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Stalking has been relatively understudied compared to other dimensions of intimate partner violence. The purpose of this article was to examine concurrent and subsequent intimate partner abuse, strategic responses and symptomatic... more
Stalking has been relatively understudied compared to other dimensions of intimate partner violence. The purpose of this article was to examine concurrent and subsequent intimate partner abuse, strategic responses and symptomatic consequences of severe stalking experienced by battered women. Thirty-five battered women classified as "relentlessly stalked" and 31 infrequently stalked battered women were compared. Compared to infrequently stalked battered women, relentlessly stalked battered women reported: (a) more severe concurrent physical violence, sexual assault and emotional abuse: (b) increased post-separation assault and stalking; (c) increased rates of depression and PTSD; and (d) more extensive use of strategic responses to abuse. Results underscore the scope and magnitude of stalking faced by battered women and have implications for assessment and intervention strategies.
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This review examines the question of whether there should be a cluster of disorders, including the adjustment disorders (ADs), acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and the dissociative disorders (DDs), in a... more
This review examines the question of whether there should be a cluster of disorders, including the adjustment disorders (ADs), acute stress disorder (ASD), posttraumatic stress disorder (PTSD), and the dissociative disorders (DDs), in a section devoted to abnormal responses to stress and trauma in the DSM-5. Environmental risk factors, including the individual's developmental experience, would thus become a major diagnostic consideration. The relationship of these disorders to one another is examined and also their relationship to other anxiety disorders to determine whether they are better grouped with anxiety disorders or a new specific grouping of trauma and stressor-related disorders. First how stress responses have been classified since DSM-III is reviewed. The major focus is on PTSD because it has received the most attention, regarding its proper placement among the psychiatric diagnoses. It is discussed whether PTSD should be considered an anxiety disorder, a stress-induc...
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This is a review of the relevant empirical literature concerning the DSM-IV-TR diagnostic criteria for PTSD. Most of this work has focused on Criteria A1 and A2, the two components of the A (Stressor) Criterion. With regard to A1, the... more
This is a review of the relevant empirical literature concerning the DSM-IV-TR diagnostic criteria for PTSD. Most of this work has focused on Criteria A1 and A2, the two components of the A (Stressor) Criterion. With regard to A1, the review considers: (a) whether A1 is etiologically or temporally related to the PTSD symptoms; (b) whether it is possible to distinguish "traumatic" from "non-traumatic" stressors; and (c) whether A1 should be eliminated from DSM-5. Empirical literature regarding the utility of the A2 criterion indicates that there is little support for keeping the A2 criterion in DSM-5. The B (reexperiencing), C (avoidance/numbing) and D (hyperarousal) criteria are also reviewed. Confirmatory factor analyses suggest that the latent structure of PTSD appears to consist of four distinct symptom clusters rather than the three-cluster structure found in DSM-IV. It has also been shown that in addition to the fear-based symptoms emphasized in DSM-IV, trau...
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Female Veterans are at high risk for physical, sexual, and psychological forms of intimate partner violence (IPV) victimization. This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans... more
Female Veterans are at high risk for physical, sexual, and psychological forms of intimate partner violence (IPV) victimization. This study evaluated the accuracy of a brief IPV victimization screening tool for use with female Veterans Health Administration (VHA) patients. Participants completed a paper-and-pencil mail survey that included the four-item Hurt/Insult/Threaten/Scream (HITS) and the 39-item Revised Conflict Tactics Scales (CTS-2). Operating characteristics, including sensitivity and specificity, were calculated using the CTS-2 as the reference standard for past-year IPV. Female veterans from a roster of randomly selected female patients of the New England VA Healthcare System. Women must have reported being in an intimate relationship in the past year to be included. Primary measures included the HITS (index test) and the CTS-2 (reference standard). This study included 160 women. The percentage of women who reported past-year IPV, as measured by any physical assault, se...
Research Interests: Domestic Violence, Combat Veterans, General Internal Medicine, Adolescent, Intimate Partner Violence, and 13 moreHumans, Female, Veterans, Young Adult, Clinical Sciences, Aged, Middle Aged, Adult, New England, Military Women and Veterans, Sensitivity and Specificity, Veterans Health, and Socioeconomic Factors
The 4-item Hurt/Insult/Threaten/Scream (HITS) tool accurately detects past-year intimate partner violence (IPV) among female Veterans Health Administration (VHA) patients; however, it lacks a sexual IPV item. This study evaluated the... more
The 4-item Hurt/Insult/Threaten/Scream (HITS) tool accurately detects past-year intimate partner violence (IPV) among female Veterans Health Administration (VHA) patients; however, it lacks a sexual IPV item. This study evaluated the accuracy of an extended HITS (E-HITS), which adds a sexual IPV item, in female VHA patients. A sample of 80 female U.S. veteran VHA patients in New England completed a mail survey (50.0% response rate) that included the 5-item E-HITS and the Revised Conflict Tactics Scales (CTS-2). Women were included if they were in an intimate relationship in the past year. The women averaged 49 years of age and 86.0% of the sample was White. Accuracy of the 4-item HITS was compared to the 5-item E-HITS, using the CTS-2 as the reference. There were 20 women (25.0%) who reported past-year IPV on the CTS-2. The receiver operator characteristic curves demonstrated that the HITS and E-HITS performed nearly identically at their optimal cutoff scores of 6 and 7, respectivel...
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This study examined the effect of child sexual or physical abuse on brief cognitive-behavioral therapy treatments with adults with posttraumatic stress disorder (PTSD). We analyzed secondary data from two randomized controlled trials... more
This study examined the effect of child sexual or physical abuse on brief cognitive-behavioral therapy treatments with adults with posttraumatic stress disorder (PTSD). We analyzed secondary data from two randomized controlled trials (Resick, Nishith, Weaver, Astin, & Feuer, 2002; Resick et al., 2008) that included women with PTSD who did or did not have child sexual abuse (CSA) or child physical abuse (CPA) histories to determine whether childhood abuse impacted dropout rate or reduction in PTSD symptoms. In Study 1, presence, duration, or severity of CSA was not associated with dropout; however, frequency of CSA significantly predicted dropout (OR = 1.23). A significant CPA Severity × Treatment Group interaction emerged such that CPA severity was associated with greater dropout for prolonged exposure (PE; OR = 1.45), but not cognitive processing therapy (CPT; OR = 0.90). Study 2 found no differences in dropout. Study 1, comparing CPT and PE among women who experienced at least 1 r...
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This study examined whether cognitive distortions (i.e., assimilated and overaccommodated thoughts) and realistic (i.e., accommodated) thoughts assessed from impact statements written 5-10 years after completing cognitive processing... more
This study examined whether cognitive distortions (i.e., assimilated and overaccommodated thoughts) and realistic (i.e., accommodated) thoughts assessed from impact statements written 5-10 years after completing cognitive processing therapy (CPT) accurately predicted posttreatment maintenance or decline in treatment gains during the same period. The sample included 50 women diagnosed with posttraumatic stress disorder (PTSD) secondary to rape who participated in a randomized clinical trial of CPT for PTSD. Cognitions were assessed via coding and analyses of participants' written impact statements at three time points: beginning of treatment, end of treatment, and at 5-10 years follow-up. Primary mental health outcomes were symptoms of PTSD (Clinician-Administered PTSD Scale) and depression (Beck Depression Inventory). Changes in trauma-related beliefs between the end of treatment and long-term follow-up were associated with concomitant changes in PTSD and depression symptoms (ef...
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Intimate partner violence (IPV) survivors often report histories of childhood maltreatment, yet the unique contributions of childhood maltreatment on IPV survivors' distinct posttraumatic stress disorder (PTSD) symptoms remain... more
Intimate partner violence (IPV) survivors often report histories of childhood maltreatment, yet the unique contributions of childhood maltreatment on IPV survivors' distinct posttraumatic stress disorder (PTSD) symptoms remain inadequately understood. Using interview and self-report measures, we examined IPV as a potential mediator of the association between childhood maltreatment and severity of PTSD symptom clusters (reexperiencing, avoidance, numbing, and hyperarousal) among a sample of 425 women seeking help for recent IPV. Structural equation modeling demonstrated that while both childhood maltreatment and IPV were both positively associated with PTSD symptom clusters, IPV did not mediate the association between childhood maltreatment and severity of PTSD symptom clusters among acute IPV survivors. Childhood maltreatment has persistent effects on the PTSD symptoms of IPV survivors, suggesting that child maltreatment may need to be addressed in addition to IPV during PTSD tr...
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With the advent of managed care, there is an increasing need for short-term, empirically based treatments. This article presents a cognitive behavioral therapy protocol for the treatment of adult survivors of childhood sexual abuse,... more
With the advent of managed care, there is an increasing need for short-term, empirically based treatments. This article presents a cognitive behavioral therapy protocol for the treatment of adult survivors of childhood sexual abuse, Cognitive Processing Therapy for Sexual Abuse (CPT-SA). Based on information processing, developmental and self-trauma theories, this 26-session model combines group and individual therapy over a 17-week period. Clients are asked to write about the trauma, and explore adaptive, schema congruent, and discrepant beliefs that developed during and after the abuse. Focus is placed on beliefs related to safety, trust, power/control, self-esteem, and intimacy, with individual modules for each of these areas. Initial pilot data (N = 15), clinical implications, and two client case studies are also discussed.
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This study conducted secondary analyses of a published trial and sought to determine if different domains of psychosocial functioning (e.g., daily living, work, nonfamily relationships) improved following trauma-focused treatment for... more
This study conducted secondary analyses of a published trial and sought to determine if different domains of psychosocial functioning (e.g., daily living, work, nonfamily relationships) improved following trauma-focused treatment for posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT), an empirically supported treatment that involves evaluating trauma-related beliefs and written trauma accounts, was compared to its components: CPT without the written accounts or written accounts only in a sample of 78 women with PTSD secondary to interpersonal violence. Overall and individual domains of functioning significantly improved with treatment and results were similar across treatment groups, Fs (2, 150) ≥ 11.87, ps < .001. Additionally, we investigated whether changes in different PTSD symptom clusters were associated with outcomes in domains of psychosocial functioning, after collapsing across treatment condition. Multiple hierarchical linear regression analyses revealed that overall clinician-assessed PTSD symptom reduction was associated with outcomes in all domains of functioning, βs = .44 to .68, ps < .001. Additionally, improvements in the emotional numbing symptom cluster were associated with outcomes in the nonfamily relationships domain, β = .42, p < .001, and improvements in the hyperarousal symptom cluster were associated with outcomes in the overall, daily living, and household tasks domains, βs = .34 to .39, ps < .01. Results suggest that it may be important to monitor improvements in emotional numbing and hyperarousal symptoms throughout treatment to increase the likelihood of changes in psychosocial functioning.
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This study examined the clinical course of different dimensions of anger and their relationship to change in posttraumatic stress disorder (PTSD) in a sample of 139 female survivors of interpersonal violence suffering from PTSD.... more
This study examined the clinical course of different dimensions of anger and their relationship to change in posttraumatic stress disorder (PTSD) in a sample of 139 female survivors of interpersonal violence suffering from PTSD. Specifically, this study evaluated differences in the rates of change in anger dimensions by responsivity to treatment status (responders, non-responders, and drop-outs). Responders and non-responders did not differ in rate of change on state anger and anger directed inward, suggesting that treatment led to improvements in these dimensions of anger regardless of final PTSD diagnosis. Responders did evidence statistically significantly more change in trait anger and control over one's anger than did the non-responders, suggesting that changes in these dimensions of anger may be related to recovery from PTSD. Individuals who terminated therapy prematurely did not experience the same gains in state anger, trait anger, or anger-in as those who completed trea...
Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure... more
Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy
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Few studies have examined the impact of trauma research participation upon trauma survivors. Empirical data regarding reactions to research participation would be very useful to address the question of whether it is harmful for trauma... more
Few studies have examined the impact of trauma research participation upon trauma survivors. Empirical data regarding reactions to research participation would be very useful to address the question of whether it is harmful for trauma survivors to participate in trauma studies. We examined participant reactions to different trauma assessment procedures in domestic violence (N = 260), rape (N = 108),
Research Interests: Psychology, Domestic Violence, Violence, Mental Health, Traumatic Stress, and 21 moreDepression, Rape, Victimology, Stress, Sexual Assault, Adolescent, Comparative Study, Humans, Biomedical Research, Posttraumatic stress disorder, Survivors, Female, Male, Young Adult, Attitude, Middle Aged, Adult, Scientific Research, Patient Participation, Subjective Experience, and Traumatic
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The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms,... more
The purpose of this study was to assess the relationship between sleep difficulties and drinking motives in female rape victims with posttraumatic stress disorder (PTSD). Seventy-four participants were assessed for PTSD symptoms, depression, sleep difficulties, and drinking motives. Results demonstrated that neither PTSD symptoms nor depression were related to any motives for using alcohol. On the other hand, after controlling
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ABSTRACT In this article, we report on a pilot study of Strength at Home-Couples (SAH-C), a 10-session cognitive-behavioral couples-based group intervention designed to prevent intimate partner violence (IPV) in military couples. The... more
ABSTRACT In this article, we report on a pilot study of Strength at Home-Couples (SAH-C), a 10-session cognitive-behavioral couples-based group intervention designed to prevent intimate partner violence (IPV) in military couples. The primary purposes of this pilot study were to determine feasibility of recruiting, retaining, and assessing SAH-C participants in addition to those participating in a comparison Supportive Therapy (ST) group-based couples intervention. Recruitment was challenging for this pilot study and we report on several barriers to recruitment as well as “lessons learned” for enhancing recruitment and overall intervention efforts. Preliminary pilot data were promising with respect to reductions and prevention of IPV in those receiving the SAH-C intervention. Initial results for the secondary intervention targets were less favorable for the SAH-C intervention, with effect sizes suggesting a trend in which relationship satisfaction increased more in the ST intervention.
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This study examined the relative contributions of the three forms of childhood family violence exposure on physical intimate partner violence (IPV) victimization among recent robbery victims and tested a gender-matching modeling... more
This study examined the relative contributions of the three forms of childhood family violence exposure on physical intimate partner violence (IPV) victimization among recent robbery victims and tested a gender-matching modeling prediction for IPV risk. Data from a sample of 103 male and 93 female victims of a robbery were analyzed to investigate the effects of exposure to childhood physical abuse (CPA), childhood sexual abuse (CSA), and witnessing parental violence on the likelihood of IPV in adulthood. As expected, witnessing parental violence was associated with a 2.4-fold increase in IPV for both men and women. Neither CPA nor CSA was significantly associated with IPV after accounting for the effect of witnessing parental violence. There was support for the gender-matching hypothesis with men more likely to report IPV if they had witnessed mother-to-father violence and women more likely to report IPV if they had witnessed father-to-mother violence. Witnessing parental violence is strongly associated with risk for IPV victimization, particularly when the victim is the same-gender parent. Future directions and clinical implications are discussed.
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Research Interests: Psychology, Traumatic Stress, Rape, Victimology, Treatment, and 21 moreStress, Treatment Outcome, Health, Sexual Assault, Humans, Sleep Quality, Posttraumatic stress disorder, Physical Health, Female, Cognitive Therapy, Sleep disorders, Cognitive behavior therapy, Cognitive Process, Empirical Study, Health Status, Questionnaires, Adult, Self Perception, Traumatic, Mortality rate, and Health Outcome
Research Interests: Psychology, Traumatic Stress, Humans, Female, Regression Analysis, and 8 moreMissouri, Floods, Aged, Middle Aged, Questionnaires, Adult, Illinois, and Traumatic
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Eating disorders and posttraumatic stress disorder (PTSD) are debilitating conditions that frequently co-occur. Although the two disorders have different clinical presentations, they share associated features, including cognitive... more
Eating disorders and posttraumatic stress disorder (PTSD) are debilitating conditions that frequently co-occur. Although the two disorders have different clinical presentations, they share associated features, including cognitive disturbances, emotion dysregulation, dissociation, and impulsivity. We hypothesized that reductions in PTSD symptoms following cognitive processing therapy (CPT) and its treatment components (CPT without the written account or the written account only) would be associated with improvements in symptoms common to PTSD and eating disorders. Participants in the current investigation included women with PTSD (N = 65) who reported a history of rape or physical assault, were in a randomized dismantling study of CPT, and completed the Eating Disorder Inventory-2 (EDI-2) at pre- and posttreatment. Latent growth modeling results indicated that decreases in PTSD symptom scores were significantly associated with reductions in the Impulse Regulation, Interoceptive Awareness, Interpersonal Distrust, Ineffectiveness, and Maturity Fears subscales of the EDI-2. Thus, PTSD treatment affected symptoms shared by PTSD and eating disorders. Currently, there are no clear guidelines for treatment of comorbid PTSD and eating disorders. Traditional CPT may impact symptoms common to both, but additional therapy may be needed for specific disordered eating attitudes and behaviors.