Bridging the gap between posttraumatic stress disorder research and clinical practice: The example of exposure therapy.

Cook, Joan M.; Schnurr, Paula P.; Foa, Edna B.

doi:10.1037/0033-3204.41.4.374

Cited by 103 publications

(84 citation statements)

References 69 publications

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“…Significant level of treatment drop-out and high nonresponse rates have been found in studies of exposure treatments (Schottenbauer et al, 2008). As Cook et al (2004) point out, care needs to be taken in applying PE so that "the rigors of exposure are tempered by empathy and a collaborative therapeutic alliance" (p. 381).…”

Section: Exposure Therapies For Post-traumatic Stress Disordermentioning

confidence: 99%

The Referential Process as a Common Factor Across Treatment Modalities

Bucci

2013

ResPsy

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Abstract. The paper emphasizes the need for a process component in psychotherapy research, and the need for a theoretical framework within which process measures may be designed and validated. The referential process, defined in the context of multiple code theory, provides a general psychological framework for understanding the mechanisms of therapeutic change in different treatment modalities. The referential process includes three major phases: arousal/activation; narrative/symbolizing and reorganizing/reflection. The paper reviews the theoretical roots of psychodynamic treatments, and several forms of cognitive behavioral treatments, including schema therapy for borderline personality disorder and exposure treatments for post-traumatic stress disorder, and shows how the phases of the referential process provide common mechanisms of change in each of these approaches. Computerized measures of the referential process, in English and Italian versions, which have been applied and validated in clinical and experimental studies, are discussed. Keywords: change mechanisms, referential process, computerized measuresThe field of psychotherapy research is in need of scientific evidence concerning the basic processes underlying emotional disorders and therapeutic change. Such evidence is needed to guide clinical work, and to develop new and more effective treatments. Comparing the outcomes of competing theories is not useful if we do not identify the psychological mechanisms that bring about the observed results. To provide evidence concerning the psychological processes underlying therapeutic change and to develop new and more effective treatment forms, research is needed in both experimental and naturalistic contexts-in fields such as cognitive psychology, affective neuroscience, psycholinguistics, and developmental psychology; as well as in the therapeutic context.In order to carry out such research in a way that will be applicable to clinical issues, an overarching theoretical framework is required. The study of internal psychological processes and variables, such as needs, desires, memories and perceptions, that figure in the psychotherapy process can be likened to the study of the fundamental constituents of matter in modern particle physics. Subatomic particles, like psychological processes, are known and assessed through the signals they send out and their observable effects. The advances in fields such as particle physics have occurred through development of a systematic theoretical framework that is constantly being re-examined and revised, with well defined concepts and relationships among the concepts; and with reliable and valid measures of external events from which inferences to these concepts and relationships can be made. The nature of the human emotional information processing system is at least as complicated as the nature of matter, but we know much less about it. Perhaps this is because it is more difficult to recognize how little we know in a scientific sense about emotional processes that we can ...

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Section: Exposure Therapies For Post-traumatic Stress Disordermentioning

confidence: 99%

The Referential Process as a Common Factor Across Treatment Modalities

Bucci

2013

ResPsy

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“…A common critique for these treatments among providers is that the samples included in research trials often do not represent the real-world patient population. The most challenging cases, they argue, such as patients with extreme trauma or several comorbidities are often excluded from participation in clinical trials (Cook, Schnurr, & Foa, 2004). Therefore, efficacy demonstrated in clinical trials may not translate to effectiveness in the real world.…”

Section: Research and Practice Discontinuitymentioning

confidence: 99%

“…Therapists delivering PE may feel sympathy for such patients and scale back the exposure or cut it short. Unfortunately, this can reinforce avoidance and make symptoms worse by impeding emotional processing (Cook, Schnurr, & Foa, 2004). Similarly, other symptoms of PTSD can themselves be barriers to effective PE delivery.…”

Section: Research and Practice Discontinuitymentioning

confidence: 99%

“…Extreme anger or emotional numbing can prevent patients from engaging in treatment, while intense anxiety can lead to overengagement. Experts recommend that the PE protocol be followed through to completion, with some minor modifications, to overcome these barriers (Cook, Schnurr, & Foa, 2004). Unfortunately, without proper training in PE, clinicians may be hesitant or unaware of how to do so.…”

Section: Research and Practice Discontinuitymentioning

confidence: 99%

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Improving Utilization of and Adherence to Treatment for Post-Traumatic Stress Disorder Among U.S. Servicemembers and Veterans

Kurz¹

2015

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“…A number of authors propose that trauma-focused treatments can be offered to those who have experienced repeated interpersonal trauma without any major modifications (e.g. Cook, Schnurr, & Foa, 2004; Resick, Nishith, & Griffin, 2003; Van Minnen et al, 2012). Others propose that outcomes for complex presentations can be improved using a phase-based or sequenced approach involving three phases, each with a distinct function (e.g.…”

Section: Introductionmentioning

confidence: 99%

Developing an Emotion- and Memory-Processing Group Intervention for PTSD with complex features: a group case series with survivors of repeated interpersonal trauma

Clifford

Meiser‐Stedman

Johnson

et al. 2018

European Journal of Psychotraumatology

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Individuals who experience repeated interpersonal trauma exposure often present with posttraumatic stress disorder (PTSD) with more complex features. There is currently no consensus regarding whether current evidence-based interventions for PTSD need to be tailored to better account for these complex features. However, one recommended adaptation is to adopt a phase-based or sequenced approach involving three phases, each with a distinct function. This paper describes the development of a 12-session Emotion- and Memory-Processing Group Programme, adapted from Cloitre’s Skills Training in Affective and Interpersonal Regulation (STAIR) phase-based treatment protocol. A single case series provided a preliminary examination of the group-based intervention’s efficacy for three groups of women with a history of repeated interpersonal trauma and PTSD with complex features (N = 15; age 19–46 years) at The Haven Sexual Assault Referral Centre in London. Results revealed significant reductions in: PTSD, complex features of PTSD, and depression, along with improvements in process measures of maladaptive cognitions and emotion processing. Results from this case series demonstrate that an Emotion- and Memory-Processing Group Programme holds promise for treating individuals with a history of interpersonal trauma in outpatient settings, and provides evidence to warrant the completion of a feasibility trial.

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Bridging the gap between posttraumatic stress disorder research and clinical practice: The example of exposure therapy.

Cited by 103 publications

References 69 publications

The Referential Process as a Common Factor Across Treatment Modalities

The Referential Process as a Common Factor Across Treatment Modalities

Improving Utilization of and Adherence to Treatment for Post-Traumatic Stress Disorder Among U.S. Servicemembers and Veterans

Developing an Emotion- and Memory-Processing Group Intervention for PTSD with complex features: a group case series with survivors of repeated interpersonal trauma

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