The role of gender and child sexual abuse history in treatment response in two treatments for posttraumatic stress disorder

Abstract

Objective: This study tested whether a reported history of child sexual abuse (CSA) differentially affected treatment outcomes in men and women receiving written exposure therapy (WET) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD).MethodParticipants were treatment-seeking men (n = 66) and women (n = 60) with a primary diagnosis of PTSD randomized to either WET or CPT. Approximately half of the sample (n = 60) reported a history of CSA. Masked evaluators assessed participants’ PTSD symptoms and remission status at baseline and 6, 12, and 24 weeks after the first treatment session using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). An intent-to-treat linear mixed-effects model tested the association of the interaction between gender, CSA, treatment group, and time with PTSD symptom scores at 24-weeks after the first treatment session. Stratified chi-square tests of independence for each treatment group also examined the association between gender and CSA history with PTSD remission status at 24 weeks.ResultsThe linear mixed effects model revealed a significant interaction between gender, history of CSA, treatment group, and time (B = 1.29, t[158] = 2.33, p = .021). Follow-up multiple comparison t-tests showed that women without a history of CSA randomized to CPT experienced greater reductions in PTSD symptoms than all other groups. No other statistically significant differences were observed between groups. Additionally, a larger proportion of women without CSA experienced PTSD remission at 24 weeks than women with a history of CSA (χ²(1, n = 24) = 4.00, p = .046). This pattern was not observed in WET.ConclusionThese findings imply a potentially meaningful difference in treatment response in women with and without CSA history receiving CPT for PTSD.