Foa, E. B., Rothbaum, B. O., Riggs, D. S., & Murdock, T. B. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59(5), 715−723. https://doi.org/10.1037/0022-006X.59.5.715

Type of Study: Randomized controlled trial
Number of Participants: 45

Population:

• Age — Mean=31.8 years
• Race/Ethnicity — 73% White, 25% Black, and 2% Hispanic
• Gender — 100% Female
• Status — Participants were recruited through referrals from local professionals and victim assistance agencies, recruitment by local newspaper advertisements, and from a separate assessment study of the response to rape.

Location/Institution: Department of Psychiatry, Medical College of Pennsylvania

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of Prolonged Exposure Therapy [now called Prolonged Exposure Therapy for PTSD for Adults (PE)]. Participants were randomly assigned to 1 of 4 conditions: Stress Inoculation Training (SIT), PE, supportive counseling (SC), or wait-list control (WL). Measures utilized include the Rape Aftermath Symptom Test (RAST), the Slate-Trait Anxiety Inventory (STAl), and the Beck Depression Inventory (BDI). Results indicate that all conditions produced improvement on all measures immediately posttreatment and at follow-up. However, SIT produced significantly more improvement on PTSD symptoms than did SC and WL immediately following treatment. At follow-up, PE produced superior outcome on PTSD symptoms. Limitations include small sample size, low recruitment rates, and concerns about generalizability.

Length of controlled postintervention follow-up: Mean=3.5 months.

Foa, E. B., Dancu, C. V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder in female assault victims. Journal of Consulting and Clinical Psychology, 67(2), 194−200. https://doi.org/10.1037//0022-006x.67.2.194

Type of Study: Randomized controlled trial
Number of Participants: 96

Population:

• Age — Mean=34.9 years
• Race/Ethnicity — 63% Caucasian and 36% African American
• Gender — 100% Female
• Status — Participants were female victims of sexual and nonsexual assault with chronic posttraumatic stress disorder (PTSD).

Location/Institution: Not Specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess assault victims with chronic PTSD that were assigned to one of 4 treatment conditions: Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)], Stress Inoculation Training (SIT), combined treatment (PE-SIT), or wait-list control (WL). Participants were randomly assigned to PE, SIT, PE-SIT, or WL. Measures utilized include the Structured Clinical Interview for DSM–IV Axis I Disorders with Psychotic Screen (SCID), the PTSD Symptom Scale—Interview (PSS-I), the Beck Depression Inventory (BDI), Social Adjustment Scale (SAS), and State-Trait Anxiety Inventory (STAI). Results indicate that all 3 active treatments reduced severity of posttraumatic stress disorder (PTSD) and depression compared with WL, but did not differ significantly from each other, and these gains were maintained throughout the follow-up period. However, in the intent-to-treat sample, PE was superior to SIT and PE-SIT on posttreatment anxiety and global social adjustment at follow-up and had larger effect sizes on PTSD severity, depression, and anxiety. SIT and PE-SIT did not differ significantly from each other on any outcome measure. Limitations include differences in dropout rates between the treatment groups.

Length of controlled postintervention follow-up: 3, 6, and 12 months.

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Counseling and Clinical Psychology, 70(4), 867–879. https://doi.org/10.1037/0022-006X.70.4.867

Type of Study: Randomized controlled trial
Number of Participants: 171

Population:

• Age — Mean=32 years
• Race/Ethnicity — 71% White, 25% African American, and 4% Other
• Gender — 100% Female
• Status — Participants were female rape victims.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Cognitive-Processing Therapy (CPT) with Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)], and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. Participants were randomly assigned to one of the three groups, CPT, PE, or minimal attention waiting-list condition (MA). Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Interview for DSM–IV—Patient Version (SCID), Standardized Trauma Interview, the PTSD Symptom Scale, the Structured Clinical Interview for DSM–IV, the Beck Depression Inventory, the Trauma-Related Guilt Inventory (TRGI), and the Expectancy of Therapeutic Outcome Scale. Results indicate that CPT and PE treatments were superior to MA. The two therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales. Among those who completed the treatments as designed, the effect sizes for both treatments were quite large. There was a slight advantage in effect sizes and end-state functioning favoring CPT over PE through the 3-month follow-up. Limitations include concerns regarding generalization beyond rape traumas.

Length of controlled postintervention follow-up: 3 months, some women also received a 9-month follow-up.

Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A., Riggs, D. S., Feeny, N. C., & Yadin, E. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73(5), 953−964. https://doi.org/10.1037/0022-006X.73.5.953

Type of Study: Randomized controlled trial
Number of Participants: 171

Population:

• Age — Mean=31 years
• Race/Ethnicity — 88 Caucasian, 78 African American, and 13 Other
• Gender — 100% Female
• Status — Participants were female assault survivors with chronic posttraumatic stress disorder (PTSD).

Location/Institution: Center for the Treatment and Study of Anxiety (CTSA), or through Women Organized Against Rape (WOAR)

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)], PE plus cognitive restructuring (PE/CR), or wait-list (WL) for participants who suffered from PTSD. Participants were randomly assigned to PE, PE/CR or the WL condition. Measures utilized include the Structured Clinical Interview for DSM–IV Axis I Disorders With Psychotic Screen, the PTSD Symptom Scale—Interview (PSS), the Beck Depression Inventory (BDI), the Social Adjustment Scale (SAS), and the PTSD Symptom Scale—Self-Report (PSS–SR). Results indicate that both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition, and social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found. Treatment in the hands of counselors with minimal cognitive– behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment. Limitations include the lack of a control group and lack of generalizability to other population groups.

Length of controlled postintervention follow-up: 3, 6, and 12 months.

Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18(6), 607−616. https://doi.org/10.1002/jts.20069

Type of Study: Randomized controlled trial
Number of Participants: 74

Population:

• Age — Mean=33.8 years
• Race/Ethnicity — 68% Caucasian
• Gender — 100% Female
• Status — Participants were individuals with posttraumatic stress disorder (PTSD).

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)], and Eye Movement Desensitization and Reprocessing (EMDR) compared to a no-treatment waitlist control (WAIT) in the treatment of PTSD in adult female rape victims. Participants were randomly assigned to either PE, EMDR or WAIT conditions. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Assault Information Interview (AII), the Stressful Life Events Screening Questionnaire (SLESQ), the Structured Clinical Interview for DSM–IV Non Patient Version (SCID), the PTSD Symptom Scale-Self-Report (PSS-SR), the Impact of Event Scale-Revised (IES-R), the Beck Depression Inventory (BDI), the Dissociative Experiences Scale-II (DES-II), and the State-Trait Anxiety Inventory (STAI). Results indicate that improvement in PTSD was significantly greater in both the PE and EMDR group than the WAIT group. Limitations include the small sample size and lack of generalizability due to gender.

Length of controlled postintervention follow-up: 6 months (PE and EMDR only).

Rothbaum, B. O., Cahill, S. P., Foa, E. B., Davidson, J. R., Compton, J., Connor, K. M., Astin, M. C., & Hahn, C. G. (2006). Augmentation of sertraline with prolonged exposure in the treatment of posttraumatic stress disorder. Journal of Traumatic Stress, 19(5), 625−638. https://doi.org/10.1002/jts.20170

Type of Study: Randomized controlled trial
Number of Participants: 74

Population:

• Age — Mean=39.3 years
• Race/Ethnicity — 80% White, 19% African American, and 2% Other
• Gender — 65% Female
• Status — Participants were outpatient men and women with chronic posttraumatic stress disorder (PTSD).

Location/Institution: Emory University in Atlanta, Georgia; University of Pennsylvania in Philadelphia, Pennsylvania; and Duke University in Durham, North Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether augmenting sertraline with Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)] would result in greater improvement than continuation with sertraline alone. Participants were randomly assigned to either continue sertraline on its own or to receive sertraline in combination with PE. Measures utilized include the Structured Clinical Interview for DSM–Patient Edition with Psychotic Screen (SCID), the Standardized Trauma Interview (STI), the Structured Interview for PTSD (SIP), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). Results indicate that continuing sertraline on its own led to no further reductions, while participants who received PE in addition to sertraline showed further reduction in PTSD severity. This effect was observed only for participants who showed a partial response to medication. Limitations include the lack of a PE-only control group, lack of follow-up, and that findings may not generalize to other medications.

Length of controlled postintervention follow-up: None.

Schnurr, P. P., Friedman, M. J., Engel, C. C., Foa, E. B., Shea, M. T., Chow, B. K., Resick, P. A., Thurston, V., Orsillo, S. M., Haug, R., Turner, C., & Bernardy, N. (2007). Cognitive behavioral therapy for posttraumatic stress disorder in women. Journal of the American Medical Association, 297(8), 820−830. https://doi.org/10.1001/jama.297.8.820 

Type of Study: Randomized controlled trial
Number of Participants: 277

Population:

• Age — Not specified
• Race/Ethnicity — Not specified
• Gender — 100% Female
• Status — Participants were women who suffered from posttraumatic stress disorder (PTSD).

Location/Institution: Nine VA medical centers

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)] with Present-Centered Therapy for the treatment of PTSD. Participants were randomly assigned to PE or Present-Centered Therapy. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the PTSD Checklist, and the Structured Clinical Interview for DSM–IV (SCID). Results indicate that women who received PE experienced greater reduction of PTSD symptoms relative to women who received Present-Centered Therapy. The PE group was more likely than the Present-Centered Therapy group to no longer meet PTSD diagnostic criteria and achieve total remission. Limitations include attrition bias and findings may not generalize to other populations.

Length of controlled postintervention follow-up: 3 and 6 months.

Rauch, S. A., Grunfeld, T. E., Yadin, E., Cahill, S. P., Hembree, E., & Foa, E. B. (2009). Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder. Depression and Anxiety, 26(8), 732−738. https://doi.org/10.1002/da.20518

Type of Study: Randomized controlled trial
Number of Participants: 105

Population:

• Age — Mean=31 years
• Race/Ethnicity — 53% Caucasian, 39% African American, and 8% Other
• Gender — 100% Female
• Status — Participants were female assault survivors with chronic posttraumatic stress disorder (PTSD).

Location/Institution: Center for the Treatment and Study of Anxiety (CTSA), or through Women Organized Against Rape (WOAR)

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Foa et al. (2005). The purpose of the study was to compare Prolonged Exposure (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)] or PE combined with Cognitive Restructuring (PE/CR) to a waitlist and examine negative health perceptions and general social functioning change with treatment of chronic PTSD among women. Only those participants that were classified as completers from the original sample were examined. Participants were randomly assigned to PE, PE/CR or waitlist control group. Measures utilized include the Pennebaker Inventory of Limbic Languidness (PILL), the Social Adjustment Scale, the Structured Clinical Interview for DSM–IV Axis I Disorders with Psychotic Screen, the PTSD Symptom Scale—Interview (PSS), the Beck Depression Inventory (BDI), the Social Adjustment Scale (SAS), and the PTSD Symptom Scale—Self-Report (PSS–SR). Results indicate that self-reported physical health difficulties were significantly reduced in the PE and PE/CR conditions compared to the waitlist condition. These reductions did not demonstrate significant change during the 12-month follow-up period. Self-reported discomfort associated with physical health difficulties did not demonstrate significant change over treatment. No difference was detected between the active treatment and waitlist conditions. Both the PE and PE/CR groups reported improved social functioning at posttreatment compared to the waitlist. Additional improvement in general social functioning was found between 3- and 12-month follow-up assessments. Changes in PTSD and depressive symptoms over treatment accounted for 29% of the variance in reduction of reported health problems and 30% of the variance in improvement of general social functioning. Importantly, only changes in PTSD symptoms significantly contribute to the model predicting change in physical health problems with depression associated only at a trend level. Limitations include the small sample size, missing data, and reliance on self-reported measures.

Length of controlled postintervention follow-up: 3 and 12 months.

Nacasch, N., Foa, E. B., Huppert, J. D., Tzur, D., Fostick, L., Dinstein, Y., Polliack, M., & Zohar, J. (2011). Prolonged exposure therapy for combat- and terror-related posttraumatic stress disorder: A randomized control comparison with treatment as usual. The Journal of Clinical Psychiatry, 72(9), 1174−1180. https://doi.org/10.4088/JCP.09m05682blu

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

• Age — PE: Mean=34.8 years; TAU: Mean=33.7 years
• Race/Ethnicity — Not specified
• Gender — Not specified
• Status — Participants were patients in a psychiatric trauma unit with posttraumatic stress disorder (PTSD) related to combat or terror.

Location/Institution: Chaim Sheba Medical Center in Israel

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine patients of a trauma unit within a psychiatric outpatient clinic. Participants were randomly assigned to either Prolonged Exposure Therapy (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)] or treatment as usual (TAU). Measures utilized include the Mini International Neuropsychiatric Interview, the PTSD Symptom Scale—Interview (PSS-I), the Beck Depression Inventory (BDI), the Social Adjustment Scale (SAS), the State-Trait Anxiety Inventory (STAI), and the Posttraumatic Cognitions Inventory (PTCI). Results indicate that posttraumatic stress disorder (PTSD) was significantly lower in patients who received PE in comparison to patients who received TAU. Limitations include the sample size and concerns about generalizability due to the vast majority of the participants being male.

Length of controlled postintervention follow-up: 12 months.

Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., Gradus, J. L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80(2), 201−210. https://doi.org/10.1037/a0026602

Type of Study: Randomized controlled trial
Number of Participants: 144

Population:

• Age — Mean=32 years
• Race/Ethnicity — 71% White, 25% African American, and 4% Other
• Gender — 100% Female
• Status — Participants were female rape victims.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Resick et al. (2002). The purpose of the study was to conduct a long-term follow-up assessment of participants from a randomized controlled trial which compared Cognitive Processing Therapy (CPT) with Prolonged Exposure Therapy (PE) [now called Prolonged Exposure Therapy for PTSD for Adults (PE)]. Participants were randomly assigned to PE or CPT. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Interview for DSM–IV—Patient Version (SCID), the Standardized Trauma Interview, the PTSD Symptom Scale, the Structured Clinical Interview for DSM–IV, the Beck Depression Inventory, the Trauma-Related Guilt Inventory (TRGI), and the Expectancy of Therapeutic Outcome Scale. Results indicate that substantial decreases in symptoms due to PE were maintained throughout the follow-up period, as evidenced by little change over time from posttreatment through follow-up. No significant differences emerged during the follow-up between the treatment conditions and maintenance of improvements could not be attributed to further therapy or medications. Limitations include poor generalizability due to ethnicity and gender.

Length of controlled postintervention follow-up: 5−10 years (mean=6 years).