Research: MARKS and colleagues, Ins

Listed in Issue 32


MARKS and colleagues, Institute of Psychiatry and Bethlem-Maudsley Hospital, London UK I. compared the value of cognitive restructuring on its own and in combination with prolonged exposure therapy in the treatment of posttraumatic stress disorder .



87 patients with posttraumatic stress disorder of at least 6 months duration were randomly assigned to have 10 sessions of one of four treatments: 1) prolonged exposure (imaginal and live) alone 2) cognitive restructuring alone 3) combined prolonged exposure and cognitive restructuring or 4) relaxation without prolonged exposure or cognitive restructuring. The integrity of the audio taped treatment sessions was satisfactory as judged by an assessor who was unaware of the treatment assignment. 77 patients completed treatment.


The pattern of results was similar, regardless of the rater, statistical method, measure, occasion and therapist. Exposure and cognitive restructuring, singly or in combination, improved posttraumatic stress disorder considerably on a broad front. The gains continued to 6-month follow-up and were significantly greater than the moderate improvement from the relaxation group.


Both prolonged exposure and cognitive restructuring were each therapeutic on their own, they were not mutually enhancing in combination, and were each superior to relaxation .


Marks I et al. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Arch Gen Psychiatry. 55(4): 317-25. Apr 1998.

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