An examination of symptom discontinuities and shifts, flexibility, and capitalization in cognitive processing therapy for post-traumatic stress disorder
Date
2023
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Publisher
University of Delaware
Abstract
Cognitive Processing Therapy (CPT) is an empirically-supported treatment for adult posttraumatic stress disorder (PTSD), but little is known about how it has its effects. One possible path forward is to conceptualize PTSD as a “stuck system” and therapy as a way to disrupt the stasis and facilitate change. This framework focuses on identifying discontinuities and transition periods and the processes that facilitate or amplify these symptom shifts. Two discontinuities that have been identified in psychotherapy research as predictors of treatment outcomes are sudden decreases (sudden gains) or increases and then decreases (spikes) in symptoms. The current study investigates sudden gains, symptom spikes, and other symptom shifts that do not meet criteria for gains or spikes as predictors of PTSD symptom outcomes. The sample includes 55 adults with PTSD who received CPT as part of a non-inferiority trial comparing written exposure therapy (WET) to CPT. An observational coding system was used to code: 1) client psychological flexibility, 2) client capitalization or leveraging of symptom shifts, and 3) therapist capitalization. Consistent with other studies on the importance of the sudden gain pattern in therapeutic change, the findings suggest that sudden gains were a significant predictor of improvement in PTSD symptoms. In addition, the magnitude and sign of the largest symptom shift, which did not have to meet criteria for a sudden gain or spike, predicted more symptom improvement. There were no significant differences in flexibility and capitalization (client or therapist) between gains or spikes and other symptom shifts. Client capitalization after both sudden gains and largest symptom decreases predicted improvement in PTSD symptoms. The largest symptom decrease therefore may be a simple prognostic indicator with clinical utility. What clients do with those early symptom improvements (capitalization) also seems to matter.
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Keywords
Cognitive processing therapy, Post-traumatic stress disorder, Written exposure therapy, Therapist capitalization, Psychotherapy research