Cognitions in prolonged exposure therapy for posttraumatic stress disorder1

This quasi-experimental study investigates the impact of prolonged exposure treatment on cognitive changes in patients with posttraumatic stress disorder (PTSD). Seventy-seven PTSD patients with mixed traumas went through 8 to 12 sessions of imaginal exposure and exposure in vivo without any cognitive interventions. Reexperiencing symptoms and the most important cognition (i.e., its frequency and credibility) were assessed weekly. Exposure treatment resulted in significant reductions of negative trauma-related cognitions, although these were not paid attention to during treatment. Reductions in cognitions were associated with reductions in PTSD symptoms. Pre to post-treatment reductions in cognitions did not predict PTSD at follow up after controlling for pre to post-treatment reductions in PTSD symptoms. Finally, reductions in the frequency of reexperiences and trauma-related cognitions were preceded by reductions in the distress caused by the reexperiences. The credibility of trauma-related cognitions was the last variable to decline. Distress caused by the reexperiences being the first symptom to decline may mean that reductions of negative trauma-related cognitions are the result of PTSD symptom reductions. This complicated relationship between cognitions and symptom change surely merits further exploration.