Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency.

Posttraumatic stress disorder (PTSD) is prevalent in youth involved in delinquency, but it is often not effectively treated. A randomized clinical trial was conducted comparing the outcomes of an emotion regulation therapy (Trauma Affect Regulation: Guide for Education and Therapy, or TARGET) with a relational supportive therapy (Enhanced Treatment as Usual, or ETAU) with 59 delinquent girls (age 13-17 years) who met criteria for full or partial PTSD. Mixed model regression analyses demonstrated generally large effects for pre-post change in PTSD symptoms for both therapies but not in emotion regulation. Both therapies had small to medium effect size changes in anxiety, anger, depression, and posttraumatic cognitions. Treatment × Time interactions showed small to medium effects favoring TARGET for change in PTSD (intrusive reexperiencing and avoidance) and anxiety symptoms, posttraumatic cognitions, and emotion regulation, and favoring ETAU for change in hope and anger. Results provide preliminary support for TARGET as a potentially efficacious therapy for PTSD with delinquent girls. Relational therapies such as ETAU also may be beneficial for delinquent girls with PTSD, particularly to enhance optimism and self-efficacy and reduce anger.

A randomized clinical trial comparing affect regulation and social problem-solving psychotherapies for mothers with victimization-related PTSD.

Addressing affect dysregulation may provide a complementary alternative or adjunctive approach to the empirically supported trauma memory processing models of cognitive behavior therapy (CBT) for posttraumatic stress disorder (PTSD). A CBT designed to enhance affect regulation without trauma memory processing--trauma affect regulation: guide for education and therapy (TARGET)--was compared to present centered therapy (PCT) and wait-list (WL) conditions in a randomized clinical trial with 146 primarily low-income and ethnoracial minority mothers with PTSD. TARGET achieved statistically and clinically significant improvement on PTSD and affect regulation measures compared to WL, with more consistent and sustained (over a 6-month follow-up period) evidence of improvement than PCT. Drop-out rates (~25%) were comparable in TARGET and PCT, similar to those previously reported for trauma memory processing CBTs. Symptom worsening was rare (2-8%) and transient. Affect regulation-based CBT without trauma memory processing warrants further research as a potentially efficacious therapy for victimization-related PTSD.

Childhood maltreatment in male and female treatment-seeking pathological gamblers.

Little empirical research has evaluated childhood abuse in pathological gamblers. This study describes results of an analysis of childhood maltreatment histories among 149 pathological gamblers being treated at 1 of 7 gambling treatment programs. Measurements included instruments assessing gambling behavior and the Childhood Trauma Questionnaire (CTQ; D. P. Bernstein et al., 1994). Women scored higher than men on the overall CTQ scale and subscales measuring childhood physical neglect, emotional abuse, and sexual abuse. Severity of childhood maltreatment was significantly and independently associated with lower age of onset of gambling and increased severity of gambling problems. This study suggests that childhood maltreatment is prevalent in pathological gamblers, especially female gamblers. These results warrant further investigation of the role of childhood maltreatment in the etiology of pathological gambling and its treatment.

Tailoring cannabis dependence treatment for a diverse population.

Accumulating evidence suggests that psychosocial treatment for cannabis dependence is effective. Earlier investigations were well designed and sought to evaluate efficacy of manual-guided therapies with particular attention to protecting the independent variable. The Marijuana Treatment Project (MTP) represents an effort to build upon previous knowledge about cannabis dependence treatment through an evaluation of an integrative therapy, which was meant to allow for greater therapist latitude in its delivery, and to be more responsive to a potentially more diverse population of clients. The treatment intervention developed for delivery in the Marijuana Treatment Project (MTP) reflects an effort to find a true compromise between the needs of the scientific community to have clearly specified and measurable treatments, and the realities of the treatment community, which demand flexibility, appreciation of the multi-determined nature of most problems, and individualized approaches. This paper will describe the clinical interventions used with the MTP participants, the theoretical rationale guiding their design and practical aspects related to implementation and treatment response.