Constructive and Unproductive Processing of Traumatic Experiences in Trauma-Focused Cognitive-Behavioral Therapy for Youth

Abstract

Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the constructive processing of feared experiences, and strengthening new inhibitory learning. We examined variables thought to be associated with unproductive and constructive processing of traumatic experiences in a sample of 81 youth with elevated PTSD symptoms, who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for abuse or traumatic interpersonal loss. Sessions during the trauma narrative phase of TF-CBT were coded for indicators of unproductive processing (overgeneralization, rumination, avoidance) and constructive processing (decentering, accommodation of corrective information), as well as levels of negative emotion. In previous analyses of this trial (Ready et al., 2015), more overgeneralization during the narrative phase predicted less improvement in internalizing symptoms at posttreatment and a worsening of externalizing symptoms over the 12-month follow-up. In contrast, more accommodation predicted improvement in internalizing symptoms and also moderated the negative effects of overgeneralization on internalizing and externalizing symptoms. The current study examined correlates of overgeneralization and accommodation. Overgeneralization was associated with more rumination, less decentering, and more negative emotion, suggesting immersion in trauma-related material. Accommodation was Please address correspondence to Adele Hayes, Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA. ahayes@udel.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of Interest No conflicts of interest HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript associated with less avoidance and more decentering, suggesting a healthy distance from traumarelated material that might allow for processing and cognitive change. Decentering also predicted improvement in externalizing symptoms at posttreatment. Rumination and avoidance showed important associations with overgeneralization and accommodation, respectively, but did not predict treatment outcomes. This study identifies correlates of overgeneralization and accommodation that might shed light on how these variables relate to unproductive and constructive processing of traumatic experiences. Key...

Progress and Limitations in the Treatment of Complex PTSD and Developmental Trauma Disorder

“…It is also important to note that different aspects of emotion dysregulation may need to be addressed with different cPTSD clients depending upon their specific histories of childhood adversity and posttraumatic adaptations: for example, in early adulthood [56] and among adults in outpatient mental health treatment [55], childhood emotional abuse was associated with psychopathology and volatile relationships due to difficulty in regulating behavioral responses to emotions, whereas emotional neglect was associated with detachment from relationships and difficulty in recognizing and understanding emotions. • [46] • [26] • [43] • [28] • [31] • [32,47] • [42] • [48] • [47] • [49] • [44] • [47] • [47] • [37] Interpersonal regulation Trauma memory processing therapy for PTSD is an indirect approach to enhancing emotion regulation capacities that has been shown to be effective with adults with childhood histories of abuse [57] and (based on reductions in negative emotions) with victimized children [58]. However, there is no evidence that trauma memory processing enables adults or children to reliably overcome emotion dysregulation related to DSO or DTD.…”

Children's experiences with an intervention aimed to prevent further physical abuse

“…Avoidant behaviour could lead to more PTSD symptoms (Shenk et al, ; Shenk et al, ). Likewise, children processing painful memories could be more likely to experience better outcomes concerning both internalising and externalising symptoms (Ready et al, ) and being more able to create a cognitive distance from the trauma (Hayes et al, ).…”

“…Ready et al () identified two predictors of treatment outcome in TF‐CBT: overgeneralization and accommodation. Overgeneralization (focusing on negative events as a characteristic instead of isolated events) correlated with negative emotions and more rumination (Hayes et al, ). Accommodation refers to the individual's capacity to concrete and process information in a more realistic way and discriminates between impressions.…”

“…Children expressing accommodated beliefs showed greater improvements with both internalizing and externalizing symptoms at posttreatment and at the 1‐year follow‐up, respectively. Further accommodation was associated with less avoidance, indicating that children were processing the trauma and creating a cognitive distance from the abuse (Hayes et al, ).…”

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“…For instance, intrusive rumination might be associated with PTSD, while deliberate rumination can be linked to PTG (Zhang et al, 2018), indicating different cognitive processes in case of negative or positive trauma outcomes, even if PTSD and PTG may also coexist on an individual level. Similarly, while some forms of cognitive processes are thought to be unproductive (e.g., overgeneralization, avoidance), there are many constructive ways (e.g., decentering, accommodation of corrective information) of trauma processing (Hayes et al, 2017).…”