A large number of individuals with posttraumatic stress (PTSD) also develop symptoms of major depression (MDD). Various treatment approaches aim to reduce symptoms of both MDD and PTSD to lower the risk of social impairment and suicidal ideation that is often present in these individuals. One such method of treatment is cognitive processing therapy (CPT), which incorporates writing activities and cognitive psychotherapy (CPT-C). There is evidence that supports CPT for PTSD and MDD, suggesting that this approach can dramatically reduce symptom severity when PTSD and MDD occur together. However, until now, no study has looked at how each component of CPT, namely the CPT-C and the writing activities, independently influence symptom change in PTSD and MDD separately.
Gabrielle I. Liverant of the VA Boston Healthcare System on the Brockton Campus in Massachusetts wanted to explore this dynamic more closely. In a recent study, Liverant assessed 126 women assigned to either CPT in totality, CPT-C alone, or writing activities alone. The participants had all been diagnosed with PTSD and were evaluated 8 times over a 6 week period of treatment. Liverant discovered that each individual component of CPT worked to decrease symptoms of MDD and PTSD in the same way. Specifically, the women in the CPT-C condition saw decreases in symptoms that were similar to those realized by the women in the CPT full protocol and the condition with writing activities. Also, Liverant found that for all the conditions, symptoms of MDD and PTSD were reduced simultaneously. In other words, improvements in MDD did not lead to improvements in PTSD, and decreases in PTSD symptoms did not predict MDD symptom reductions.
This finding suggests that neither CPT nor its individual components are solely responsible for the reductions in symptoms. “Instead,” added Liverant, “This pattern of results suggests that a third factor (e.g., treatment) influenced change in both disorders simultaneously.” The fact that the writing activities condition worked equally as well as the cognitive condition also indicates that writing about a trauma may lead to cognitive shifts, equal to those realized in exposure experiments. Although these results do provide evidence of the benefits of each individual element of CPT, more research should be conducted to extend these findings to a more diverse participant sample and to individuals with other comorbid conditions.
Liverant, Gabrielle I., Michael K. Suvak, Suzanne L. Pineles, and Patricia A. Resick. Changes in posttraumatic stress disorder and depressive symptoms during cognitive processing therapy: Evidence for concurrent change. Journal of Consulting and Clinical Psychology 80.6 (2012): 957-67. Print.
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