Identifying predictors of long-term treatment outcomes using narratives from written exposure therapy and cognitive processing therapy for PTSD.

Abstract

Objective: Cognitive processing therapy (CPT), a 12-session, gold-standard treatment for posttraumatic stress disorder (PTSD), and written exposure therapy (WET), a brief, five-session treatment, have similar treatment efficacy. The aim of the present study was to identify predictors of long-term treatment outcomes of WET and CPT using clients' written narratives.

Method: Narratives from both treatments were coded with the Change and Growth Experiences Scale coding system to identify predictors of long-term PTSD symptom outcomes. Participants were 113 adults with PTSD randomly assigned to receive WET (n = 60) or CPT (n = 53).

Results: In WET, higher average levels of accommodated (balanced, healthy) beliefs predicted lower PTSD symptoms at the 60-week endpoint, as well as a decrease in symptoms over the follow-up symptom slope. In CPT, higher average negative emotions and positive view of self predicted better 60-week PTSD symptom outcomes, as did lower hopelessness, which also predicted a decrease in PTSD symptoms over the follow-up period.

Conclusions: Even without direct cognitive change techniques, adaptive processing of traumatic experiences occurred in WET and predicted PTSD long-term symptom improvement. Both emotional engagement and cognitive change might help to sustain treatment gains in CPT. (PsycInfo Database Record (c) 2025 APA, all rights reserved).