Cognitive Processing Therapy and Trauma-Related Negative Cognitions: Relationship and Effect on Treatment

Cognitive Processing Therapy (CPT) is based on the theory that posttraumatic stress disorder (PTSD) is a disorder of non-recovery after an exposure to a qualifying trauma. This non-recovery results in assimilated and overaccomodated trauma-related cognitions which negatively affects an individual's schema pertaining to self, the world, and self-blame. This post-trauma alteration in an individual's schema is typically expressed and reinforced in the form of trauma-related negative cognitions (NCs). Although the theoretical underpinnings of NCs as well as their effect on symptom severity in individuals with PTSD have been studied, the role of NCs in therapeutic outcome is less understood. In particular, although CPT specifically targets and addresses NCs, there is limited research regarding the role of NCs during and after CPT treatment. This dissertation consisted of two studies. The purpose of the first study was to examine the overall effectiveness of CPT in attenuating NCs from pre- to post-treatment. To address this study's aim, a meta-analysis of current peer-reviewed clinical trials that assessed NCs at pre- and post-CPT treatment was conducted. The purpose of the second study was to determine if NCs predict therapeutic outcome (i.e., decreases in PTSD and depression symptom severity) over the course of CPT treatment and at follow-up. To address this study's aim, a secondary analysis of a randomized clinical trial of CPT in women and men with military sexual trauma (MST)-related PTSD was performed. Specifically, cross-lagged panel analyses were conducted with NC scores entered as a predictor of subsequent reductions in PTSD and depression symptoms over the course of treatment and follow-up. The first study concluded that CPT had a large effect size in reducing NCs from pre- to post-treatment. Results from the second study were indicative that NCs about self-blame predict subsequent reductions in PTSD symptom severity over the course of CPT and follow-up in veterans with MST-related PTSD. These studies provide further information regarding the effectiveness of CPT in addressing NCs as well as the mediating role of NCs during and after treatment.