Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation

Abstract

Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during relieving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcome and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.

Culture and the Remembering of Trauma

“…Negative changes in self-concept have been found to predict a greater risk of developing PTSD (e.g., Dunmore, Clark & Ehlers, 2001;Ehlers, Mayou, & Bryant, 1998) and poorer response to exposure in those receiving treatment (Ehlers, Clark, Dunmore, Jaycox, Meadows, & Foa, 1998). Thus, the findings highlight the importance of considering self-concept in PTSD interventions, such as schema work that addresses 'vulnerable identities' (Brewin, 2003), integrating current views of the self into existing self-knowledge, and making sense of the trauma in respect to existing aspects of self-concept (Hembree & Foa, 2004).…”

Mental Defeat Is Associated With Suicide Intent in Patients With Chronic Pain

“…Thoughts and images of mental defeat reported by chronic pain patients are not dissimilar to those reported by victims of torture or assault who subsequently develop chronic depression and posttraumatic stress disorder (PTSD) [1]. In fact, in the depression and PTSD literature, mental defeat has been highlighted as a key cognitive predictor of symptom severity and treatment response [20][21][22][23]. Using the Pain Self Perception Scale (PSPS) to measure mental defeat, it has been found that the level of mental defeat was much elevated in patients with chronic pain compared with patients with acute pain, community volunteers with chronic or acute pain, and pain-free controls [19].…”

Behavioural Neurology of Personality Disorders: A Bi-dimensional Model

“…In some disorders, theory of mind might become pathologically extended causing disturbing and dysfunctional feelings of 'alienation' from oneself and/or others, such as in PTSD [199][200][201][202] and borderline personality disorder [203,204].…”