No abstract

This trial reports the first evidence that within-person change in shame and guilt predicts change in PTSD symptoms from session to session during treatment.

The present study examined both the intraindividual relationship between alliance components (task, goal, and bond) and subsequent posttraumatic stress disorder (PTSD) symptoms over the course of therapy and the interindividual relationships between the initial level of the alliance components and overall PTSD outcome. PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery rescripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10-week residential program. They were assessed repeatedly (weekly) on alliance and PTSD symptom measures. The centering method of detrending (Curran & Bauer, 2011) was used to separate the variance related to the intraindividual process of change during treatment (within-person component) from the variance related to initial individual differences (between-person component). The hypothesis of a negative within-person effect of the alliance components agreement about the tasks of therapy and bond on subsequent PTSD symptoms was supported for the component task agreement. As expected, this effect was stronger in IE than in IR. Moreover, there was a negative relationship between interindividual differences in initial Task and Bond scale scores and slope of PTSD symptoms over the course of therapy. By contrast, within-person variations in PTSD symptoms did not predict subsequent alliance components. The present results suggest the importance of agreement about therapy tasks during the process of IE or IR within prolonged exposure for PTSD patients, particularly in IE.

Although self-compassion is considered a promising change agent in the treatment of posttraumatic stress disorder (PTSD), no studies of this hypothesis exist. This study examined the within-person relationship of self-compassion components (self-kindness, common humanity, mindfulness, self-judgment, isolation, over-identification) and subsequent PTSD symptoms over the course of therapy.Method: PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery re-scripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10 weeks residential program. They were assessed weekly on self-compassion and PTSD symptom measures. The centering method of detrending was used to separate the variance related to the within-person process of change over the course of treatment from between-person variance.Results: The self-compassion components self-kindness, self-judgment, isolation, and over-identification had a within-person effect on subsequent PTSD symptoms. These relationships were independent of therapy form. The within-person relationship between self-judgment and subsequent PTSD symptoms was stronger in patients with higher initial self-judgment. By contrast, there were few indications that within-person variations in PTSD symptoms predict subsequent self-compassion components.Conclusion: The results support the role of self-compassion components in maintaining PTSD and imply the recommendation to facilitate decrease of self-judgment, isolation, and over-identification and increase of self-kindness in the treatment of PTSD patients. The reduction of self-judgment appears to be most important, especially for patients with a high initial level of self-judgment.