Measuring multimodal emotional processing in trauma-focused cognitive behavioral therapy: an integrative approach
Date
2018
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Publisher
University of Delaware
Abstract
Emotional 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.
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Keywords
Psychology, Child psychotherapy, Emotional processing, Posttraumatic stress disorder, Psychotherapy process, Trauma, Trauma-focused cognitive behavioral therapy