Category: Trauma and Stressor Related Disorders and Disasters
Blair Wisco, Ph.D.
University of North Carolina at Greensboro
Greensboro, North Carolina
J Gayle Beck, Ph.D.
University of Memphis
Memphis, Tennessee
Blair Wisco, Ph.D.
University of North Carolina at Greensboro
Greensboro, North Carolina
Madeline Bruce, M.S.
Saint Louis University
Ballwin, Missouri
Philip Held, Ph.D.
Assistant Professor
Rush
Chicago, Illinois
Lily Brown, Ph.D.
University of Pennsylvania
Philadelphia, Pennsylvania
Adam McGuire, Ph.D.
Assistant Professor
The University of Texas at Tyler
Chandler, Texas
Cognitive behavioral treatments (CBT), such as Prolonged Exposure and Cognitive Processing Therapy, are currently recommended as first-line posttraumatic stress disorder (PTSD) treatments. Cognitive factors (e.g., negative beliefs about one’s self, the future, and the world) are important risk factors for PTSD and mediate changes in PTSD symptoms during CBT. Although the efficacy of CBT for PTSD is well-established, up to 40% of patients still meet PTSD criteria following treatment, indicating the need for more research. A better understanding of which cognitive processes are affected in PTSD, how these change during treatment, and the development of novel interventions are all needed to improve outcomes. In this symposium, we present five studies that advance our understanding of cognitive factors in PTSD risk and treatment. Our first two talks delineate specific cognitive processes implicated in PTSD development. Our first speaker presents data on different types of repetitive negative thinking, or thinking passively and repetitively about negative content, and their associations with PTSD. She finds that trauma-focused rumination, or repetitive thinking about the trauma itself, is more robustly associated with PTSD than the more commonly studied processes of rumination and worry. Our second speaker tests the cognitive growth and stress model of PTSD in samples of bereaved and trauma-exposed participants. She finds that intrusive rumination, or trauma-related thinking perceived as uncontrollable, is strongly associated with PTSD in both groups. Both talks highlight trauma-focused rumination as an understudied but important cognitive process in PTSD research. The next three talks focus on cognitive changes over the course of CBT for PTSD. Prior research has demonstrated that changes in negative beliefs about one’s self, the future, and the world mediate changes in PTSD symptoms during CBT. But it is unclear whether individuals who do not respond to treatment fail to show the same cognitive changes or evidence the same cognitive changes without symptom improvement. Our third speaker examines these possibilities in a sample of individuals receiving Cognitive Processing Therapy, a front-line CBT for PTSD. He finds that two-thirds of treatment nonresponders show no cognitive change, highlighting the importance of engaging these cognitions during PTSD treatment. Our fourth speaker examines changes in other cognitive processes during Prolonged Exposure, another front-line CBT for PTSD. She finds that Prolonged Exposure leads to declines in rumination, but not reflection, a more adaptive, insight-oriented way of thinking about trauma. Her findings suggest that rumination should be examined along with the more typically studied negative beliefs when examining cognitive mechanisms of CBT. Our fifth presenter examines cognitive changes during a novel PTSD treatment based on positive psychology. He finds that a moral elevation intervention increases positive rumination, a potentially adaptive cognitive style, among veterans with PTSD. Finally, our discussant, a renowned PTSD expert, synthesizes these findings, discusses clinical implications, and provides recommendations for future research on this important topic.
Presenter: Blair E. Wisco, Ph.D. – University of North Carolina at Greensboro
Co-author: Cameron P. Pugach, M.A. – University of North Carolina at Greensboro
Co-author: Faith Nomamiukor, MA – UNC-Greensboro
Co-author: Casey May, MA – UNC-Greensboro
Co-author: Allison Campbell, PhD – UNC-Greensboro
Presenter: Madeline J. Bruce, M.S. – Saint Louis University
Presenter: Philip Held, Ph.D. – Rush
Co-author: Dale Smith, PhD – Rush University Medical Center
Co-author: Debra Kaysen, ABPP, Ph.D. – Stanford University
Presenter: Lily A. Brown, Ph.D. – University of Pennsylvania
Co-author: Emily Ballentine, PhD – University of Pennsylvania
Co-author: Keith Bredemeier, PhD – University of Pennsylvania
Co-author: Jeremy Tyler, PsyD – University of Pennsylvania
Co-author: Rachel Schwartz, PhD – University of Pennsylvania
Co-author: Erica weitz, PhD – University of Pennsylvania
Presenter: Adam P. McGuire, Ph.D. – The University of Texas at Tyler