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Changes in negative cognitions mediate PTSD symptom reductions during client-centered therapy and prolonged exposure for adolescents

https://doi.org/10.1016/j.brat.2015.03.008Get rights and content

Highlights

  • Change in negative cognitions mediated change in PTSD and depressive symptoms.

  • Change in PTSD and depressive symptoms did not mediate change in negative cognitions.

  • The mediating effect of negative cognitions was stronger in the exposure group.

  • Negative cognitions are a mechanism of prolonged exposure for adolescents with PTSD.

Abstract

Objective

To assess whether changes in negative trauma-related cognitions play an important role in reducing symptoms of posttraumatic stress disorder (PTSD) and depression during prolonged exposure therapy for adolescents (PE-A).

Method

Secondary analysis of data from a randomized controlled trial comparing PE-A with client-centered therapy (CCT) for PTSD. Participants were 61 adolescent female sexual assault survivors ages 13–18 who received 8–14 weekly sessions of PE-A or CCT at a community rape crisis center. PTSD severity was assessed at baseline, mid-treatment, post-treatment, and 3-months post-treatment. Participants also completed self-report measures of negative posttraumatic cognitions and depressive symptoms at the same assessment points.

Results

Cross lag panel mediation analyses showed that change in negative trauma-related cognitions mediated change in PTSD symptoms and depressive symptoms whereas change in PTSD and depressive symptoms did not mediate change in negative cognitions.

Conclusion

Our findings support EPT and suggest that change in negative trauma-related cognitions is a mechanism of both PE-A and CCT.

Section snippets

Participants

The current study analyzed data from the original RCT described in Foa et al. (2013). Participants were 61 adolescent girls between the ages of 13 and 18 (M age = 15.3, SD = 1.5) who were seeking treatment at a rape crisis center in Philadelphia, Women Organized Against Rape (WOAR). For inclusion in the study, participants must have a primary DSM-IV diagnosis of current or subthreshold (i.e. ≥1 re-experiencing symptom, ≥2 avoidance symptoms, ≥2 arousal symptoms) PTSD resulting from sexual abuse

Overall analyses

We obtained data from participants at 225 (92%) out of a possible 244 total assessments (pre-, mid-, post-treatment and 3-month follow-up assessments for 61 participants). As expected, outcomes 3-months post-treatment were superior in PE-A compared to CCT across all three measures, b = 11.70, t(123) = 5.19, p < .001 for CPSS, b = 6.69, t(86) = 3.39, p = .001 for CDI, and b = 10.67, t(112) = 3.59, p < .001 for CPTAS. In addition, the slopes of improvement were faster in PE-A than in CCT for all

Discussion

This study investigated a key assumption of emotional processing theory for PTSD (Foa et al., 2006, Foa and Kozak, 1986), namely, that reductions in negative trauma-related cognitions are a key driver of recovery from PTSD. This is the first study to show that change in negative trauma-related cognitions is a mechanism of PE in an adolescent-only sample. Our results are consistent with findings from prior adult studies that examined the relationships between negative cognitions and symptoms of

Conflict of interest

None.

References (29)

  • E.B. Foa et al.

    The Posttraumatic Cognitions Inventory (PTCI): development and validation

    Psychological Assessment

    (1999)
  • E.B. Foa et al.

    Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics

    Journal of Consulting and Clinical Psychology

    (2005)
  • E.B. Foa et al.

    Emotional processing theory: an update

  • E.B. Foa et al.

    The child PTSD symptom scale (CPSS): a preliminary examination of its psychometric properties

    Journal of Clinical Child Psychology

    (2001)
  • Cited by (0)

    This study was supported by National Institute of Health, Grant 5-R01-MH-074505-04, PI: Edna Foa.

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