Using Prolonged Exposure Therapy to Treat Post- Traumatic Stress Disorder a Latina Female with a Complex Trauma History

In the United States, an estimated 0.5% to 1% of people experience a rape or sexual assault in their lifetime; in 2009, over 35 million Americans of Hispanic origin reported having experienced a rape or sexual assault at some point in their life (Truman & Rand, 2010). A common squealae of a sexual assault is Post Traumatic Stress Disorder (PTSD: Au,Dickstein, Comer, Salters-Pedneault, & Litz, 2013). The lifetime prevalence of PTSD among the general population is estimated to be 7-8% (National Center for PTSD, 2014). Interestingly Hispanics have been documented to experience more severe (e.g., Marshall, Schell, & Miles, 2009) and higher rates of PTSD than other ethnic groups (Marques, Robinaugh, LeBlanc, & Hinton, 2011). Despite the higher prevalence and more severe symptom presentation, few researchers have focused on the treatment of PTSD with Hispanics despite that the manner in which the disorder manifests may be related to ethnicity. Indeed, Benuto, Olmo, and Reyes (2011) found that among Spanish-Speaking Puerto Rican veterans, symptoms of PTSD are best conceptualized in four different clusters: intrusion, avoidance, numbing, and hyperarousal. This is contrary to the DSM-IV diagnostic criteria, which conceptualizes PTSD as consisting of three symptom clusters: re-experiencing, avoidance, and symptoms of increased arousal (APA, 2000). However, in the DSM-5 the criteria have been revised to consist of the following symptom clusters: intrusion symptoms, avoidance, negative cognitions and mood, and arousal and reactivity (APA, 2013). "Numbing" (a factor identified in the Benuto, Olmo, and Reyes [2011] study) fits under the negative cognitions and mood diagnostic criterion in the DSM-% (APA, 2013). Nonetheless, it is not clear that the symptoms under the "numbing" cluster (from the Benuto, Olmo, and Reyes [2011] study) are consistent with the symptoms under the "negative cognitions and mood" cluster in the DSM-5 (APA, 2013). Because treatment is directly focused on the reduction of symptoms and symptom presentation may vary by ethnicity, cultural considerations in the treatment of PTSD among Hispanics may be necessary. In fact, Henslee, Schumacher, Holloman, and Coffey (2009) discussed that Hispanic individuals may have a differential presentation of PTSD symptoms and may present with more severe avoidance and hyperarousal symptoms.Despite the push in the field towards evidence-based practice (Chambless & Ollendick, 2001; Lilienfeld & O'Donohue, 2007; Ollendick, 2012) and the clear emphasis on the provision of culturally sensitive interventions (American Psychological Association, 2002), there is very little research in terms of the provision of evidencebased interventions to Hispanics (Benuto & O'Donohue, Under Review). Indeed the majority of the research on Hispanics is focused on etiological factors and epidemiological characteristics of disorders as opposed to on treatment outcome (Benuto & Leany, 2011). In fact a review of the extant literature revealed only a single study (Hinton, Hofmann, Rivera, Otto, & Pollack, 2011) that compared culturally adapted Cognitive Behavioral Therapy (CA-CBT) to Applied Muscle Relaxation (AMR) among Latinas (N = 24) who were diagnosed with PTSD. Through the cultural adaptation process Hinton and colleagues identified key CBT techniques (e.g., modifying catastrophic cognitions about PTSD and anxiety symptoms) that could be adapted for treating this population including adding content that is specific to cultural syndromes, including culture-specific analogies, discussing culturally idioms of distress etc. Results from this study indicated that the CA-CBT group experienced greater treatment gains than the AMR group as evidenced by lower anxiety scores on standardized measures (e.g., the PTSD Checklist) suggesting that addressing cultural factors can improve treatment outcome. In addition to the above, Kichic, Verga, and Reyes-Rabanillo (2011) also discussed having culturally adapted the Prolonged Exposure treatment protocol and while they did not conduct an empirical investigation, they did note the importance of including family members when using exposure-based Cognitive Behavioral Therapy (CBT) with Puerto Rican veterans. …