally

asse

ssed

.

6m

onth

follo

w-u

pfr

omen

dof

trea

tmen

t;an

alys

esar

eba

selin

eth

roug

hfo

llow

-up

(lis

ted

as“1

2m

onth

s”).

Yes

onP

TS

D:

•SS

outp

erfo

rmed

the

cont

rolo

nsy

mpt

oms

(PC

Lto

tala

ndsu

bsca

les

avoi

danc

ean

dar

ousa

l).

•Bot

hco

ndit

ions

impr

oved

onP

CL

intr

usio

n.Y

eson

SU

D:

•Bot

hSS

and

the

cont

rolo

nal

coho

land

drug

s(A

SIco

mpo

site

s).

Yes

onot

her

vari

able

s:•S

Sou

tper

form

edth

eco

ntro

lon

soci

alsu

ppor

t,da

ysw

orke

d,an

dps

ycho

path

olog

y(S

CL

-30)

.•B

oth

cond

itio

nsim

prov

edon

heal

th(S

F-1

2m

edic

alsc

ore)

,ps

ycho

path

olog

y(A

SIps

ychi

atri

cco

mpo

site

and

SF12

men

tals

core

),da

ysho

mel

ess

and

self

-est

eem

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(15)

SS cont

rolle

dtr

ial

Lyn

chet

al.,

2012

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Yes •S

Sou

tper

form

edco

ntro

lon

sym

ptom

s(P

CL

).

Not

asse

ssed

due

topr

ison

sett

ing.

Yes • S

Sou

tper

form

edco

ntro

lon

allo

ther

vari

able

sas

sess

ed:

depr

essi

on(C

ES-

D);

rela

tion

ship

func

tion

ing

(IIP

);ad

apti

veco

ping

,and

mal

adap

tive

copi

ng(s

core

son

Bri

efC

OP

E);

and

onam

ount

ofre

liabl

ech

ange

.

Not

asse

ssed

.

Tre

atm

ent

sati

sfac

tion

was

not

form

ally

asse

ssed

.

(16)

SSR

CT

hybr

idH

ien,

Coh

enet

al.,

2004

Yes •S

Sou

tper

form

edT

AU

onfr

eque

ncy

and

seve

rity

ofsy

mpt

oms

(PSS

-SR

and

CA

PS)

.•B

oth

SSan

dR

Pim

prov

edon

the

abov

eva

riab

les.

Yes • S

Sou

tper

form

edT

AU

onse

veri

ty(S

UI

tota

l)ve

rifie

dby

urin

alys

is).

•Bot

hSS

and

RP

impr

oved

onth

eab

ove

vari

able

s.

Yes • S

Sou

tper

form

edT

AU

onps

ycho

path

olog

y(B

SIto

tal,

HD

RS

tota

ls).

•Bot

hSS

and

RP

impr

oved

onth

eab

ove

vari

able

s.

Yes

onP

TS

D:

• SS

outp

erfo

rmed

TA

Uw

ith

sust

aine

dim

prov

emen

tson

freq

uenc

yan

dse

veri

tyof

sym

ptom

s(P

SS-S

Ran

dC

AP

S)at

6-an

d9-

mon

thfo

llow

-ups

.•B

oth

SSan

dR

Pim

prov

edon

the

abov

eva

riab

les.

Yes

onS

UD

:•S

San

dR

Pou

tper

form

edT

AU

wit

hsu

stai

ned

impr

ovem

ents

ondr

ugus

ese

veri

ty(S

UI)

at6-

and

9-m

onth

follo

w-u

ps.

•Bot

hSS

and

RP

impr

oved

onth

eab

ove

vari

able

s.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(17)

SSR

CT

Naj

avit

set

al.,

2006

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

cogn

itio

ns(W

AS

bene

vole

nce

subs

cale

).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

subs

tanc

eus

epr

oble

ms

(7su

bsca

les

ofth

eP

EI

incl

udin

gpo

lydr

ugus

e,pr

eocc

upat

ion

wit

hdr

ugs,

loss

ofco

ntro

l,et

c.);

asw

ell

asA

xis

ISU

Dsy

mpt

oms

(AP

S));

and

cogn

itio

ns(R

FU

).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

Axi

sI

anor

exia

,so

mat

izat

ion,

and

Axi

sII

pers

onal

ity

diso

rder

fact

oran

dob

sess

ive-

com

puls

ive

(AP

Ssc

ore/

subs

cale

).M

oder

ate

trea

tmen

tsa

tisf

acti

on.

3m

onth

sfr

omen

dof

trea

tmen

t;an

alys

isfr

omba

selin

e(l

iste

das

“3m

onth

s”)

Yes

onS

UD

:•S

Sou

tper

form

edth

eco

ntro

lsub

stan

ceus

epr

oble

ms

(7su

bsca

les

ofP

EI

incl

udin

gpo

lydr

ugus

e,pr

eocc

upat

ion

wit

hdr

ugs,

loss

ofco

ntro

l,et

c.);

asw

ella

sA

xis

ISU

Dsy

mpt

oms

(AP

S);a

ndco

gnit

ions

(RF

U).

Yes

ontr

aum

a/P

TS

D:

•SS

outp

erfo

rmed

the

cont

rolo

nsy

mpt

oms

(TSC

Csu

bsca

les

sexu

alco

ncer

nsan

dse

xual

dist

ress

)an

dco

gnit

ions

(WA

Ssu

bsca

lebe

nevo

lenc

e).

Yes

onot

her

vari

able

s:•S

Sou

tper

form

edth

eco

ntro

lon

psyc

hopa

thol

ogy

(AP

Ssu

bsca

les

Axi

sI

anor

exia

,som

atiz

atio

n,m

ajor

depr

essi

on).

(18)

SSR

CT

Bod

enet

al.,

2012

100%

ofel

igib

lera

ndom

ized

sam

ple

(ful

lint

ent-

to-t

reat

anal

ysis

).

No

Nei

ther

SSno

rco

ntro

lim

prov

edon

sym

ptom

s(I

ES-

R).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

drug

use

(ASI

com

posi

te).

•Bot

hSS

and

cont

rol

impr

oved

onal

coho

l(A

SIco

mpo

site

).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

allo

ther

vari

able

s:at

tend

ance

,co

ping

(CR

I),a

ndcl

ient

sati

sfac

tion

(CSQ

).S

tron

gtr

eatm

ent

sati

sfac

tion

.

3m

onth

follo

w-u

pfr

omen

d-of

-tre

atm

ent;

anal

ysis

from

base

line.

(“6

mon

thfo

llow

-up”

)Y

eson

PT

SD

:•B

oth

SSan

dco

ntro

lim

prov

edon

sym

ptom

s(I

ES-

R).

Yes

onS

UD

:•S

Sou

tper

form

edth

eco

ntro

lon

drug

s(A

SIco

mpo

site

;31%

grea

ter

redu

ctio

n).

•Bot

hSS

and

cont

roli

mpr

oved

onal

coho

l(A

SIco

mpo

site

).N

oot

her

vari

able

sw

ere

asse

ssed

atth

isti

mep

oint

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(19)

Par

tial

-do

se(%

vari

ed)

SSR

CT

Zlo

tnic

ket

al.,

2009

100%

ofth

ose

rand

omiz

ed(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Not

asse

ssed

(no

outc

ome

asse

ssm

ent

cond

ucte

dat

end

ofac

tive

phas

eof

trea

tmen

t).

Not

asse

ssed

(no

outc

ome

asse

ssm

ent

cond

ucte

dat

end

ofac

tive

phas

eof

trea

tmen

t).

Not

asse

ssed

(no

outc

ome

asse

ssm

ent

cond

ucte

dat

end

ofac

tive

phas

eof

trea

tmen

t).

Tre

atm

ents

atis

fact

ion

was

stro

ng(a

ndw

asth

eon

lyva

riab

lera

ted

atth

een

dof

the

acti

veph

ase

oftr

eatm

ent)

.

3fo

llow

-ups

:(A

)1–

1.5

mon

ths

from

end

ofac

tive

phas

e(g

roup

trea

tmen

tin

pris

on,

liste

das

“12

wee

ksaf

ter

inta

ke”)

;(B

)4.

25-4

.75

mon

ths

from

end

ofac

tive

phas

e(l

iste

das

“3m

onth

spo

st-r

elea

sefr

ompr

ison

”).

(C)

7.25

-7.7

5m

onth

sfr

omen

dof

activ

eph

ase

(lis

ted

as“6

mon

ths

post

-rel

ease

from

pris

on”)

.A

llan

alys

esar

efr

omba

selin

eun

less

othe

rwis

ein

dica

ted.

Yes

onP

TS

D:

•Bot

hco

ndit

ions

impr

oved

onP

TSD

(CA

PS

tota

lsco

re)

atA

,B,a

ndC

tim

epoi

nts.

•SS

outp

erfo

rmed

cont

rolo

nco

mpl

extr

aum

asy

mpt

oms

(TSC

-40)

inth

atSS

had

impr

ovem

ent

atea

chti

mep

oint

A,B

,and

C,w

here

asco

ntro

lhad

iton

lyat

A.

Yes

onS

UD

:•B

oth

cond

itio

nsim

prov

edon

drug

use

(ASI

com

posi

te)

atth

etw

oav

aila

ble

tim

epoi

nts

(Ban

dC

).Y

eson

othe

rva

riab

les:

•Bot

hco

ndit

ions

impr

oved

onps

ycho

path

olog

y(B

SIto

tal)

atti

mep

oint

sA

,B,a

ndC

.•S

Sou

tper

form

edco

ntro

lon

psyc

hopa

thol

ogy

(BSI

tota

l),i

mpr

ovin

gfr

omA

toB

,and

Ato

C,w

here

asco

ntro

ldid

not.

•Bot

hco

ndit

ions

impr

oved

onle

galp

robl

ems

(ASI

com

posi

te)

atti

mep

oint

sB

and

C.

•Neg

ativ

eou

tcom

e:C

ontr

olou

tper

form

edSS

onal

coho

l(A

SIco

mpo

site

)at

one

tim

epoi

nt(B

).


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(20)

Par

tial

-do

se(2

4%)

SSR

CT

Ghe

eet

al.,

2009

Maj

orit

y(7

1%)o

fth

ose

enro

lled

(of

51w

omen

,the

n=

36w

hoat

tend

edat

leas

t5

ofth

e6

Seek

ing

Safe

tyse

ssio

ns).

Yes •S

Sou

tper

form

edth

eco

ntro

lon

sym

ptom

s(M

PSS

;and

TSC

-40

sexu

alab

use

trau

ma

inde

x(t

hela

tter

was

the

only

subs

cale

anal

yzed

).

Unc

lear

No

pre-

to-p

ost

SUD

outc

ome;

and

the

maj

orit

yin

both

cond

itio

nsdi

dno

tpr

ovid

ean

endp

oint

urin

esa

mpl

e.N

odi

ffer

ence

inpe

rcen

tne

gati

veur

inal

yses

betw

een

the

two

cond

itio

ns(u

sing

the

stan

dard

assu

mpt

ion

that

am

issi

ngur

ine

isco

ded

posi

tive

).

Not

asse

ssed

.N

otas

sess

ed.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(21)

Par

tial

-do

se(4

8%)

SS

RC

TH

ien

etal

.,20

09

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Yes •B

oth

SSan

dW

HE

impr

oved

onP

TSD

freq

uenc

yan

dse

veri

tyto

tals

core

s(P

SS-S

Ran

dC

AP

S).

No

for

over

alls

ampl

e•N

eith

erSS

nor

Con

trol

(WH

E)

impr

oved

ondr

ugus

e(S

UI

veri

fied

byur

inal

ysis

and

saliv

ate

stin

g)or

alco

holo

rdr

ug(A

SIco

mpo

site

s).

Yes

onse

cond

ary

anal

yses

(see

next

row

).

Yes

onot

her

vari

able

s•S

Sou

tper

form

edW

HE

onH

IVse

xual

risk

(RB

Sto

talH

IVR

isk)

,eat

ing

diso

rder

s(E

DE

Qto

tal)

,and

ther

apeu

tic

allia

nce

(HA

Q-I

Ito

tal)

.•B

oth

SSan

dco

ntro

l(W

HE

)re

duce

dbi

nge

eati

ng(E

DE

Qsu

bsca

le).

Yes

onP

TS

D:

•Bot

hSS

and

WH

Esu

stai

ned

impr

ovem

ents

onP

TSD

(PSS

-SR

,C

AP

S).

No

onS

UD

:•

Nei

ther

SSno

rC

ontr

ol(W

HE

)im

prov

edon

drug

use

(SU

Ive

rifie

dby

urin

alys

isan

dsa

liva

test

ing)

oral

coho

lor

drug

(ASI

com

posi

tes)

.

“”

End

oftr

eatm

ents

econ

dary

anal

yses

†(e

ach

belo

wa

sepa

rate

pape

r).

Yes

onP

TS

D:

•SS

outp

erfo

rmed

WH

Eon

redu

cing

PT

SDse

veri

tyan

dfr

eque

ncy

and

subs

cale

arou

sal(

PSS

-SR

)am

ong

alco

holm

isus

ers

(n=

111)

.Y

eson

SU

D:

•SS

outp

erfo

rmed

WH

Eon

alco

hola

ndco

cain

ese

veri

ty(A

SIco

mpo

site

)am

ong

heav

ysu

bsta

nce

use

grou

pw

ith

PT

SDim

prov

emen

ts(n

=17

4).

•SS

outp

erfo

rmed

WH

Eon

alco

hola

ndco

cain

ese

veri

ty(A

SIco

mpo

site

)am

ong

trea

tmen

tti

trat

ors

(n=

86).

•SS

outp

erfo

rmed

WH

Eon

alco

hol(

ASI

com

posi

te)

amon

g12

-Ste

pat

tend

ees

who

atte

nded

12-s

tep

regu

larl

yaf

ter

trea

tmen

t.B

utW

HE

outp

erfo

rmed

SS

onal

coho

l(A

SIco

mpo

site

)am

ong

thos

ew

hodi

dno

tat

tend

12-s

tep

regu

larl

yaf

ter

trea

tmen

t.•S

Sou

tper

form

edW

HE

onst

imul

ant

use

outc

omes

(ASI

);am

ong

heav

yst

imul

ant

user

s;no

diff

eren

ces

for

nons

tim

ulan

tan

dlig

htst

imul

ant

user

s.•S

Sou

tper

form

edW

HE

inm

edia

tion

effe

cts:

i.e.,

SSou

tper

form

edW

HE

inre

duci

ngP

TSD

whi

chin

turn

was

asso

ciat

edw

ith

low

eral

coho

land

coca

ine

use;

the

effe

cts

wer

egr

eate

stam

ong

thos

ew

hore

ceiv

edth

em

ost

sess

ions

.Y

eson

othe

rva

riab

les:

•SS

outp

erfo

rmed

WH

Eon

redu

cing

unsa

fese

xual

occa

sion

s(R

BS)

amon

gth

ose

wit

hhi

ghri

skse

xual

beha

vior

atba

selin

e.•S

Sou

tper

form

edW

HE

onal

lianc

e(H

AQ

-II)

,as

note

din

colu

mn

Eab

ove,

and

high

eral

lianc

ew

asre

late

dto

decr

ease

dP

TSD

and

high

ertr

eatm

ent

atte

ndan

ce.

† Sec

onda

ryan

alys

esar

ere

port

edon

this

stud

ybe

caus

eit

isth

eon

lyst

udy

wit

hsu

ffici

ent

sam

ple

size

topr

ovid

eri

goro

usse

cond

ary

anal

yses

inre

lati

onto

asp

ecifi

ctr

eatm

ent

mod

el.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(22)

WIT

pilo

tC

ovin

gton

etal

.,20

08

♦A

min

orit

y(2

1.8%

;n

=44

ofth

en

=20

2el

igib

lesa

mpl

e)O

fn=

202

elig

ible

,onl

yth

ose

who

com

plet

edth

ere

side

ntia

lSU

Dpr

ogra

m(n

=15

7of

the

202)

plus

com

plet

edth

ere

side

ntia

lpro

gram

“suc

cess

fully

”(d

efine

das

havi

ng“c

ompl

eted

thei

rtr

eatm

ent

plan

sor

goal

s”be

fore

exis

ting

the

resi

dent

ialS

UD

prog

ram

;n=

86of

the

157)

,plu

sco

mpl

eted

both

part

sof

WIT

(HW

Ran

dB

T)

and

all

asse

ssm

ents

(n=

44).

♦Y

eson

sym

ptom

s(T

SC-4

0su

bsca

les

anxi

ety,

diss

ocia

tion

,de

pres

sion

,sle

ep;f

orth

ose

who

com

plet

edbo

thH

WR

and

BT,

i.e.,

the

WIT

mod

el,

plus

succ

essf

ully

com

plet

edth

eS

UD

resi

dent

ialp

rogr

am,

plus

did

alla

sses

smen

tpo

ints

;see

atle

ft).

♦N

oda

tare

port

ed.

♦Y

eson

depr

essi

on(B

DI;

for

thos

ew

hoco

mpl

eted

both

HW

Ran

dB

T(i

.e.,

the

WIT

mod

el)

plus

succ

essf

ully

com

plet

edth

eS

UD

resi

dent

ial

prog

ram

plus

did

all

asse

ssm

entp

oint

s;se

eat

left

).♦

Neg

ativ

eou

tcom

e:un

clea

r;no

nere

port

edfo

rth

esa

mpl

ead

dres

sed,

but

nore

port

onth

ose

who

drop

ped

out

ofW

IT.

Not

asse

ssed

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(23)

GR

TR

CT

Mes

sina

etal

.,20

10

100%

ofra

ndom

ized

(ful

lint

ent

totr

eat)

.N

otas

sess

ed.

Not

asse

ssed

.N

otas

sess

ed.

Tre

atm

ent

sati

sfac

tion

not

asse

ssed

.

Follo

w-u

psw

ere

aver

age

of9

mon

ths

and

14m

onth

sfr

ompa

role

,i.e

.re

leas

efr

ompr

ison

(whi

chw

asno

tnec

essa

rily

end

oftr

eatm

ent)

;an

alys

isis

base

line

thro

ugh

12m

onth

s(f

ollo

w-u

pslis

ted

as“6

and

12m

onth

s”af

ter

pris

onre

leas

e).

PT

SDno

tas

sess

ed.

Yes

onS

UD

:B

oth

GR

Tan

dT

AU

impr

oved

onal

coho

land

drug

(ASI

com

posi

tes)

.Y

eson

othe

rva

riab

les:

•Bot

hG

RT

and

TA

Uim

prov

edon

psyc

hopa

thol

ogy

(ASI

psyc

hiat

ric

com

posi

te).

•GR

Tim

prov

edon

fam

ily(A

SIco

mpo

site

)bu

tT

AU

did

not

(but

onw

ithi

n-gr

oup,

not

betw

een-

grou

pan

alys

is).

•Neg

ativ

eou

tcom

e:T

AU

impr

oved

onSe

lf-E

ffica

cybu

tG

RT

did

not

(but

onw

ithi

n-gr

oup,

not

betw

een-

grou

pan

alys

is).

(24)

ICB

Tpi

lot

McG

over

net

al.,

2009

♦A

min

orit

y(4

7.8%

)of

the

elig

ible

sam

ple

(of

n=

23el

igib

le,

n=

11w

hoco

mpl

eted

atle

ast

two

sess

ions

ofIG

BT

and

had

atle

ast

one

follo

w-u

pas

sess

men

t).

♦Y

eson

sym

ptom

s(C

AP

Sto

tala

ndsu

bsca

les

reex

peri

enci

ng,

avoi

danc

e,ar

ousa

l).

♦Y

eson

alco

hola

nddr

ugs

(ASI

com

posi

tes)

.

Not

asse

ssed

.T

reat

men

tsa

tisf

acti

onno

tas

sess

ed.

♦3

mon

ths

from

end

oftr

eatm

ent;

prim

ary

anal

ysis

isen

dof

trea

tmen

tto

follo

w-u

p.•Y

eson

PT

SD

:sym

ptom

s(C

AP

Sto

tala

ndsu

bsca

lear

ousa

l).

No

onSU

Don

alco

holo

rdr

ugs

(ASI

com

posi

tes)

.N

oot

her

vari

able

sas

sess

ed.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(25)

ICB

TR

CT

McG

over

net

al.,

2011

♦D

esig

nst

ates

inte

ntto

trea

t.H

owev

er,

52%

mor

epa

rtic

ipan

tsw

ere

rand

omiz

edto

ICB

Tth

anto

IDC

(wit

hno

rati

onal

eno

rde

scri

ptio

nof

the

rand

omiz

atio

npr

oced

ure)

,res

ulti

ngin

very

uneq

ual

sam

ple

size

sat

base

line.

Not

repo

rted

.N

otre

port

ed.

Not

repo

rted

.T

reat

men

tsa

tisf

acti

onno

tas

sess

ed.

♦A

llbe

low

are

appr

oxim

atel

y3

mon

ths

from

end

oftr

eatm

ent;

anal

ysis

from

base

line

(lis

ted

as“6

mon

ths”

).♦

Sam

ple

size

sar

eno

tre

port

edfo

ran

you

tcom

ean

alys

es,o

ther

than

noti

ngth

at53

%of

the

sam

ple

was

avai

labl

eat

follo

w-u

p.Y

eson

PT

SD

:•I

CB

Tou

tper

form

edID

Con

diag

nosi

san

dre

-exp

erie

ncin

gsu

bsca

le(C

AP

S).

•Bot

hIC

BT

and

IDC

impr

oved

onsy

mpt

oms

(CA

PS

tota

land

subs

cale

sav

oida

nce

and

arou

sal)

.Y

eson

SU

D:

•Bot

hIC

BT

and

IDC

impr

oved

(day

sof

drug

use.

Yes

onot

her

vari

able

s:•B

oth

ICB

Tan

dID

Cim

prov

edon

psyc

hopa

thol

ogy

(ASI

com

posi

te)

and

depr

essi

on(B

DI)

.

(26)

TA

RG

ET

RC

TF

rism

anet

al.,

2008

♦D

esig

nst

ates

inte

ntto

trea

t.H

owev

er,

98%

mor

epa

rtic

ipan

tsw

ere

rand

omiz

edto

TA

RG

ET

than

toT

AU

,res

ulti

ngin

very

uneq

uals

ampl

esi

zes

atba

selin

e.(R

easo

nst

ated

was

toim

prov

eat

tend

ance

atT

AR

GE

T).

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

♦Fo

llow

-up

appr

oxim

atel

y4

and

10m

onth

sfr

omen

dof

trea

tmen

t;an

alys

isfr

omba

selin

e(l

iste

das

“6m

onth

s”an

d“1

2m

onth

s”fr

omba

selin

e).

Unc

lear

onSU

D:

•Bot

hco

ndit

ions

appe

arto

impr

ove

(GA

INsu

bsca

lesu

bsta

nce

freq

uenc

yin

dex;

and

perc

enta

ges

on3

item

s:dr

ink

toin

toxi

cati

on,

use

any

drug

s,an

dsu

bsta

nce

abus

e).

Unc

lear

onP

TSD

.U

ncle

aron

othe

rva

riab

les.

•Bot

hco

ndit

ions

appe

arto

impr

ove

onan

xiet

yan

dde

pres

sion

(GA

INsu

bsca

les)

.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(27)

TR

EM

cont

rolle

dtr

ial

Tous

sain

tet

al.,

2007

100%

ofen

rolle

din

clud

edin

outc

ome

anal

ysis

(ful

lin

tent

-to-

trea

tan

alys

is).

Not

repo

rted

(no

end-

of-t

reat

men

tas

sess

men

t).

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Follo

w-u

pap

prox

imat

ely

2an

d8

mon

ths

from

end

oftr

eatm

ent;

anal

ysis

from

base

line

(lis

ted

as“6

mon

ths”

and

“12

mon

ths”

from

base

line)

.U

ncle

aron

PT

SD:

No

diff

eren

cebe

twee

nco

ndit

ions

atei

ther

follo

w-u

ppo

int,

and

noac

ross

-tim

est

atis

tica

ltes

ting

repo

rted

(PSS

).U

ncle

aron

SUD

:N

odi

ffer

ence

betw

een

cond

itio

nsat

eith

erfo

llow

-up

poin

t,an

dno

acro

ss-t

ime

stat

isti

calt

esti

ngre

port

ed(A

SIdr

ug,a

lcoh

olco

mpo

site

s).

Yes

onan

othe

rva

riab

le:

TR

EM

outp

erfo

rmed

cont

rolo

nps

ycho

path

olog

y(B

SIsu

bsca

leG

SI)

at8

mon

ths

afte

rtr

eatm

ent.

(28)

BC

M/

TR

EM

cont

rolle

dtr

ial

Am

aro

etal

.,20

07a,

2007

b

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.T

heau

thor

sre

port

stro

ngsa

tisf

acti

onw

ith

BC

M(2

007a

);ho

wev

er,t

wo

ofth

ree

sati

sfac

tion

rati

ngs

wer

eno

tsi

gnifi

cant

lydi

ffer

ent

betw

een

the

two

cond

itio

ns.

Follo

w-u

ps6

and

12m

onth

sfr

omba

selin

e;un

clea

rho

wth

ese

tim

epoi

nts

rela

teti

me-

wis

eto

end

ofB

CM

orT

RE

Man

alys

isfr

omba

selin

e.Y

es/U

ncle

aron

PT

SD

:B

CM

outp

erfo

rmed

the

cont

roli

nth

eac

ross

-tim

ean

alys

isfr

omba

selin

eth

roug

h12

mon

ths

onsy

mpt

oms

(PSS

);un

clea

rat

6m

onth

s.Y

eson

SU

D:

Bot

hco

ndit

ions

impr

oved

onal

coho

land

drug

s(A

SIco

mpo

site

s)fr

omba

selin

eth

roug

h12

mon

ths.

Yes

/Unc

lear

onan

othe

rva

riab

le:

BC

Mou

tper

form

edth

eco

ntro

lin

the

acro

ss-t

ime

anal

ysis

from

base

line

thro

ugh

12m

onth

son

psyc

hopa

thol

ogy

(BSI

GSI

);un

clea

rat

6m

onth

s.


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(29)

TR

EM

cont

rolle

dtr

ial

Fal

lot

etal

.,20

11

100%

ofen

rolle

d(f

ull

inte

ntto

trea

t).

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

Not

rate

d(n

oen

d-of

-tre

atm

ent

asse

ssm

ent)

.

2m

onth

sbe

fore

end

oftr

eatm

ent(

liste

das

6m

onth

s)an

d4

mon

ths

afte

rtr

eatm

ente

nded

(lis

ted

as12

mon

ths)

;ana

lysi

sfr

omba

selin

eth

roug

h4

mon

ths.

Yes

onS

UD

:(bu

trep

orte

don

lyon

thos

epo

siti

vefo

rS

UD

atba

selin

e;le

ssth

anha

lfth

efu

llsa

mpl

e).

•TR

EM

plus

inte

grat

edtr

aum

ase

rvic

es+

TA

Uou

tper

form

edT

AU

onal

coho

land

drug

use

(ASI

com

posi

tes)

for

the

subs

ampl

ew

how

ere

usin

gat

base

line.

Yes

onP

TS

D:

Bot

hco

ndit

ions

impr

oved

onP

TSD

(PSS

).Y

eson

othe

rva

riab

les:

•psy

chop

atho

logy

(BSI

scor

es:G

SI,s

ubsc

ale

depr

essi

on,h

osti

lity)

.N

egat

ive

outc

ome:

•U

ncle

ar.M

eans

for

TR

EM

onal

coho

land

drug

sar

ein

dire

ctio

nof

wor

seni

ngfr

om6

mon

ths

to12

mon

ths

(in

cont

rast

toth

eco

ntro

l),

but

noan

alys

esad

dres

s6

vers

us12

mon

ths

for

any

vari

able

s.

(30)

CT

PC

Dpi

lot

Bra

dyet

al.,

2001

♦A

min

orit

y(3

8.5%

)of

the

orig

inal

sam

ple

(fro

mth

eor

igin

aln

=39

,the

yre

port

onth

en

=15

who

com

plet

ed10

orm

ore

sess

ions

,i.e

.,62

.5%

,of

the

trea

tmen

t).

♦Y

esfo

rtr

eatm

ent

com

plet

ers

onsy

mpt

oms

(CA

PS

tota

land

thre

esu

bsca

les;

IES

intr

usio

nsu

bsca

le;

and

Mis

siss

ippi

Scal

e).

♦Y

esfo

rtr

eatm

ent

com

plet

ers

onal

coho

lan

ddr

ugs

(ASI

com

posi

tes)

.

♦Y

esfo

rtr

eatm

ent

com

plet

ers

onps

ycho

path

olog

y(A

SIps

ychi

atri

cco

mpo

site

and

BD

I).

Follo

w-u

p6

mon

ths

from

end

oftr

eatm

ent;

anal

ysis

from

base

line

(lis

ted

as“6

mon

ths”

).♦

Yes

for

trea

tmen

tcom

plet

ers;

atfo

llow

-up

this

is13

%of

the

orig

inal

sam

ple

(n=

7).

•PT

SD

sym

ptom

s:(C

AP

Ssu

bsca

lehy

pera

rous

alan

dM

issi

ssip

piSc

ale)

.•S

UD

alco

hola

nddr

ug(A

SIco

mpo

site

s).

•Oth

erva

riab

les:

psyc

hopa

thol

ogy

(BD

I);a

ndem

ploy

men

t(A

SIco

mpo

site

).


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(31)

SSpi

lot

Naj

avit

set

al.,

2005

100%

ofen

rolle

d(f

ull

inte

nt-t

o-tr

eat

anal

ysis

).

•Yes

onsy

mpt

oms

(TSC

-40

tota

l;su

bsca

les

anxi

ety,

diss

ocia

tion

,and

sexu

altr

aum

ain

dex)

and

cogn

itio

ns(W

AS

subs

cale

mea

ning

fuln

ess)

.

•Yes

ondr

ugs

(ASI

com

posi

te,v

erifi

edby

urin

alys

is).

•Yes

fam

ily/s

ocia

lpr

oble

ms

(ASI

com

posi

te),

func

tion

ing

(GA

F),

psyc

hopa

thol

ogy

(BSI

host

ility

subs

cale

),an

dov

eral

lcha

nge

(CG

IS).

Not

asse

ssed

.

Str

ong

trea

tmen

tsa

tisf

acti

on.

(32)

SDP

Tpi

lot

Tri

fflem

an,

2000

♦U

ncle

arR

esul

tsre

port

edon

lyfo

rth

ose

who

com

plet

edat

leas

ton

ese

ssio

n.N

oda

taon

how

man

ydi

dno

tat

tend

atle

ast

one

sess

ion.

♦Y

esB

oth

SDP

and

12SF

impr

oved

onsy

mpt

oms

and

diag

nosi

s(C

AP

Sto

tal,

num

ber

ofsy

mpt

oms,

and

perc

ent

posi

tive

for

PT

SD).

♦Y

esB

oth

SDP

and

12SF

impr

oved

onon

eit

em(A

SInu

mbe

rof

days

ofsu

bsta

nce

use)

.

♦Y

esB

oth

SDP

and

12SF

impr

oved

onps

ycho

path

olog

y(A

SIps

ychi

atri

cco

mpo

site

).

1m

onth

from

end

oftr

eatm

ent;

anal

ysis

isba

selin

eto

follo

w-u

p.•Y

eson

SU

D:

Bot

hSD

Pan

d12

SFim

prov

edon

drug

(ASI

com

posi

te),

num

ber

ofda

ysus

ing

asu

bsta

nce.

•Yes

onP

TS

D:

Bot

hSD

Pan

d12

SFim

prov

edon

sym

ptom

san

ddi

agno

sis

(CA

PS

tota

l,nu

mbe

rof

sym

ptom

s,an

dpe

rcen

tpo

siti

vefo

rP

TSD

).•Y

eson

anot

her

vari

able

:B

oth

SDP

and

12SF

impr

oved

onps

ycho

path

olog

y(A

SIps

ychi

atri

cco

mpo

site

).


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(33)

Exp

osur

epl

usSU

Dtr

eatm

ent

RC

TC

offe

yet

al.,

2006

♦A

min

orit

y(3

9.5%

)of

the

orig

inal

sam

ple.

(Of

n=

43en

rolle

d,th

en

=17

who

atte

nded

the

init

ial

lab

sess

ion

plus

all6

clin

ical

sess

ions

,i.e

.,50

%of

thos

eas

sign

edto

expo

sure

,63%

tore

laxa

tion

).

♦Y

esE

xpos

ure

plus

SU

Dtr

eatm

ent

outp

erfo

rmed

SU

Dal

one

for

trea

tmen

tco

mpl

eter

s(I

ES-

R).

♦N

egat

ive

outc

ome:

Non

elis

ted,

but

uncl

ear

due

tore

port

ing

ofre

sult

son

lyfo

rtr

eatm

ent

com

plet

ers.

Not

asse

ssed

(no

end

oftr

eatm

ent

SUD

asse

ssm

ent)

.

Not

asse

ssed

.N

otas

sess

ed(n

ofo

llow

-up)

.

(34)

CO

PE

RC

TM

ills

etal

.,20

12

100%

ofra

ndom

ized

(ful

lint

ent-

to-t

reat

anal

ysis

).

No

diff

eren

cebe

twee

nC

OP

Ean

dT

AU

onsy

mpt

oms

ordi

agno

sis

(CA

PS)

atth

eti

mep

oint

clos

est

toen

dof

trea

tmen

t(3

mon

ths)

.

No

diff

eren

cebe

twee

nC

OP

Ean

dT

AU

onsy

mpt

oms

ordi

agno

sis

(CID

I),n

ornu

mbe

rof

drug

clas

ses

used

(OT

I)at

the

tim

ecl

oses

tto

end

oftr

eatm

ent

(3m

onth

s).

No

diff

eren

cebe

twee

nC

OP

Ean

dT

AU

onsy

mpt

oms

orde

pres

sion

(BD

I-II

),no

ran

xiet

y(S

TA

I)at

the

tim

epoi

ntcl

oses

tto

end

oftr

eatm

ent

(3m

onth

s).N

ow

ithi

n-gr

oup

anal

ysis

prov

ided

from

base

line

toth

isti

mep

oint

.

6m

onth

sfr

omen

dof

trea

tmen

t,an

alys

isfr

omba

selin

e(l

iste

das

“9m

onth

s”).

Yes

onP

TS

D:

•CO

PE

outp

erfo

rmed

TA

Uon

sym

ptom

s(C

AP

S).

•Bot

hC

OP

Ean

dth

eco

ntro

lim

prov

edon

diag

nosi

s(C

AP

S).

Yes

onS

UD

:•B

oth

cond

itio

nsim

prov

edon

seve

rity

and

diag

nosi

s(o

nC

IDI)

,and

num

ber

ofdr

ugcl

asse

sus

ed(O

TI)

.Y

eson

othe

rva

riab

les:

•Bot

hco

ndit

ions

impr

oved

onde

pres

sion

(BD

I-II

)an

dan

xiet

y(S

TA

I).


Tab

le2

Con

tinu

ed

(A)

Stud

ynu

mbe

r(s

eeT

able

1)

(B)

Out

com

ere

sult

sar

ere

port

edon

wha

tpe

rce

ntof

the

orig

inal

sam

ple

recr

uite

d?

(C)

Posi

tive

outc

omes

for

PT

SD

/tra

uma

(pre

-to

end-

of-

trea

tmen

t)?

(D)

Posi

tive

outc

omes

for

subs

tanc

eus

e/ad

dict

ion

(pre

-to

end-

of-t

reat

men

t)?

(E)

Posi

tive

othe

rou

tcom

es(p

re-

toen

d-of

-tre

atm

ent)

?A

lso

trea

tmen

tsa

tisf

acti

on?

(F)

Posi

tive

outc

omes

atfo

llow

-up2

for

PT

SD/t

raum

a,SU

D,a

ndot

her

vari

able

s(a

ndan

you

tcom

esin

dica

ting

ane

gati

veou

tcom

e(w

orse

ning

over

tim

e,or

the

cont

rolo

utpe

rfor

min

gth

eex

peri

men

tal

trea

tmen

t)

(35)

CC

pilo

tN

ajav

its

&Jo

hnso

n,un

der

revi

ew

100%

ofen

rolle

din

clud

edin

outc

ome

anal

ysis

(ful

lin

tent

-to-

trea

tan

alys

is).

•Yes

onsy

mpt

oms

(PC

Lto

tala

ndav

oida

nce

subs

cale

;T

SC-4

0to

tala

nd5

subs

cale

s);a

ndco

gnit

ions

(WA

Sto

tal)

.

•Yes

onco

gnit

ions

(BA

SUto

tal)

.•Y

eson

func

tion

ing

(BA

SIS-

32to

tal,

and

subs

cale

sde

pres

sion

/anx

iety

and

daily

livin

g),

psyc

hopa

thol

ogy

(BSI

tota

land

6su

bsca

les)

,co

ping

(CSI

soci

alsu

ppor

tsu

bsca

le),

self

-har

mco

gnit

ions

(SB

Q).

Not

asse

ssed

.

Str

ong

trea

tmen

tsa

tisf

acti

on.

Not

e.1.

We

are

only

repo

rtin

gsi

gnifi

cant

diff

eren

ces.

Any

null

findi

ngs

(“no

diff

eren

ce”)

are

not

repo

rted

,as

thes

eof

ten

refle

ctlim

ited

pow

er/s

ampl

esi

ze.A

lso,

notr

ends

are

repo

rted

(onl

yre

sult

sof

p<

.05)

and

only

resu

lts

onps

ycho

met

rica

llyva

lidin

stru

men

ts.

2.U

nles

sot

herw

ise

indi

cate

d,al

lfol

low

-ups

liste

din

follo

w-u

pco

lum

nar

eti

med

from

end

oftr

eatm

ent

tobe

com

para

ble

acro

ssst

udie

s.3.

♦Thi

ssy

mbo

lind

icat

esab

senc

eof

asu

ffici

ent

sam

ple

(les

sth

anha

lfof

thos

een

rolle

d)an

dth

usca

utio

nne

eded

inin

terp

reti

ngth

est

udy

resu

lts.

4.Sc

ale

abbr

evia

tion

s:A

PS

Ado

lesc

ent

Psy

chop

atho

logy

Scal

e;A

SI

Add

icti

onSe

veri

tyIn

dex;

BA

SIS

-32

Beh

avio

ran

dSy

mpt

omId

enti

ficat

ion

Scal

e(3

2it

emve

rsio

n);

BA

SU

Bel

iefs

Abo

utSu

bsta

nce

Use

;BD

I-II

Bec

kD

epre

ssio

nIn

vent

ory,

2nd

edit

ion;

BS

IB

rief

Sym

ptom

Inve

ntor

y;B

SI

GS

IB

rief

Sym

ptom

Inve

ntor

yG

loba

lSev

erit

yIn

dex;

CA

PS

Clin

icia

nA

dmin

iste

red

PT

SDSc

ale;

CID

IC

ompo

site

Inte

rnat

iona

lDia

gnos

tic

Inte

rvie

w;C

GIS

Clin

ical

Glo

balI

mpr

essi

ons

Scal

e;C

RI

Cop

ing

Res

pons

esIn

vent

ory;

CS

IC

opin

gSt

rate

gies

Inve

ntor

y;C

SQ

Clie

ntSa

tisf

acti

onQ

uest

ionn

aire

;DA

TS

Dru

gA

buse

Scre

enin

gT

est;

ED

EQ

Eat

ing

Dis

orde

rsE

xam

inat

ion

Que

stio

nnai

re;H

AQ

IIH

elpi

ngA

llian

ceQ

uest

ionn

aire

vers

ion

2;H

DR

SH

amilt

onR

atin

gSc

ale

for

Dep

ress

ion;

IES

-RIm

pact

ofE

vent

sSc

ale-

Rev

ised

;IIP

Inve

ntor

yof

Inte

rper

sona

lPro

blem

s;G

AF

Glo

balA

sses

smen

tof

Fun

ctio

ning

;G

AIN

Glo

bal

App

rais

alof

Indi

vidu

alN

eeds

;M

AS

TM

ichi

gan

Alc

ohol

Scre

enin

gT

est;

MP

SS

Mod

ified

PT

SDSy

mpt

omSc

ale;

OT

IO

piat

eT

reat

men

tIn

dex;

PC

LP

TSD

Che

cklis

t;P

EI

Per

sona

lE

xper

ienc

esIn

vent

ory;

PS

DS

Post

trau

mat

icSt

ress

Dia

gnos

tic

Scal

e;P

SS

PT

SDSy

mpt

omSc

ale

and

PS

S-R

revi

sed

vers

ion;

PT

CI

Post

-T

raum

atic

Cog

niti

ons

Inve

ntor

y;R

FU

Rea

sons

for

Usi

ng;S

AS

Soci

alA

djus

tmen

tSc

ale;

SB

QSu

icid

alB

ehav

iors

Que

stio

nnai

re;S

CID

Stru

ctur

edC

linic

alIn

terv

iew

for

DSM

IV;

SC

SSe

lf-C

ompa

ssio

nSc

ale;

ST

AI

Stai

t-T

rait

Anx

iety

Inve

ntor

y;S

UI

Subs

tanc

eU

seIn

vent

ory;

TS

C-4

0T

raum

aSy

mpt

omC

heck

list

40;T

SC

CT

raum

aSy

mpt

omC

heck

list

for

Chi

ldre

n;T

SI

Tra

uma

Sym

ptom

Inve

ntor

y;W

AS

Wor

ldA

ssum

ptio

nsSc

ale.

HelpingVulnerablePopulations:AComprehensiveReviewofthe...

Documents

Transcript of HelpingVulnerablePopulations:AComprehensiveReviewofthe...