Identifying Predictors of Long-Term Treatment Outcomes Using Narratives From Written Exposure Therapy and Cognitive Processing Therapy for PTSD
Date
2024-12-12
Journal Title
Journal ISSN
Volume Title
Publisher
Psychological Trauma: Theory, Research, Practice, and Policy
Abstract
Objective: Cognitive processing therapy (CPT), a 12-session, gold-standard treatment for posttraumatic stress disorder (PTSD), and written exposure therapy (WET), a brief, five-session treatment, have similar treatment efficacy. The aim of the present study was to identify predictors of long-term treatment outcomes of WET and CPT using clients’ written narratives. Method: Narratives from both treatments were coded with the Change and Growth Experiences Scale coding system to identify predictors of long-term PTSD symptom outcomes. Participants were 113 adults with PTSD randomly assigned to receive WET (n = 60) or CPT (n = 53). Results: In WET, higher average levels of accommodated (balanced, healthy) beliefs predicted lower PTSD symptoms at the 60-week endpoint, as well as a decrease in symptoms over the follow-up symptom slope. In CPT, higher average negative emotions and positive view of self predicted better 60-week PTSD symptom outcomes, as did lower hopelessness, which also predicted a decrease in PTSD symptoms over the follow-up period. Conclusions: Even without direct cognitive change techniques, adaptive processing of traumatic experiences occurred in WET and predicted PTSD long-term symptom improvement. Both emotional engagement and cognitive change might help to sustain treatment gains in CPT.
Clinical Impact Statement
This study advances the idea that fostering healthy beliefs and adaptive processing (accommodation) are important contributors to better long-term posttraumatic stress disorder symptom outcomes in written exposure therapy. Additionally, it highlights the importance of emotional engagement in cognitive processing therapy and identifies specific cognitive variables that might help sustain treatment gains. These findings suggest that integrating and addressing these cognitive and emotional factors during therapy sessions might enhance the efficacy of written exposure therapy and cognitive processing therapy, potentially reducing the likelihood of relapse.
Description
This article was originally published in Psychological Trauma: Theory, Research, Practice, and Policy. © 2024 American Psychological Association. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. The final article is available, upon publication, at: https://doi.org/10.1037/tra0001813.
Keywords
written exposure therapy, cognitive processing therapy, posttraumatic stress disorder, trauma, therapy process
Citation
Shayani, D. R., Alpert, E., Barnes, J. B., Sloan, D. M., & Hayes, A. M. (2024). Identifying predictors of long-term treatment outcomes using narratives from written exposure therapy and cognitive processing therapy for PTSD.Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001813