Symposia
Trauma and Stressor Related Disorders and Disasters
Lily A. Brown, Ph.D.
University of Pennsylvania
Philadelphia, Pennsylvania
Emily Ballentine, PhD
Research Assistant
University of Pennsylvania
Chalfont, Pennsylvania
Keith Bredemeier, PhD
Assistant Professor
University of Pennsylvania
Philadelphia, Pennsylvania
Jeremy Tyler, PsyD
Assistant Professor
University of Pennsylvania
Philadelphia, PA
Rachel Schwartz, PhD
Postdoctoral Fellow
University of Pennsylvania
Philadelphia, Pennsylvania
Erica weitz, PhD
Pos
University of Pennsylvania
Philadelphia, Pennsylvania
Negative cognitions about the self, the world, and other people are a core mechanism of action for evidence-based treatments for posttraumatic stress disorder (PTSD). Despite this reliable finding, only two prior studies have examined changes in rumination, or repetitive negative thinking about the past in general (versus trauma-specific cognitions), in the course of PTSD treatment. No prior studies have explored changes in rumination in Prolonged Exposure Therapy (PE), a gold-standard PTSD treatment. We evaluated whether rumination and reflection (thinking about the past experiences, as measured by the Rumination and Reflection Questionnaire) were associated with PTSD in PE. We hypothesized that: relative to other anxiety-related disorders, PTSD would be associated with significant elevations in rumination; higher baseline rumination would be associated with less PTSD improvement, and that rumination (but not reflection) would significantly improve during PE.
Methods: Participants (N=822) had a principal anxiety disorder diagnosis, sought treatment at a specialized anxiety clinic, and completed questionnaires at the beginning, middle and end of treatment. A subset (n = 268) endorsed criterion A trauma exposure and had a principal PTSD diagnosis (n = 63).
Results: Participants with principal PTSD had significantly higher rumination than those with principal panic disorder (p < .05) and specific phobia (p < .001). In contrast, the effect of Principal Diagnosis on baseline Reflection was not significant (p=.27). Among participants with a Criterion A trauma, the Time × Baseline Rumination and Time × Baseline Reflection effects were significant (both ps < .05) such that those with higher Rumination or Reflection had a steeper reduction in the Posttraumatic Diagnostic Scale (PDS). These results did not hold among only participants with principal PTSD, possibly due to the smaller sample size. Among participants with principal PTSD, there was a significant reduction in Rumination (coef.-.03, SE=.006, p< .001) but not Reflection (p=.960) over the course of PE.
Discussion: Participants with PTSD reported elevations in rumination. In turn, elevations in rumination were associated with significantly steeper reductions in PTSD symptoms over treatment among patients with a Criterion A trauma. Patients with principal PTSD had significant reductions in rumination, but not reflection, in PE. These findings have implications for understanding how PE might improve rumination; this is important given that rumination is not a direct target of PE.