Sexual assault (SA) often occurs in the context of substances, which can impair the trauma memory and contribute to negative cognitions like self-blame. Although these factors may affect posttraumatic stress disorder (PTSD) treatment, outcomes for substance-involved SA have not been evaluated or compared with other types of SA. As such, we conducted a secondary analysis of a dismantling trial for cognitive processing therapy (CPT), focusing on 58 women with an index trauma of SA that occurred since age 14. Women who experienced a substance-involved SA (n = 21) were compared with those who experienced a non–substance-involved SA (n = 37). Participants were randomized to CPT, CPT with written account (CPT+A), or written account only (WA). Regressions controlling for pretreatment symptom levels revealed no differences by SA type in PTSD severity at posttreatment. At 6-month follow-up, substance-involved SA was associated with more severe residual PTSD severity than non–substance-involved SA, with no significant differences by treatment condition. Among participants in the substance-involved SA group, the largest effect for reduced PTSD symptom severity from pretreatment to follow-up emerged in the CPT condition, d = −2.02, with reductions also observed in the CPT+A, d = −0.92, and WA groups, d = −1.23. Although more research in larger samples is needed, these preliminary findings suggest that following substance-involved SA, a cognitive treatment approach without a trauma account may facilitate lasting change in PTSD symptoms. We encourage replications to better understand the relative value of cognitive and exposure-based treatment for PTSD following substance-involved SAs.

中文翻译：

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针对药物性侵犯的认知处理疗法：账户有助于还是阻碍康复？


性侵犯（SA）通常发生在物质环境中，这会损害创伤记忆并导致自责等负面认知。尽管这些因素可能会影响创伤后应激障碍 (PTSD) 的治疗，但尚未对涉及物质的 SA 的结果进行评估或与其他类型的 SA 进行比较。因此，我们对一项认知加工治疗 (CPT) 拆除试验进行了二次分析，重点关注 58 名自 14 岁起就遭受过 SA 指数创伤的女性。经历过物质相关 SA 的女性 ( n = 21)与那些经历过非物质相关 SA 的人相比 ( n = 37)。参与者被随机分配到 CPT、带有书面记录的 CPT (CPT+A) 或仅书面记录 (WA)。控制治疗前症状水平的回归显示，不同 SA 类型在治疗后的 PTSD 严重程度方面没有差异。在 6 个月的随访中，与不涉及物质的 SA 相比，涉及物质的 SA 与更严重的残余 PTSD 严重程度相关，但治疗条件没有显着差异。在涉及物质的 SA 组参与者中，从治疗前到随访，减少 PTSD 症状严重程度的最大效果出现在 CPT 条件下， d = -2.02，在 CPT+A 条件下也观察到减轻， d = -0.92，和 WA 组， d = −1.23。尽管需要对更大样本进行更多研究，但这些初步研究结果表明，在涉及物质的 SA 后，无需考虑创伤的认知治疗方法可能会促进 PTSD 症状的持久改变。我们鼓励重复实验，以更好地了解认知和基于暴露的治疗对物质相关 SA 后的 PTSD 的相对价值。