Mechanisms of Change in Written Exposure Treatment of Posttraumatic Stress Disorder

Abstract

Although the effectiveness of exposure therapy for PTSD is recognized, treatment mechanisms are not well understood. Emotional processing theory (EPT) posits that fear reduction within and between sessions creates new learning, but evidence is limited by self-report assessments and inclusion of treatment components other than exposure. We examined trajectories of physiological arousal and their relation to PTSD treatment outcome in a randomized controlled trial of written exposure treatment, a protocol focused on exposure to trauma memories. Hierarchical linear modeling was used to model reduction in Clinician Administered PTSD Scale score as a predictor of initial activation and within- and between-session change in physiological arousal. Treatment gains were significantly associated with initial physiological activation, but not with within- or between-session changes in physiological arousal. Treatment gains were associated with larger between-session reductions in self-reported arousal. These findings highlight the importance of multimethod arousal assessment and add to a growing literature suggesting refinements of EPT.

Keywords: PTSD; emotional processing theory; exposure; psychophysiology; written exposure treatment.

Conflict of interest statement

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

Copyright © 2016. Published by Elsevier Ltd.

Figures

FIGURE 1

Association between Treatment Response and Between-Session Change in Self-Reported Arousal. Note. CAPS = Clinician-Administered PTSD Scale. CAPS change was analyzed as a continuous variable, but is split into low and high groups here for ease of graphical presentation. Low and high CAPS change scores were defined as one standard deviation below and above the mean, respectively. Sessions were coded as 0 to 4 for the purposes of the HLM analyses; session 0 was the first treatment session.