Debra Kaysen

Stanford University, Psychiatry and Behavioral Sciences, Faculty Member

University of Washington, Department of Psychiatry and Behavioral Sciences, Faculty Member

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Dr. Kaysen is a clinical psychologist and Professor in the Psychiatry and Behavioral Sciences Department at Stanford University. Previously she was a Professor in the Psychiatry and Behavioral Sciences Department at University of Washington. She is currently the President-Elect for the International Society for Traumatic Stress Studies (www.istss.org). She has received grants from several federal funders including NIAAA, NIDA, the Department of Defense, and USAID and is active in disseminating her work, with over 120 published peer reviewed articles. Her research is situated at the interface of posttraumatic stress disorder (PTSD) and addictions, and includes both etiologic and prevention/treatment-oriented studies. In addition she is one of the leading experts in research on adapting Cognitive Processing Therapy for diverse populations.

Dr. Kaysen is board certified in Cognitive and Behavioral Psychology and she maintains an active clinical presence. She conducts trainings in Cognitive Processing Therapy across the U.S. and internationally.

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The impact of Cognitive Processing Therapy on stigma among survivors of sexual violence in eastern Democratic Republic of Congo: results from a cluster randomized controlled trial

Conflict and Health, Feb 12, 2018

Background: Sexual violence is associated with a multitude of poor physical, emotional, and socia... more Background: Sexual violence is associated with a multitude of poor physical, emotional, and social outcomes. Despite reports of stigma by sexual violence survivors, limited evidence exists on effective strategies to reduce stigma, particularly in conflict-affected settings. We sought to assess the effect of group Cognitive Processing Therapy (CPT) on stigma and the extent to which stigma might moderate the effectiveness of CPT in treating mental health problems among survivors of sexual violence in the Democratic Republic of Congo. Methods: Data were drawn from 405 adult female survivors of sexual violence reporting mental distress and poor functioning in North and South Kivu. Women were recruited through organizations providing psychosocial support and then cluster randomized to group CPT or individual support. Women were assessed at baseline, the end of treatment, and again six months later. Assessors were masked to women's treatment assignment. Linear mixedeffect regression models were used to estimate (1) the effect of CPT on feelings of perceived and internalized (felt) stigma, and (2) whether felt stigma and discrimination (enacted stigma) moderated the effects of CPT on combined depression and anxiety symptoms, posttraumatic stress, and functional impairment. Results: Participants receiving CPT experienced moderate reductions in felt stigma relative to those in individual support (Cohen's D = 0.44, p = value = 0.02) following the end of treatment, though this difference was no longer significant six-months later (Cohen's D = 0.45, p = value = 0.12). Neither felt nor enacted stigma significantly moderated the effect of CPT on mental health symptoms or functional impairment. Conclusions: Group cognitive-behavioral based therapies may be an effective stigma reduction tool for survivors of sexual violence. Experiences and perceptions of stigma did not hinder therapeutic effects of group psychotherapy on survivors' mental health. Trial registration: ClinicalTrials.gov NCT01385163.

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Prospective predictors of work limitations in young adult lesbian and bisexual women: An examination of minority stress, trauma exposure, and mental health

Stigma and health, May 1, 2023

Daily relationships between posttraumatic stress symptoms, drinking motives, and alcohol consumption in trauma-exposed sexual minority women

Psychology of Addictive Behaviors, Feb 1, 2021

Objective: Sexual minority women (SMW) evidence elevated rates of trauma exposure, posttraumatic ... more Objective: Sexual minority women (SMW) evidence elevated rates of trauma exposure, posttraumatic stress (PTS), and alcohol consumption. Self-medication models of drinking suggest that individuals may drink to cope with symptoms of PTS, but this possibility remains untested among SMW. Method: The current study used data from drinking days collected via daily diary assessments from 81 trauma-exposed SMW. Participants were mostly White (72.8%) and ranged in age from 18 to 25 (M = 23.8). Participants were followed over 2 14-consecutive-day measurement bursts (720 person-days reported). Analyses were conducted to examine whether coping drinking motives (vs. social, enhancement, and conformity drinking motives), as assessed by an adapted Drinking Motives Questionnaire, mediated the daily level relationship between PTS symptoms (assessed by the PTSD Checklist) and the number of standard drinks per drinking day. Results: Results from multilevel structural equation models indicated that day-to-day fluctuations in PTS symptoms, as well as average levels of PTS symptoms, were associated with increased coping drinking motives. Coping drinking motives, but not other drinking motives, mediated within-person associations between PTS and drinking, such that daily fluctuations in PTS symptoms were associated with stronger-than-normal coping drinking motives, which in turn predicted more drinks per drinking day. Conclusions: Results highlight the importance of coping drinking motives and suggest that alternative coping strategies may help trauma-exposed SMW to manage heightened PTS symptoms without increasing their alcohol consumption. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prevalence and Factor Structure of PTSD in <i>DSM-5</i> Versus <i>DSM-IV</i> in a National Sample of Sexual Minority Women

Journal of Interpersonal Violence, Dec 13, 2019

The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic... more The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.

Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial

PLOS ONE, Nov 29, 2022

To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), ... more To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22);

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Maintenance of intervention effects: long-term outcomes for participants in a group talk-therapy trial in the Democratic Republic of Congo

Global Mental Health

Background Despite the growth of psychotherapy trials in low- and middle-income countries, there ... more Background Despite the growth of psychotherapy trials in low- and middle-income countries, there have been limited follow-up studies of more than 2 years. This study follows up female sexual violence survivors approximately 6 years after completing a 12-session group cognitive processing therapy (CPT) program in the eastern Democratic Republic of Congo. Methods Baseline trial data were collected in December 2010 from 134 women in 7 study villages randomly allocated to CPT. Study women were over 18 years, reported personally experiencing or witnessing sexual violence, and reported elevated depression, anxiety and/or posttraumatic stress symptoms. Women were followed up (1) post-treatment (6-months after baseline); (2) 6 months later; (3) 12 months later; and (4) in March 2017 (6.3 years after baseline). At the long-term follow-up, 103 women (77%) in 6 of 7 CPT villages were re-assessed; one village was not visited due to ongoing insecurity. Results We found strong continued intervent...

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Provider fidelity and modifications to cognitive processing therapy in a diverse community health clinic: Associations with clinical change

Journal of Consulting and Clinical Psychology, 2019

The purpose of this study is to examine associations between therapist adherence, competence, and... more The purpose of this study is to examine associations between therapist adherence, competence, and modifications of an evidence-based protocol (EBP) delivered in routine clinical care and client outcomes. Method: Data were derived from a NIMH-funded implementation-effectiveness hybrid study of Cognitive Processing Therapy (CPT) for PTSD in a diverse community health center. Providers (n=19) treated clients (n=58) as part of their routine clinical care. Clients completed the PCL-S

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In-the-moment dissociation, emotional numbing, and sexual risk: The influence of sexual trauma history, trauma symptoms, and alcohol intoxication

Psychology of Violence, 2016

Prior research on the effects of sexual trauma has examined dissociation but not emotional numbin... more Prior research on the effects of sexual trauma has examined dissociation but not emotional numbing during sex and has relied exclusively on retrospective surveys. The present experiment examined associations among distal factors of childhood sexual abuse (CSA), adolescent/adult sexual assault (ASA), and trauma symptoms and the proximal factor of acute alcohol intoxication on in-the-moment dissociation, emotional numbing, and sexual risk intentions. Young adult female drinkers (N = 436) at elevated sexual risk were randomized to receive alcohol (target peak breath alcohol concentration = .10%) or no alcohol. They then read an eroticized sexual scenario and reported on their dissociation and emotional numbing experiences, unprotected sex refusal self-efficacy, and unprotected sex intentions. Path analysis revealed that CSA was indirectly associated with increased unprotected sex intentions through increased ASA severity, increased trauma-related symptoms, increased emotional numbing, and decreased unprotected sex refusal self-efficacy. Further, alcohol intoxication was indirectly associated with increased unprotected sex intentions through increased emotional numbing and decreased unprotected sex refusal self-efficacy. Emotional numbing, but not dissociation, was associated with unprotected sex intentions and may be one potential target for interventions aimed at reducing HIV/STI-related risk among women with a history of sexual trauma.

Readiness to Change Drinking Behavior in Female College Students

Journal of Studies on Alcohol and Drugs, Supplement, 2009

A Person-Centered Approach to Examining Heterogeneity and Subgroups Among Survivors of Sexual Assault

Journal of abnormal psychology, Jan 8, 2015

This study identified subgroups of female sexual assault survivors based on characteristics of th... more This study identified subgroups of female sexual assault survivors based on characteristics of their victimization experiences, validated the subgroup structure in a second cohort of women recruited identically to the first, and examined subgroups' differential associations with sexual risk/safety behavior, heavy episodic drinking (HED), psychological distress symptomatology, incarceration, transactional sex, and experiences with controlling and violent partners. The community sample consisted of 667 female survivors of adolescent or adult sexual assault who were 21 to 30 years old (M = 24.78, SD = 2.66). Eligibility criteria included having unprotected sex within the past year, other HIV/STI risk factors, and some experience with HED, but without alcohol problems or dependence. Latent class analyses (LCA) were used to identify subgroups of women with similar victimization experiences. Three groups were identified and validated across 2 cohorts of women using multiple-group LCA:...

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Racial/ethnic differences in identity and mental health outcomes among young sexual minority women

Cultural Diversity and Ethnic Minority Psychology, 2015

Traumatic Revictimization of Men Who Have Sex With Men Living With HIV/AIDS

Journal of Interpersonal Violence, 2014

Abuse in childhood has been established as a predictor of adult abuse, with the strongest associa... more Abuse in childhood has been established as a predictor of adult abuse, with the strongest associations found between childhood sexual abuse (CSA) and adult sexual victimization. Revictimization has been demonstrated among women, and there is a growing literature on revictimization experiences among men who have sex with men (MSM). No studies have assessed revictimization among MSM living with HIV, despite strong evidence for disproportionately high rates of life span abuse among this group, along with the added vulnerability of living with HIV and sexual minority stress. In this study, we contribute to the literature by exploring associations between multiple types of childhood and adult abuse experiences (physical, sexual, and psychological; perpetrated by partners and non-partner), rather than examining sexual victimization alone. A sample of 166 HIV-positive MSM attending primary HIV health care clinics in Seattle, Washington, completed a one-time questionnaire. Results of regres...

Tonic Immobility Among College Female Sexual Assault Survivors: Perceived Threat and Alcohol Use

PsycEXTRA Dataset

Resilience in Community: A Social Ecological Development Model for Young Adult Sexual Minority Women

American journal of community psychology, Jan 9, 2015

Family support and rejection are associated with health outcomes among sexual minority women (SMW... more Family support and rejection are associated with health outcomes among sexual minority women (SMW). We examined a social ecological development model among young adult SMW, testing whether identity risk factors or outness to family interacted with family rejection to predict community connectedness and collective self-esteem. Lesbian and bisexual women (N = 843; 57 % bisexual) between the ages of 18-25 (M = 21.4; SD = 2.1) completed baseline and 12-month online surveys. The sample identified as White (54.2 %), multiple racial backgrounds (16.6 %), African American (9.6 %) and Asian/Asian American (3.1 %); 10.2 % endorsed a Hispanic/Latina ethnicity. Rejection ranged from 18 to 41 % across family relationships. Longitudinal regression indicated that when outness to family increased, SMW in highly rejecting families demonstrated resilience by finding connections and esteem in sexual minority communities to a greater extent than did non-rejected peers. But, when stigma concerns, concea...

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Coping as a Mediator of Internalized Homophobia and Psychological Distress Among Young Adult Sexual Minority Women

Psychology of sexual orientation and gender diversity, 2014

Sexual minorities have higher rates of depression and anxiety than their heterosexual counterpart... more Sexual minorities have higher rates of depression and anxiety than their heterosexual counterparts. This elevated risk of psychological distress has generally been hypothesized to be a result of the effects of discrimination including internalized negative beliefs about sexual minorities. However, little research has examined the role of various types of coping in mediating between internalized homophobia and mental health. We tested the direct relationship between internalized homophobia and psychological distress and evaluated general and sexual minority-specific coping strategies as potential mediators using structural equation modeling. Data are from a national sample of 1,099 young adult sexual minority women who were on average 20.86 (SD= 2.12) years old, participating in a study on mental health and substance use. The model demonstrated acceptable fit, χ(2) (83) = 402.9, p <.001, CFI=.94, TLI=.92, SRMR= .07, and RMSEA=.06, accounting for 73% of variance in psychological di...

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Proximal relationships between PTSD symptoms and drinking among female college students: Results from a daily monitoring study

Psychology of Addictive Behaviors, 2014

The self-medication hypothesis has been proposed to explain comorbidity between PTSD and drinking... more The self-medication hypothesis has been proposed to explain comorbidity between PTSD and drinking, whereupon problem drinking develops as an attempt to modulate negative affect and ameliorate PTSD symptoms. Studies have begun utilizing daily monitoring methodologies to refine our understanding of proximal relations between PTSD, affect, and alcohol use. 136 female college drinkers with a past history of sexual victimization and 38 female college drinkers with no past trauma history, completed electronic monitoring of PTSD symptoms, affect, alcohol use, and alcohol cravings, daily for 4 weeks. A two-part mixed hurdle model was used to examine likelihood of drinking and amount of alcohol consumed on drinking days. We did find significant relationships between daily PTSD symptoms, affect, and drinking. On days women experienced more intrusive and behavioral avoidance symptoms of PTSD they experienced stronger urges to drink and were more likely to drink on that day. On days where women experienced more negative affect than their average, they experienced stronger urges to drink whereas on days where women experienced more of the dysphoric symptoms associated with PTSD than their average, they drank less. On days with higher positive affect women reported stronger urges to drink and were more likely to drink. Results suggest the need to examine both aspects of affect and specific PTSD symptoms as they may differentially predict drinking behavior. Differences in the ways in which PTSD symptoms and affect influence drinking suggest that interventions more specifically address the function of drinking behaviors in reducing alcohol use among college women.

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Event-specific drinking among college students

Psychology of Addictive Behaviors, 2011

Randomized controlled trial of a Spring Break intervention to reduce high-risk drinking

Journal of Consulting and Clinical Psychology, 2014

Objective-While recent studies have documented high-risk drinking occurring during Spring Break (... more Objective-While recent studies have documented high-risk drinking occurring during Spring Break (SB), particularly on SB trips with friends, published intervention studies are few. The present study evaluated the efficacy of Event Specific Prevention (ESP) strategies for reducing SB drinking among college students, compared to general prevention strategies and an assessmentonly control group, as well as evaluated inclusion of peers in interventions and mode of intervention delivery (in-person vs. web). Method-Participants included 783 undergraduates (56.1% women, average age 20.5) intending to go on a SB trip with friends as well as to drink heavily on at least one day of SB. Participants completed assessments prior to SB and were randomized to one of five intervention conditions: SB in-person BASICS, SB web BASICS, SB in-person BASICS with friend, SB web BASICS with friend, general BASICS, or an attention control condition. Follow-up assessment was completed one week after SB. Results-While the SB web BASICS (with and without friends) and general BASICS interventions were not effective at reducing SB drinking, results indicated significant intervention effects for SB in-person BASICS in reducing SB drinking, particularly on trip days. Follow-up analyses indicated change in descriptive norms mediated treatment effect and reductions in drinking, while SB drinking intentions and positive expectancies did not. Conclusions-Overall, results suggest an in-person SB-specific intervention is effective at reducing SB drinking, especially during trips. In contrast, interventions that contain non-SB related content, are web-based, or seek to involve friends may be less effective at reducing SB drinking.

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Alcohol problems and posttraumatic stress disorder in female crime victims

Journal of traumatic stress, 2006

Comorbidity between alcohol use and posttraumatic stress disorder (PTSD) has been well documented... more Comorbidity between alcohol use and posttraumatic stress disorder (PTSD) has been well documented. However, there are few longitudinal studies with acute trauma samples. The present study examined symptoms of alcohol use disorders (AUDs) and PTSD longitudinally after assault. Female sexual (n = 69) and physical assault victims (n = 39) were assessed 2 to 4 weeks and 3 months post trauma. Women who had lifetime AUD had higher intrusive and avoidance symptoms than those who did not have AUD. Women who had any alcohol problems had higher PTSD symptoms. Participants who had alcohol problems had the same pattern of symptom recovery as those who did not have alcohol problems but remained more symptomatic over the 3 months. These findings suggest that early intervention strategies for women who have previous histories of alcohol problems and seek medical attention early post trauma may be indicated.

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Posttraumatic stress disorder, alcohol use, and physical health concerns

Journal of behavioral medicine, 2008

PTSD is a risk factor for alcohol problems and both in turn have been independently associated wi... more PTSD is a risk factor for alcohol problems and both in turn have been independently associated with increased health problems. However, it is unclear whether alcohol use moderates the relationship between PTSD and health. Participants were battered women (N = 336) recruited from local domestic violence shelters and non-shelter victim-assistance agencies. A 2 (PTSD diagnosis) x 3 (abstainer, infrequent/light, regular/heavy drinking) ANCOVA was conducted, with injuries and length of abuse as covariates and health concerns as the dependent variable. Main effects for PTSD and alcohol use were significant but not the interaction. Women with PTSD reported the greatest number of health concerns. Women who abstained from drinking and those who drank regularly/heavily reported more health concerns than the infrequent/light drinkers. Health concerns associated with PTSD do not appear to be due to problem drinking. In addition, infrequent/light drinking, even for women with PTSD, may be associ...

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