***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This article describes a second treatment- outcome study of cognitive trauma therapy for battered women with posttraumatic stress disorder ( PTSD ; CTT-BW ) . CTT-BW includes trauma history exploration : PTSD education ; stress management ; exposure to abuse and abuser reminders ; self-monitoring of negative self-talk ; cognitive therapy for guilt ; and modules on self-advocacy , assertiveness , and how to identify perpetrators . One hundred twenty-five ethnically diverse women were r and omly assigned to immediate or delayed CTT-BW .  PTSD remitted in 87 % of women who completed CTT-BW , with large reductions in depression and guilt and substantial increases in self-esteem .  White and ethnic minority women benefited equally from CTT-BW . Similar treatment outcomes were obtained by male and female therapists and by therapists with different levels of education and training . Gains were maintained at 3- and 6-month follow-ups OBJECTIVE Veterans who served in Operation Enduring Freedom ( OEF ) and Operation Iraqi Freedom ( OIF ) commonly experience alcohol misuse and symptoms of posttraumatic stress disorder ( PTSD ) following their return from deployment to a war zone . We conducted a r and omized clinical trial to evaluate the efficacy of a newly developed , 8-module , self-management web intervention ( VetChange ) based on motivational and cognitive-behavioral principles to reduce alcohol consumption , alcohol-related problems , and PTSD symptoms in returning combat veterans . METHOD Six hundred participants , recruited through targeted Facebook ads , were r and omized to either an Initial Intervention Group ( IIG ; n = 404 ) or a Delayed Intervention Group ( DIG ; n = 196 ) that waited 8 weeks for access to VetChange . Primary outcome measures were Drinks per Drinking Day , Average Weekly Drinks , Percent Heavy Drinking Days , and PTSD symptoms . Intent-to-treat analyses compared changes in outcome measures over time between IIG and DIG as well as within-group changes . RESULTS IIG participants demonstrated greater reductions in drinking ( p < .001 for each measure ) and PTSD symptoms ( p = .009 ) between baseline and end-of-intervention than did DIG participants between baseline and the end of the waiting period . DIG participants showed similar improvements to those in IIG following participation in VetChange .  Alcohol problems were also reduced within each group between baseline and 3-month follow-up . CONCLUSIONS Results indicate that VetChange is effective in reducing drinking and PTSD symptoms in OIF/OEF veterans . Further studies of VetChange are needed to assess web-based recruitment and retention methods and to determine VetChange 's effectiveness in demographic and clinical sub- population s of returning veterans AIMS To examine the impact of post-traumatic stress disorder ( PTSD ) on 2-year treatment outcomes for heroin dependence . DESIGN Prospect i ve longitudinal study . PARTICIPANTS Data were obtained from a predominantly treatment seeking sample of 615 dependent heroin users who were followed-up at 3 , 12 and 24 months ( follow-up rates : 89 % , 81 % and 76 % , respectively ) . MEASUREMENTS Outcomes examined include treatment retention and exposure , substance use , general physical and mental health and employment . FINDINGS Despite improvements in substance use , PTSD was associated with continued physical ( beta - 1.69 , SE 0.61 , P < 0.01 ) and mental disability ( beta - 2.07 , SE 0.66 , P < 0.01 ) , and reduced occupational functioning ( OR 0.67 , 95 % CI : 0.48 - 0.93 ) throughout the 2-year follow-up . CONCLUSIONS Although conventional treatment services are successful in producing improvements in substance use and associated disability , the disability associated with PTSD remains . An intervention targeting both heroin dependence and PTSD may help to improve the outcomes of those with PTSD The prevalence of alcohol use disorder ( e.g. , alcohol dependence ; AD ) among individuals with posttraumatic stress disorder ( PTSD ) is quite high , with estimates of 52 % for men and 30 % for women ( Kessler , Sonnega , Bromet , Hughes , & Nelson , 1995 ) . There are several interviews and self-report measures of PTSD with good published psychometric properties , and they are routinely used with comorbid AD and PTSD . However , none of these instruments was vali date d with this population . The current study fills this gap by examining the psychometric properties of the  PTSD Symptom Scale-Interview ( PSS-I )  and  the self-report PTSD Diagnostic Scale ( PDS )  in individuals diagnosed with current PTSD and AD . Both scales comprised of 17 items provide diagnostic and symptom severity information according to DSM-IV-TR criteria . Participants were 167 individuals who were diagnosed with AD and chronic PTSD and were enrolled in a r and omized controlled treatment study . Results revealed excellent internal consistency of both the PSS-I and the PDS , good test-retest reliability over a 1-month period , and good convergent validity with the SCID . The specificity of the PSS-I diagnosis of PTSD was better than the PDS diagnosis , the latter exhibiting a greater percentage of false positives . In sum , the results showed that the PSS-I and PDS performed well in this population and can be used with confidence to assess PTSD diagnosis and symptom severity BACKGROUND Although women with substance use disorders ( SUDs ) have high rates of trauma and posttraumatic stress , many addiction programs do not offer trauma-specific treatments . One promising intervention is Pennebaker 's expressive writing , which involves daily , 20-minute writing sessions to facilitate disclosure of stressful experiences . METHODS Women ( N = 149 ) in residential treatment completed a r and omized clinical trial comparing expressive writing with control writing . Repeated- measures analysis of variance was used to document change in psychological and physical distress from baseline to 2-week and 1-month follow-ups . Analyses also examined immediate levels of negative affect following expressive writing . RESULTS Expressive writing participants showed greater reductions in posttraumatic symptom severity , depression , and anxiety scores , when compared with control writing participants at the 2-week follow-up . No group differences were found at the 1-month follow-up . Safety data were encouraging : although expressive writing participants showed increased negative affect immediately after each writing session , there were no differences in pre-writing negative affect scores between conditions the following day . By the final writing session , participants were able to write about traumatic/stressful events without having a spike in negative affect . CONCLUSIONS Results suggest that expressive writing may be a brief , safe , low-cost , adjunct to SUD treatment that warrants further study as a strategy for addressing posttraumatic distress in substance-abusing women 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 design ed 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 r and omized clinical trial with 146 primarily low-income and ethnoracial minority mothers with PTSD . TARGET achieved statistically and clinical ly 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 IMPORTANCE Alcohol dependence comorbid with posttraumatic stress disorder ( PTSD ) has been found to be resistant to treatment . In addition , there is a concern that prolonged exposure therapy for PTSD may exacerbate alcohol use . OBJECTIVE To compare the efficacy of an evidence -based treatment for alcohol dependence ( naltrexone ) plus an evidence -based treatment for PTSD ( prolonged exposure therapy ) , their combination , and supportive counseling . DESIGN , SETTING , AND PARTICIPANTS A single-blind , r and omized clinical trial of 165 participants with PTSD and alcohol dependence conducted at the University of Pennsylvania and the Philadelphia Veterans Administration . Participant enrollment began on February 8 , 2001 , and ended on June 25 , 2009 . Data collection was completed on August 12 , 2010 . INTERVENTIONS Participants were r and omly assigned to ( 1 ) prolonged exposure therapy plus naltrexone ( 100 mg/d ) , ( 2 ) prolonged exposure therapy plus pill placebo , ( 3 ) supportive counseling plus naltrexone ( 100 mg/d ) , or ( 4 ) supportive counseling plus pill placebo . Prolonged exposure therapy was composed of 12 weekly 90-minute sessions followed by 6 biweekly sessions . All participants received supportive counseling . MAIN OUTCOMES AND MEASURES The Timeline Follow-Back Interview and the PTSD Symptom Severity Interview were used to assess the percentage of days drinking alcohol and PTSD severity , respectively , and the Penn Alcohol Craving Scale was used to assess alcohol craving . Independent evaluations occurred prior to treatment ( week 0 ) , at posttreatment ( week 24 ) , and at 6 months after treatment discontinuation ( week 52 ) . RESULTS Participants in all 4 treatment groups had large reductions in the percentage of days drinking ( mean change , -63.9 % [ 95 % CI , -73.6 % to -54.2 % ] for prolonged exposure therapy plus naltrexone ; -63.9 % [ 95 % CI , -73.9 % to -53.8 % ] for prolonged exposure therapy plus placebo ; -69.9 % [ 95 % CI , -78.7 % to -61.2 % ] for supportive counseling plus naltrexone ; and -61.0 % [ 95 % CI , -68.9 % to -53.0 % ] for supportive counseling plus placebo ) . However , those who received naltrexone had lower percentages of days drinking than those who received placebo ( mean difference , 7.93 % ; P = .008 ) . There was also a reduction in PTSD symptoms in all 4 groups , but the main effect of prolonged exposure therapy was not statistically significant . Six months after the end of treatment , participants in all 4 groups had increases in percentage of days drinking . However , those in the prolonged exposure therapy plus naltrexone group had the smallest increases . CONCLUSIONS AND RELEVANCE In this study of patients with alcohol dependence and PTSD , naltrexone treatment result ed in a decrease in the percentage of days drinking .  Prolonged exposure therapy was not associated with an exacerbation of alcohol use disorder . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00006489 A cognitive-behavioral therapy ( CBT ) program for posttraumatic stress disorder ( PTSD ) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers .  CBT was compared with treatment as usual ( TAU ) in a r and omized controlled trial with 108 clients with PTSD and either major mood disorder ( 85 % ) or schizophrenia or schizoaffective disorder ( 15 % ) , of whom 25 % also had borderline personality disorder . Eighty-one percent of clients assigned to CBT participated in the program . Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessment s in PTSD symptoms , other symptoms , perceived health , negative trauma-related beliefs , knowledge about PTSD , and case manager working alliance . The effects of CBT on PTSD were strongest in clients with severe PTSD . Homework completion in CBT predicted greater reductions in symptoms . Changes in trauma-related beliefs in CBT mediated improvements in PTSD . The findings suggest that clients with severe mental illness and PTSD can benefit from CBT , despite severe symptoms , suicidal thinking , psychosis , and vulnerability to hospitalizations Women in drug treatment struggle with co-occurring problems , including trauma and post-traumatic stress disorder ( PTSD ) , which can heighten HIV risk . This study examines the impact of two group therapy interventions on reduction of unprotected sexual occasions ( USO ) among women with substance use disorders ( SUD ) and PTSD . Participants were 346 women recruited from and receiving treatment at six community-based drug treatment programs participating in NIDA ’s Clinical Trials Network . Participants were r and omized to receive 12-sessions of either seeking safety ( SS ) , a cognitive behavioral intervention for women with PTSD and SUD , or women ’s health education ( WHE ) , an attention control psychoeducational group . Participants receiving SS who were at higher sexual risk ( i.e. , at least 12 USO per month ) significantly reduced the number of USO over 12-month follow up compared to WHE . High risk women with co-occurring PTSD and addiction may benefit from treatment addressing coping skills and trauma to reduce HIV risk This r and omized controlled pilot study compared a cognitive-behavioral therapy ( 
    Output:
    
There were no data on the effects on drug/alcohol use for individual therapy .
Evidence showed that individual trauma-focused psychological therapy delivered alongside SUD therapy did better than TAU/minimal intervention in reducing PTSD severity post-treatment and at long-term follow-up , but only reduced SUD at long-term follow-up .
There was evidence that fewer participants receiving trauma-focused therapy completed treatment .
There was very little evidence to support use of non-trauma-focused individual- or group-based integrated therapies .