Appraisals are perceptions people have related to a particular event or emotion. For trauma survivors, appraisals surrounding the traumatic event may result in feelings of guilt, shame, fear, and anger, among others. Changing these appraisals may be the key to unlocking the door to recovery for many people with posttraumatic stress (PTSD). Birgit Kleim of the Department of Psychology at King’s College in London recently led a study that examined whether or not appraisals and change in appraisals predicted change in symptom severity for people undergoing a form of trauma-focused cognitive behavioral therapy known as Cognitive Therapy for PTSD (CT-PTSD).
Kleim assessed 268 individuals with PTSD before, during, and after they underwent the intervention. She found that even though the participants all had varying levels of symptom severity and differing appraisals surrounding their traumas, they all saw significant decreases in symptoms as a result of the CT-PTSD. These results in symptoms were directly predicted by changes in appraisals. Specifically, as the appraisals of the trauma changed for the better, the symptoms diminished. In fact, the majority of the participants were below the clinical threshold for PTSD after the intervention. When Kleim looked to see if the relationship between symptom change and appraisal change was bidirectional, she found it was not.
These results give researchers a clue as to what creates the dynamic change in trauma-focused cognitive therapies. “Our finding that reductions in negative appraisals predict later reductions in PTSD symptoms is thus in direct support of cognitive mediation in CT-PTSD,” said Kleim. It also provides evidence that this type of approach can be just as helpful to people with moderate or severe PTSD symptoms. Another interesting finding was that participants with even highly negative appraisals benefited from the intervention. By understanding the mechanisms that work to afford change, clinicians can focus on addressing those mechanisms as they help clients try to minimize the impact of PTSD.
Kleim, B., Grey, N., Wild, J., Nussbeck, F. W., Stott, R., Hackmann, A., Clark, D. M., and Ehlers, A. (2012). Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0031290
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