Therapeutic processes in written exposure therapy and cognitive processing therapy
Date
2017
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Publisher
University of Delaware
Abstract
Posttraumatic stress disorder (PTSD) is an important focus of research, given its high prevalence rates and significant impairment across several domains of functioning. Cognitive processing therapy (CPT) is a 12-session cognitive-behavioral treatment for PTSD that has been shown to have good efficacy and effectiveness and is being disseminated widely. In addition, researchers have developed a brief 5-session written exposure treatment (written exposure therapy; WET) for PTSD that requires limited therapist involvement to increase client acceptability, reduce dropout, and improve access to care. The developers of this treatment have completed a non-inferiority randomized controlled trial in a sample of 126 adults with PTSD, demonstrating equivalent efficacy between WET and CPT. The current study examined processes of change by coding the content of the written narrative components from these treatments. Levels of multimodal trauma network activation, avoidance, assimilation, overgeneralization, and accommodation were compared and examined as predictors of dropout and of 6- and 12-week PTSD treatment outcomes within and between groups. Word count, level of narrative detail, and extent of trauma focus were also compared. Results suggested that although the CPT treatment group wrote longer trauma recounting narratives with more detail and therapeutic focus, both treatments showed similar levels of avoidance and multimodal trauma network activation and that higher levels of trauma network activation predicted better outcomes for the WET group. Across written components of both treatments, overgeneralization decreased in the CPT group only, and accommodation improved across both treatments. In terms of outcomes, improvements in overgeneralization and accommodation predicted better 12-week outcomes in both groups, and these changes predicted outcome over and above levels of trauma network activation. Finally, higher levels of assimilation in initial narratives were positively associated with dropout, which was higher in the CPT group (40% versus 6%). These findings add to the primary RCT by demonstrating similar change processes in WET, but with lower dropout rates and less burden.
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Keywords
Psychology, Cognitive behavioral therapy, Cognitive processing therapy, PTSD, Written exposure therapy