The effect of cognitive processing therapy on cognitions: Impact statement coding

Abstract

This study compared the cognitions of 37 female rape survivors before and after completing cognitive processing therapy (CPT). It was hypothesized that CPT would be associated with reductions in posttraumatic stress disorder (PTSD) symptoms and problematic (i.e., assimilated and overaccommodated) thoughts as well as increases in the number of realistic (i.e., accommodated) cognitions. Cognitions were assessed via coding and analyses of participants' written impact statements at the beginning and end of treatment. Posttraumatic stress disorder symptoms were assessed with the Clinician-Administered PTSD Scale and PTSD Symptom Scale. As predicted, there were significant increases in accommodated statements and significant decreases in overaccommodated and assimilated statements. The hypothesis that cognitive changes would be related to symptom reduction was partially supported.A growing body of research has explored the relationship between traumatic events and subsequent cognitions. For instance, survivors sometimes exhibit self-blaming thoughts and guilt about actions that they did or did not engage in during a traumatic incident (Foa, Ehlers, Clark, Tolin, & Orsillo, 1999;Frazier & Schauben, 1994;Janoff-Bulman & Wortman, 1977;Kubany, 1994;Resick, Nishith, Weaver, Astin, & Feuer, 2002;Resick & Schnicke, 1993). Because of their experiences, survivors sometimes develop cognitive distortions, which are inaccurate thoughts. Foa and Rothbaum (1997) proposed that posttrauma cognitions can be classified into two general categories: beliefs that the world is dangerous and thoughts about being incompetent. A more elaborated theory by McCann, Sakheim, and Abrahamson (1988) delineated trauma-related cognitive distortions in five areas: agency-which refers to the attributed cause of a traumatic event-safety, trust, power, esteem, and intimacy.Consistent with the cognitive processing theories of McCann and Pearlman (1990), Resick and Schnicke (1993) suggested that when individuals are confronted with new information that is inconsistent with preexisting schemas (i.e., stored bodies of knowledge), one of two processes occurs: assimilation or accommodation. Piaget (1987) was the first to describe these two processes. Assimilation is the incorporation or alteration of new information to fit into existing schemas. Accommodation is the modification of existing schemas to incorporate new events and information. In trauma survivors, these processes often involve the themes of agency, safety, trust, power, esteem, and intimacy. Resick and Schnicke (1993) proposed that although accommodation is necessary to integrate a new event, traumatized individuals sometimes overaccommodate trauma-relevant information. They noted that overaccommodation occurs when schema changes are inaccurate and overgeneralized. For instance, an overaccommodated belief is that people are either totally in control or out of control of life events.Assimilation, on the other hand, can occur by incorporating new, unchanged information into a preexisting sch...

Rape survivors' trauma-related beliefs before and after Cognitive processing therapy: Associations with PTSD and depression symptoms

“…Trained coders rated impact statements for the three types of cognitions (assimilation, overaccommodation, and accommodation) using the coding manual developed by Sobel et al (2009). Accordingly, sentences were divided into clauses prior to coding, because single sentences may contain multiple thoughts that reflect separate categories.…”

“…We were able to extend the findings of Sobel et al (2009) by including now available 5e10 year posttreatment follow-up data from participants in the Resick et al (2002) CPT trial. We also expanded the scope of outcome measures to include depressive as well as PTSD symptoms.…”

“…Impact statements are an important component of CPT in which clients are asked to write a description of the meaning of the index event and describe how the event has impacted their beliefs about themselves, other people, and the world (Resick et al, 2014). In a randomized clinical trial (RCT) of CPT for female rape survivors (Resick et al, 2002), Sobel et al (2009) found that impact statements reflected significant decreases in assimilated and overaccommodated cognitions, as well as increases in accommodated cognitions, over the course of treatment. Additionally, improvements in accommodation and declines in overaccommodation were significantly associated with reductions in PTSD symptoms from pre-to posttreatment.…”

“…Only one study, however, has used direct qualitative evaluation of clients' impact statements, written at the beginning and end of CPT, to assess changes specifically in assimilated, overaccommodated, and accommodated thinking (Sobel, Resick, & Rabalais, 2009). Impact statements are an important component of CPT in which clients are asked to write a description of the meaning of the index event and describe how the event has impacted their beliefs about themselves, other people, and the world (Resick et al, 2014).…”

Writing Therapy for Posttraumatic Stress: A Meta-Analysis

“…When effective, writing therapy for PTS may constitute an important alternative to these treatment models. Third, when effective, written narratives produced in writing therapy for PTS offer promising new ways to investigate trauma recovery, such as the identification of linguistic indicators of (un)successful trauma processing or comorbid depressive symptoms [18,19,20,21]. …”