Mechanisms of Change in Trauma-Focused Treatment for PTSD: The Role of Rumination. (January 2022)

• Record Type: Journal Article
• Authors: Schumm, Hannah; Krüger-Gottschalk, Antje; Dyer, Anne; Pittig, Andre; Cludius, Barbara; Takano, Keisuke; Alpers, Georg W.; Ehring, Thomas
• Is Part Of: Behaviour research and therapy. Volume 148(2022)
• Publication Date: 2022-01
• Subjects: rumination -- PTSD -- Mechanisms of change -- Trauma-focused treatment; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2021.104009
• Languages: English
• ISSNs: 0005-7967

Abstract

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. 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