Browsing by Author "Alpert, Elizabeth"
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Item An examination of multiple components of emotional processing theory as predictors of symptom change in prolonged exposure for posttraumatic stress disorder(University of Delaware, 2021) Alpert, ElizabethProlonged exposure (PE) is an empirically supported treatment for adult posttraumatic stress disorder (PTSD). The foundation of PE, emotional processing theory (EPT), posits that PTSD is maintained by a pathological network of associations among stimuli, responses, and meaning. Therapeutic change occurs when the network is activated and new information is integrated, which weakens the pathological associations and facilitates learning of more adaptive associations. Studies of EPT have focused on a limited number of indicators of emotional processing, and some findings have been mixed. A more thorough approach to studying EPT is proposed, using observational methods to measure multiple components of EPT in one trial. These include: 1) conditions that facilitate clients' learning and processing of new information, 2) weakening of old, pathological learning, and 3) strengthening of new, more adaptive learning. Participants were 42 adults with PTSD receiving PE as part of an ongoing trial. Video recordings of sessions were coded to capture the components of EPT and to examine how they relate to each other and to change in PTSD symptoms. Facilitators of processing were largely uncorrelated with measures of processing, and each group of variables did not predict unique variance in PTSD symptom improvement. Two individual variables emerged as predictors of symptom improvement: lower cognitive rigidity and a greater decrease in negative trauma-related cognitions across sessions. Findings contribute to growing evidence suggesting the importance of cognitive change as part of emotional processing, beyond activation and reduction in negative emotions. Implications for measurement of EPT and for clinical practice are discussed.Item Measuring multimodal emotional processing in trauma-focused cognitive behavioral therapy: an integrative approach(University of Delaware, 2018) Alpert, ElizabethEmotional processing theory (Foa & Kozak, 1986; Foa, Huppert, & Cahill, 2006) posits that psychopathology related to anxiety and traumatic stress is maintained by a maladaptive network of stimulus, response, and meaning elements. Exposure therapies seek to weaken this network and strengthen a network of adaptive learning. Research on exposure therapies has generally highlighted fear extinction as the hypothesized mechanism of change, but fear extinction has not consistently predicted treatment outcomes, prompting some researchers to question the utility of emotional processing theory. The current study seeks instead to broaden measurement of emotional processing to more fully test the most recent version of the theory. In a community sample of 81 trauma-exposed youth (67% female, ages 7-17) receiving trauma-focused cognitive behavioral therapy (TF-CBT), we examined changes in four components of emotional processing during the trauma processing phase of TF-CBT as predictors of post-treatment internalizing and externalizing. These included: 1) negative networks of trauma-related functioning (cognitive, emotional, behavioral, somatic); 2) positive networks of functioning in the same domains; 3) maladaptive emotion regulation (ER) strategies (avoidance, rumination, overgeneralization); and 4) adaptive ER strategies (decentering, meaning-making, accommodation). More curvilinear (concave-down) change over time in negative networks and greater decreases in maladaptive ER strategies predicted lower post-treatment internalizing symptoms, and greater increases in positive networks and adaptive ER strategies predicted lower post-treatment externalizing symptoms. Findings suggest promise in broadening measurement of emotional processing to incorporate changes in an array of negative and positive areas of functioning during treatment.