Category: PTSD


Decentering and Other Processes of Change in Written Exposure Therapy and Cognitive Processing Therapy for PTSD

Saturday, November 18
1:45 PM - 3:15 PM
Location: Sapphire Ballroom O & P, Level 4, Sapphire Level

Keywords: Stress | Therapy Process
Presentation Type: Symposium

Background: The current study expands prior research by examining processes of change in PTSD treatment using a coding system that assesses both positive and negative processes. Decentering, or stepping back to view one’s thoughts and feelings from an adaptive distance, was specifically examined as a process that may help people to disengage from unconstructive processing and facilitate constructive processing of their traumatic experiences. In a previous trial of trauma-focused cognitive behavioral therapy (TF-CBT) for youth with PTSD, coding of treatment sessions indicated that more decentering predicted better treatment outcome and was also related to less overgeneralization (global, exaggerated beliefs about self, others, or the world that are applied broadly across life situations and time) and more accommodation (new more adaptive and balanced beliefs; Hayes et al., 2017). The current study uses the same coding system to measure these processes of change in written narratives provided by adults with PTSD participating in a trial of written exposure therapy (WET), a five-session treatment with minimal therapist involvement, compared with cognitive processing therapy (CPT), a 12-session gold standard treatment for PTSD.
Method: Adult participants with PTSD (N = 128) were randomized to receive WET or CPT. The 82 participants who completed treatment were included in the current study (WET, n = 57; CPT n = 25). Trauma processing narratives written by participants in both treatments were coded for change processes using the Change and Growth Experiences Scale (CHANGE; Hayes et al., 2007) and an adaptation of the accommodation variable in the Sobel et al. (2009) measure. Change processes included overgeneralization, rumination, decentering, emotional processing, and accommodation. Inter-rater agreement on all coding categories was good to excellent.
Results: In both treatments, overgeneralization decreased from the first narrative to the last (t(56) = 2.72, p < .01 WET; t(24) = 6.77, p < .01 CPT), and decentering (t(56) = -3.42 WET; t(24) = -3.48, p < .01 CPT), emotional processing (t(56) = -5.09, p < .01 WET; t(24) = -6.69, p < .01 CPT), and accommodation (t(56) = -4.84, p < .01 WET; t(24) = -7.47, p < .01 CPT) increased. Increases in decentering were associated with increases in emotional processing (r = .40, p < .01) in WET and with decreases in ruminative processing (r = -.43, p < .05) and increases in emotional processing (r = .54, p < .01) in CPT.
Conclusion: The decreases in overgeneralization and increases in positive processes in both WET and CPT are promising, given WET’s significantly shorter duration and minimal therapist involvement. Decentering is associated with emotional processing in both treatments and may be an important facilitator of change. When symptom outcome data become available shortly, relationships between treatment processes and symptom outcomes will be examined.

Elizabeth Alpert

University of Delaware


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Decentering and Other Processes of Change in Written Exposure Therapy and Cognitive Processing Therapy for PTSD

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