Identifying Predictors of Long-Term Treatment Outcomes Using Narratives From Written Exposure Therapy and Cognitive Processing Therapy for PTSD

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Author(s)Shayani, Danielle R.
Author(s)Alpert, Elizabeth
Author(s)Barnes, J. Ben
Author(s)Sloan, Denise M.
Author(s)Hayes, Adele M.
Date Accessioned2025-03-12T13:48:08Z
Date Available2025-03-12T13:48:08Z
Publication Date2024-12-12
DescriptionThis 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.
AbstractObjective: 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.
SponsorThe session coding for this project was conducted in the lab of Adele M. Hayes, who developed the Change and Growth Experiences Scale coding system. The authors have no conflicts of interest to disclose. The outcome study used in this research was supported by a grant from the National Institute of Mental Health, National Institutes of Health (Grant R01-MH095737) awarded to Denise M. Sloan. Denise M. Sloan reported receiving royalty payments for the published Written Exposure Therapy manual. No other disclosures were reported. The authors thank Matthew Gallagher for his statistical support on this project.Danielle R. Shayani played a lead role in conceptualization, formal analysis, writing–original draft, and writing–review and editing and an equal role in methodology. Elizabeth Alpert played a supporting role in writing–review and editing and an equal role in investigation. J. Ben Barnes played a supporting role in conceptualization, investigation, and writing–review and editing. Denise M. Sloan played a supporting role in writing–review and editing and an equal role in methodology. Adele M. Hayes played a supporting role in conceptualization, writing–original draft, and writing–review and editing and an equal role in investigation and methodology.
CitationShayani, 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
ISSN1942-969X
URLhttps://udspace.udel.edu/handle/19716/35899
Languageen_US
PublisherPsychological Trauma: Theory, Research, Practice, and Policy
Keywordswritten exposure therapy
Keywordscognitive processing therapy
Keywordsposttraumatic stress disorder
Keywordstrauma
Keywordstherapy process
TitleIdentifying Predictors of Long-Term Treatment Outcomes Using Narratives From Written Exposure Therapy and Cognitive Processing Therapy for PTSD
TypeArticle
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