Category: Treatment - CBT


Therapeutic Processes in Written Exposure Therapy and Cognitive Processing Therapy

Friday, November 17
5:15 PM - 6:15 PM
Location: Sapphire Ballroom B, Level 4, Sapphire Level

Keywords: Psychotherapy Process | Mediation / Mediators | Randomized Controlled Trial
Presentation Type: Symposium

Given the high prevalence rates of posttraumatic stress disorder (PTSD; Kilpatrick et al., 2013) and the significant impairment across domains of functioning (Dobie et al., 2004; Hoge, Terhakopian, Castro, Messer, & Engel, 2007; Kessler, 2000; Kuhn, Blanchard, & Hickling, 2003), efforts to improve the efficacy of treatments for this disorder are critical. Cognitive processing therapy (CPT; Resick, & Schnicke, 1992) is a 12-session cognitive-behavioral treatment for PTSD with demonstrated efficacy and effectiveness that is being disseminated widely, particularly in the VA system (Veterans Health Administration & Department of Defense, 2010). Another promising treatment is written exposure therapy (WET; Sloan et al., 2012), a 5-session written exposure treatment for PTSD that requires limited therapist involvement. WET is designed to be more brief and self-directed than CPT to increase transportability and accessibility (Sloan, Marx, & Keane, 2011) and perhaps reduce the high rates of early dropout associated with other treatments for PTSD (Hembree et al., 2003). The developers of this treatment are currently completing a non-inferiority randomized controlled trial comparing WET with a more traditional, therapist-lead PTSD treatment (CPT). The current study examines whether WET and CPT differ in change on key therapeutic processes and whether this change predicts dropout and treatment outcomes. The written narrative components of WET and CPT were coded using a coding system of therapeutic change processes (CHANGE; Hayes et al., 2007). Specifically, levels of multimodal trauma network activation (i.e., a composite code of cognitions, emotions, behaviors, and somatic sensations expressed while recounting index traumas), avoidance, and cognitive variables adapted from Sobel et al. (2009; assimilation, accommodation, and overgeneralization) will be compared between treatment groups. These process variables will also be examined as predictors of 6-, 12-, and 24-week PTSD treatment outcomes and dropout. Word count, level of narrative detail when recounting traumas, and extent of trauma focus (i.e., participant’s ability to stay focused on therapeutically relevant content while completing written assignments) will also be compared between groups. We hypothesized that participants would show similar levels of multimodal trauma network activation across treatments and similar decreases in avoidance, assimilation, and overgeneralization, but CPT was hypothesized to be associated with more change in accommodation because of the extra therapist support and number of sessions. Furthermore, it was hypothesized that more multimodal trauma network activation and accommodation, and less avoidance, assimilation, and overgeneralization would be associated with greater symptom improvement in both treatments. Change in accommodation was predicted to be a stronger predictor of treatment outcomes in CPT than in WET because of the more explicit focus on this process in CPT. Finally, we hypothesized that participants who dropout of both treatments would show less trauma network activation and more assimilated and overgeneralized beliefs, and that these levels would not differ between the treatments.


Benjamin Barnes

Postdoctoral fellow (effective Aug. 1, 2017)
University of Delaware


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Therapeutic Processes in Written Exposure Therapy and Cognitive Processing Therapy

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