ABSTRACT
Cognitive processing therapy (CPT) is an exposure-based protocol designed to reduce posttraumatic stress disorder (PTSD) symptoms and challenge faulty beliefs and interpretations that prevent trauma survivors from coming to terms with their traumatic experiences. This article provides a brief summary of this treatment and the related literature and describes how the CPT protocol was modified to implement this treatment in this study's setting. Also provided is a discussion of various institutional and intrapatient barriers that existed before the introduction of CPT and how these difficulties were ultimately resolved. Patients' responses to treatment, as indicated by both qualitative and quantitative data, are also reviewed. A total of 18 patients participated and completed treatment with CPT (50% Caucasian, 22.2% African American, 16.7% biracial, 5.6% Native American, and 5.6% Hispanic). Overall, the women participating in the protocol benefited greatly, and 15 of the 18 women had a statistically significant reduction in scores measuring PTSD symptoms. The article concludes with recommendations to other programs and providers interested in providing CPT to similar treatment populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved).
ABSTRACT
OBJECTIVE: This study assessed mood and neuropsychological function in a population of middle-aged women with major depressive disorder treated with escitalopram. METHODS: Psychometric data measuring severity of depression were collected from 19 women and neuropsychological data were collected from 17 women aged between 45 and 65 years with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depression in a study in the Behavioral Neuroendocrinology Program at the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine. All women were treated with escitalopram in an open-label design. Mean age was 55.94 years and mean number of years of education was 16.36 years. Diagnosis of major depressive disorder was assessed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and mood was evaluated with the 21-item Hamilton Depression Rating Scale (HAM-D) at baseline and at weekly follow-ups for 12 weeks. Cognition was assessed at baseline and 3 months after treatment using a neuropsychological test battery, which included an abbreviated measure of Full Scale Intelligence Quotient, measures of attention and processing speed, verbal and nonverbal memory, executive functioning, and verbal fluency. Self-report data were collected on current menopause status and current hormone therapy use in the postmenopausal women. Paired sample t tests were used to analyze the change in total HAM-D scores and neuropsychological variables. RESULTS: Statistically significant improvements were found in total HAM-D score, Wechsler Memory Scale III Logical Memory 1st Recall, I, and II scores, Wechsler Memory Scale III Visual Reproduction I scores, and Trail Making Test Part B scores. There was a statistically significant decrease in Controlled Oral Word Association Test FAS scores. CONCLUSIONS: Treatment of depression with escitalopram in a population of middle-aged women was shown to improve mood and cognitive efficiency in complex attention, short- and long-term recall of contextual information, short-term recall of visual information, and cognitive flexibility; however, it was shown to worsen phonemic fluency.
