A Critical Review of Negative Affect and the Application of CBT for PTSD

2016 ◽  
Vol 19 (2) ◽  
pp. 176-194 ◽  
Author(s):  
Wilson J. Brown ◽  
Daniel Dewey ◽  
Brian E. Bunnell ◽  
Stephen J. Boyd ◽  
Allison K. Wilkerson ◽  
...  
Keyword(s):  
Negative Affect ◽  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Cognitive Processing Therapy ◽  
Initial Information ◽  
Emotional Reasoning ◽  
Negative Valence ◽  
Potential Efficacy ◽  
Behavioral Therapies ◽  
The Impact

Forms of cognitive and behavioral therapies (CBTs), including prolonged exposure and cognitive processing therapy, have been empirically validated as efficacious treatments for posttraumatic stress disorder (PTSD). However, the assumption that PTSD develops from dysregulated fear circuitry possesses limitations that detract from the potential efficacy of CBT approaches. An analysis of these limitations may provide insight into improvements to the CBT approach to PTSD, beginning with an examination of negative affect as an essential component to the conceptualization of PTSD and a barrier to the implementation of CBT for PTSD. As such, the literature regarding the impact of negative affect on aspects of cognition (i.e., attention, processing, memory, and emotion regulation) necessary for the successful application of CBT was systematically reviewed. Several literature databases were explored (e.g., PsychINFO and PubMed), resulting in 25 articles that met criteria for inclusion. Results of the review indicated that high negative affect generally disrupts cognitive processes, resulting in a narrowed focus on stimuli of a negative valence, increased rumination of negative autobiographical memories, inflexible preservation of initial information, difficulty considering counterfactuals, reliance on emotional reasoning, and misinterpretation of neutral or ambiguous events as negative, among others. With the aim to improve treatment efficacy of CBT for PTSD, suggestions to incorporate negative affect into research and clinical contexts are discussed.

Introduction and Overview

2021 ◽  
pp. 1-16
Author(s):  
Frederic N. Busch ◽  
Barbara L. Milrod ◽  
Cory K. Chen ◽  
Meriamne B. Singer
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Psychodynamic Therapy ◽  
Veterans Administration ◽  
Cognitive Processing Therapy ◽  
Persistent Symptoms ◽  
Prolonged Exposure Therapy ◽  
Trauma Processing ◽  
Multiple Traumas

This chapter provides an introduction to efficacious treatments for posttraumatic stress disorder (PTSD). Despite efficacy of these treatments, many patients do not respond to them or experience persistent symptoms. Efficacious psychotherapies for PTSD used at the Veterans Administration (VA), including prolonged exposure therapy and cognitive processing therapy, are described. While these treatments can be helpful, many patients are avoidant of trauma processing and homework. Furthermore, both treatments tend to focus on one central trauma, to which exposure exercises are targeted, whereas most Veterans experience multiple traumas. An overview of the development and framework of trauma-focused psychodynamic psychotherapy (TFPP), a PTSD-symptom focused brief psychodynamic therapy, is presented. A brief background of psychoanalytic and psychodynamic literature and thinking about trauma is provided to further frame the place of TFPP

Examining the Impact of Sexual Revictimization in a Sample of Veterans Undergoing Intensive PTSD Treatment

2020 ◽  
pp. 088626051989733
Author(s):  
Vanessa Tirone ◽  
Dale Smith ◽  
Victoria L. Steigerwald ◽  
Jenna M. Bagley ◽  
Michael Brennan ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Symptom Severity ◽  
Poor Mental Health ◽  
Treatment Seeking ◽  
Cognitive Processing Therapy ◽  
Depression Symptom ◽  
Symptom Change ◽  
Sexual Revictimization ◽  
The Impact ◽  
Predominately Female

Sexual revictimization refers to exposure to more than one incident of rape and is a known risk factor for poor mental health among civilians. This construct has been understudied among veterans. In addition, although individuals who have experienced revictimization generally have greater symptom severity than those who have experienced one rape, it is unclear whether these differences persist following treatment. This study examined differences between veterans who reported histories of revictimization ( n =111) or a single rape ( n = 45), over the course of a 3-week intensive cognitive processing therapy (CPT)-based treatment program for veterans with posttraumatic stress disorder (PTSD). The sample consisted of predominately female (70.5%) post–9/11 veterans (82.7%). Self-reported PTSD and depression symptom severity were assessed regularly throughout the course of treatment. Controlling for non-interpersonal trauma exposure and whether veterans were seeking treatment for combat or military sexual trauma, sexual revictimization was generally associated with greater pretreatment distress and impairment. However, sexual revictimization did not impact rates of PTSD or depression symptom change over the course of intensive treatment, or overall improvement in these symptoms posttreatment. Our findings suggest that the rates of sexual revictimization are high among treatment-seeking veterans with PTSD. Although veteran survivors of sexual revictimization tend to enter treatment with higher levels of distress and impairment than their singly victimized peers, they are equally as likely to benefit from treatment.

Which patients initiate cognitive processing therapy and prolonged exposure in department of veterans affairs PTSD clinics?

2019 ◽  
Vol 62 ◽  
pp. 53-60 ◽  
Author(s):  
Craig S. Rosen ◽  
Nancy C. Bernardy ◽  
Kathleen M. Chard ◽  
Barbara Clothier ◽  
Joan M. Cook ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Veterans Affairs ◽  
Cognitive Processing Therapy ◽  
Department Of Veterans Affairs

The Impact of Military Status on Cognitive Processing Therapy Outcomes in the Community

2019 ◽  
Vol 32 (2) ◽  
pp. 330-336 ◽  
Author(s):  
Kirsten H. Dillon ◽  
Stefanie T. LoSavio ◽  
Teague R. Henry ◽  
Robert A. Murphy ◽  
Patricia A. Resick
Keyword(s):  
Cognitive Processing ◽  
Cognitive Processing Therapy ◽  
Therapy Outcomes ◽  
The Impact ◽  
Military Status

Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches

2019 ◽  
Vol 26 (7-8) ◽  
pp. 443-451 ◽  
Author(s):  
Lisa M Valentine ◽  
Shannon D Donofry ◽  
Rachel B Broman ◽  
Erin R Smith ◽  
Sheila AM Rauch ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Sexual Trauma ◽  
Prolonged Exposure ◽  
Cognitive Processing Therapy ◽  
Military Sexual Trauma ◽  
Health Administration ◽  
Video Technology ◽  
Post Traumatic Stress ◽  
Ptsd Treatment ◽  
Delivery Format

Introduction Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. Methods Data were drawn from veterans ( N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. Results FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. Discussion Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

The Ethics of Neglecting Clinical Relationship and Alliance Building in Trauma-Focused Treatments

2019 ◽  
Vol 21 (2) ◽  
pp. 104-116
Author(s):  
Enrico Gnaulati
Keyword(s):  
Cognitive Processing ◽  
Prolonged Exposure ◽  
Ethical Issues ◽  
American Psychological Association ◽  
Treatment Protocol ◽  
Relationship Building ◽  
Drop Out ◽  
Cognitive Processing Therapy ◽  
Clinical Relationship ◽  
Alliance Building

The American Psychological Association Clinical Practice Guideline for the Treatment of posttraumatic stress disorder (PTSD; APA, 2017) privileges two trauma-focused treatments (TFTs)—Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE)—on scientific grounds, without considering the ethical issues posed by these treatments being relatively nonrelational and nonalliance building in nature. Fidelity to treatment protocol over clinical relationship building and alliance formation and maintenance can slot practitioners into an “I-it” therapeutic stance, depriving clients of real engagement and leaving them feeling objectified as standard cases of PTSD whose symptoms need to be tracked and managed. The high drop-out and failure to initiate treatment rates associated with TFTs ought to raise concerns about how their technique-heavy, protocol-driven methods, alienate practitioners, and the traumatized clients they serve.

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