Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination.

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Publisher: Elsevier Science Publishers
Document Type: Report
Length: 416 words

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Keywords rumination; PTSD; Mechanisms of change; Trauma-focused treatment Highlights * Rumination is implicated in the etiology and maintenance of PTSD * Rumination decreases over the course of trauma-focused psychotherapy * PTSD symptoms and rumination are closely interrelated in the course of treatment * More research is needed on the role of rumination as a mechanism of change Abstract Objective Cognitive behavioral therapy (CBT) has been well established in the treatment of posttraumatic stress disorder (PTSD). In recent years, researchers have begun to investigate its underlying mechanisms of change. Dysfunctional cognitive content, i.e. excessively negative appraisals of the trauma or its consequences, has been shown to predict changes in PTSD symptoms over the course of treatment. However, the role of change in cognitive processes, such as trauma-related rumination, needs to be addressed. The present study investigates whether changes in rumination intensity precede and predict changes in symptom severity. We also explored the extent to which symptom severity predicts rumination. Method As part of a naturalistic effectiveness study evaluating CBT for PTSD in routine clinical care, eighty-eight patients with PTSD completed weekly measures of rumination and symptom severity. Lagged associations between rumination and symptoms in the following week were examined using linear mixed models. Results Over the course of therapy, both ruminative thinking and PTSD symptoms decreased. Rumination was a significant predictor of PTSD symptoms in the following week, although this effect was at least partly explained by the time factor (e.g., natural recovery or inseparable treatment effects). Symptom severity predicted ruminative thinking in the following week even with time as an additional predictor. Conclusions The present study provides preliminary evidence that rumination in PTSD is reduced by CBT for PTSD but does not give conclusive evidence that rumination is a mechanism of change in trauma-focused treatment for PTSD. Author Affiliation: (a) Department of Psychology, LMU Munich, Leopoldstr. 13, Munich, Germany (b) Institute of Psychology, WWU Münster, Fliednerstr. 21, 48149, Münster, Germany (c) ZISG Mannheim, Central Institute of Mental Health, J 5, 68159, Mannheim, Germany (d) Translational Psychotherapy, Department of Psychology, Friedrich--Alexander University Erlangen--Nürnberg (FAU), Nägelsbachstr. 49a, 91051, Erlangen, Germany (e) Department of Psychology, School of Social Sciences, University of Mannheim, L 13, 17, 68163, Mannheim, Germany * Corresponding author. Article History: Received 29 July 2021; Revised 26 September 2021; Accepted 16 November 2021 Byline: Hannah Schumm [Hannah.Schumm@psy.lmu.de] (a,*), Antje Krüger-Gottschalk [antje.krueger@uni-muenster.de] (b), Anne Dyer [Anne.Dyer@zi-mannheim.de] (c), Andre Pittig [andre.pittig@fau.de] (d), Barbara Cludius [Barbara.Cludius@psy.lmu.de] (a), Keisuke Takano [Keisuke.Takano@psy.lmu.de] (a), Georg W. Alpers [alpers@uni-mannheim.de] (e), Thomas Ehring [thomas.ehring@lmu.de] (a)

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Gale Document Number: GALE|A687615529