An estimated 7 to 12 percent of Americans and Canadians will be diagnosed with Posttraumatic Stress Disorder (PTSD) at some point in their life, with women twice as likely as men to develop the disorder. Rates of PTSD are higher among combat veterans. For example, 300,000 veterans in the United States, many of whom served in Iraq and Afghanistan, suffer from PTSD.
Military-related PTSD has been linked to the development of depression, substance use disorders, cardiovascular problems, and socioeconomic difficulties
(Holliday, Link-Malcolm, Morris, & Surís, 2014). In those with PTSD, the intrusive flashbacks and nightmares of the battlefield trauma trigger intense negative emotions and avoidance, which make the disorder debilitating. Intense symptoms can develop soon after exposure to the traumatic event. In some people the sudden sound of a balloon pop – a sound similar to a gunshot – can trigger a flood of negative emotions years later. People who go on to develop PTSD report unhelpful thoughts and beliefs (for example: “Because a bad thing happened to me, I must have been punished for something I did” or “I can’t ever trust my judgment again”). As long as these thoughts of shame and guilt are maintained, intrusive symptoms and negative emotions will persist.
An effective treatment for PTSD is cognitive processing therapy (CPT). CPT was initially developed for survivors of rape and has since been adapted to treat military-related PTSD (Holliday et al., 2014; Resick & Schnicke, 1992). Over the course of CPT, traumatized clients learn how to challenge unhelpful beliefs that maintain PTSD symptoms. And through cognitive restructuring – a technique that encourages more helpful, accurate thinking– PTSD symptoms decrease.
To date, the research methods used to understand the factors that make CPT effective in treating PTSD have been incomplete (Price, MacDonald, Adair, Koerner, & Monson, 2014; Gallegos, 2005). For example, questionnaires that clients fill out throughout treatment to monitor psychological functioning only tell us so much about the effectiveness of CPT.
Price and colleagues in the United States and in Canada enrolled 60 people with PTSD in 12 sessions of CPT. Participants were instructed to write at least one page about the traumatic event and to consider the effects it had on their beliefs about themself, others, and the world. They were also asked to consider the topics of safety, trust, power/control, esteem, and intimacy while writing their answer. Participants wrote about their traumatic experience during their first and final treatment sessions.
Two researchers then read through each participant’s narratives and coded their content for themes. For example, one participant wrote “I have to be the one in control and have all the power” and another participant wrote “I feel I need to control everything and keep the upper hand.” Both of these thought units are examples of a commonly observed belief in people with PTSD that one must be in control. Themes from participants’ first and last writing session were compared to see if people wrote about their traumatic experiences in a different way after receiving 12 sessions of CPT.
By using this thematic method to analyze changes in language use, Price and colleagues found that participants included fewer negative thoughts and references to their PTSD symptoms in their narratives in the final session of CPT relative to when they started treatment. In addition, while most participants experienced more positive emotions in their final writing session, some described continued sadness when thinking about their traumatic experience. This is common for sufferers of PTSD.
What this research tells us is that changing the way one thinks about the self and traumatic experiences is an important part of recovery from PTSD.