Cognitive Processing Therapy for Posttraumatic Stress Disorder Secondary to a Motor Vehicle Accident: A Single-Subject Report Tara E. Galovski, University of Missouri, St. Louis Patricia A. Resick, Boston University School of Medicine Motor vehicle accidents (MVAs) are fairly common occurrences in all developed countries. Although only a small percentage of total MVAs result in posttraumatic stress disorder (PTSD), the high base rate in the population has resulted in the estimation that MVAs are the leading cause of PTSD in the United States. Occupations that require substantial travel, such as long-haul trucking, significantly increase the risk of being exposed to a traumatic MVA. Developing PTSD secondary to such exposure can be disabling and can thus have significant and specific implications for occupational functioning. This case study describes the successful treatment, using Cognitive Processing Therapy (CPT), of a long-haul trucker diagnosed with PTSD after a serious MVA. The intervention is described and the results discussed with specific attention both to this case as well as to its generalizability to the larger MVA trauma population. T HERE is little question that motor vehicle accidents (MVAs) take an enormous societal and economic toll every year. In the United States alone, MVAs are the leading cause of accidental injury and death and the leading cause of death in individuals between the ages of 5 and 29 (U.S. Department of Transportation [DOT], Bureau of Transportation Statistics, 2002). Worldwide, annual MVA-related deaths number 300,000 to 500,000, with 10 to 15 million injuries attributed to roadway collisions (U.S. DOT, Bureau of Transportation Statistics, 1999). The estimated prevalence of PTSD stemming from an MVA as measured by prospective study ranges from 8% (Mayou, Bryant, & Duthie, 1993) to 40% (Blanchard & Hickling, 1997; Epstein, 1993). The range of prevalence rates found across studies is substantial. It is postulated that this variability may be due, at least in part, to timing of the assessment (the closer to the MVA, the more likely the baseline assessment will yield higher rates of PTSD), differences across samples in severity of the MVA, inclusion and exclusion criteria of study participants, and, potentially, differences in prior trauma within samples as prior PTSD has been found to predict current PTSD. Possibly due to their common occurrence relative to other trauma types (combat, sexual assault, natural disaster) epidemiological researchers estimate MVAs to be the leading cause of PTSD in the U.S. (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Norris, 1992).Thus, the psychological impact of an MVA is substantial. The MVA psychosocial intervention literature is more sparse than in the parallel trauma populations of combat and sexual assault survivors. Although there have been several studies with more acutely traumatized survivors (acute stress disorder samples), randomized, controlled treatment trials with PTSD-positive MVA survivors are few. Fecteau and Nicki (1999) compared a brief (four, 2-hour sessions) cognitive-behavioral intervention to a wait-list control condition in a sample of MVA survivors diagnosed with PTSD 5 to 95 months post-MVA. The intervention included elements of psychoeducation, relaxation train- ing, imaginal exposure and graduated in-vivo behavior practice, and some cognitive therapy. Fifty percent of cases in the treated sample (N = 10) did not meet diagnostic criteria for PTSD at the posttreatment assess- ment as compared to all 10 cases in the control condition retaining their PTSD diagnosis. A larger scale study conducted by Blanchard et al. (2003) compared a cognitive-behavioral (CBT) interven- tion to a supportive psychotherapy condition and a wait- list control. The CBT intervention (8 to 12 weekly 1-hour sessions) consisted of psychoeducation, 16 muscle group progressive relaxation, written and verbal exposure, in vivo exposure to driving-related trauma cues, strategies to increase social support, behavioral activation to decrease numbing and anhedonia, and attention to anger. There was also a cognitive component in which subjects were asked to monitor thoughts and taught to identify negative self-talk and replace it with positive self-talk. This 1077-7229/08/287–295$1.00/0 © 2008 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. Available online at www.sciencedirect.com Cognitive and Behavioral Practice 15 (2008) 287–295 www.elsevier.com/locate/cabp