| Participants |
Baseline characteristics
CBT (CPT)
Participants (at randomisation): 56 Gender: 100% female participants Age: not given Ethnicity: not given Disability: not given Time since trauma: not given Income: not given Education, M (SD) years: 13.5 (3.19) Employment: not given Sexual violence in adulthood: not given Comorbid conditions: not given Baseline PTSD, M (SD): 69.23 (15.74) Partnered: not given Randomised (N): 56 Completed post‐treatment assessment (N): 25 Dropped out or removed prior to analysis (N): 21 Numbers analysed at final applicable time point (N): 35 Number of sessions: not given Treatment completion: 25 (52%)
CBT (CPT + hypnosis)
Participants (at randomisation): 52 Gender: 100% female participants Age: not given Ethnicity: not given Disability: not given Time since trauma: not given Income: not given Education, M (SD) years: 14.7 (2.46) Employment: not given Sexual violence in adulthood: not given Comorbid conditions: not given Baseline PTSD, M (SD): 72.48 (15.01) Partnered: not given Randomised (N): 52 Completed post‐treatment assessment (N): 29 Dropped out or removed prior to analysis (N): 22 Numbers analysed at final applicable time point (N): 30 Number of sessions: not given Treatment completion: 26 (59%)
Overall
Participants (at randomisation): 108 Gender: 100% female participants Age, M (SD): 36.87 years (11.8 years) Ethnicity: 50% predominantly Black; 50% predominantly white; 20% mixed race; 3% Hispanic Disability: not given Time since trauma, M (SD): 196 months (170.4 months) Income: 74% < USD 20,000 Education (% high school, college or apprentice, university or years of education; M (SD) years): 50% at least some post‐high school education; 14.16 years (2.89 years) Employment: not given Sexual violence in adulthood: 63% sexual violence in adulthood; complex trauma histories, with lifetime endorsements of child sexual abuse 71%, child physical abuse 58%, adult criminal victimisation 32% and domestic violence 56% Comorbid conditions: not given Baseline PTSD: not given Partnered: 46% Approached (N): 181 Ineligible (N): 62 Declined (N): 11 Other (N): 0 Randomised (N): 108 Completed post‐treatment assessment (N): 54 Dropped out or removed prior to analysis (N): 43 Numbers analysed at final applicable time point (N): 65 Number of sessions: not given Treatment completion: 51 (47%)
Inclusion criteria
Female gender Diagnosis of PTSD secondary to sexual or physical assault Clinically significant sleep impairment as indicated by a severity score of 3 or more on the CAPS sleep impairment symptom At least 3 months post‐trauma at initial assessment Stable on any psychotropic medication for at least 1 month
Exclusion criteria
Psychosis Learning disability Active suicidality, parasuicidality Current drug or alcohol dependence Individuals currently in an abusive relationship or being stalked No prior therapy with CPT, or current trauma‐ or sleep‐focused therapy
Pretreatment: years of education was the only difference detected, being slightly higher in the hypnosis group. |
| Interventions |
Intervention characteristics
CBT (cognitive processing theory)
Planned number of intervention sessions: 12 Mode of delivery (face‐to‐face, online, video, telephone, blend, with explanation): face‐to‐face Format (group, individual, blend): individual Therapist qualifications and training appropriate (yes, no, unclear, with explanation): unclear, questionable whether the therapists were sufficiently experienced to deliver the CPT and hypnosis, given the high level of dropout from treatment and average scores on independent ratings, although study was strong on supervision and fidelity checks. Research allegiance or conflict of interest (yes, no, unclear, with explanation): no Treatment fidelity (yes, no, unclear, with explanation): yes, the CPT and hypnosis manuals and relevant readings were provided in the training. Expert CPT clinicians not otherwise affiliated with the study reviewed and rated treatment sessions for adherence and competence. Scores were acceptable, although some concerns around the drop out rate for 1 therapist and unclear if detected in the fidelity assessment Intervention aim and theoretical basis: following the 3 weeks of daily symptom monitoring, ssmCPT participants received CPT (see Resick 2010 for a complete protocol). CPT is predominantly a cognitive therapy in which patients are taught to identify, question, challenge and replace faulty assumptions and thoughts about the traumatic event and its implications in their current lives. While the patients engage with the traumatic memory, they are able to allow natural affect to run its course. CPT first targets specific, inaccurate interpretations of the trauma itself and then targets current and future maladaptive and inaccurate beliefs about world, self and others across a number of belief systems typically disrupted after experiencing a traumatic event. Duration of intervention: 15 weeks; 3 weeks of symptom monitoring plus 12 weeks of CPT
CBT (CPT + hypnosis)
Planned number of intervention sessions: 15 Mode of delivery (face‐to‐face, online, video, telephone, blend, with explanation): face‐to‐face Format (group, individual, blend): individual Therapist qualifications and training appropriate (yes, no, unclear, with explanation): as before Research allegiance or conflict of interest (yes, no, unclear, with explanation): no Treatment fidelity (yes, no, unclear, with explanation): as before Intervention aim and theoretical basis: researchers hypothesised that improvements in sleep realised during hypnosis would augment CPT, such that PTSD symptom reduction (during CPT) would be greater in the CPT + hypnosis condition relative to the CPT condition. Hypnosis was conducted in accordance with a manual devised for the trial following Wright 1987. Duration of intervention: 15 weeks
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