دانلود رایگان مقاله مکانیزم تغییر در WET در اختلال استرس پس از سانحه

Although the effectiveness of exposure therapy for PTSD is recognized, treatment mechanisms are not well understood. Emotional processing theory (EPT) posits that fear reduction within and between sessions creates new learning, but evidence is limited by self-report assessments and inclusion of treatment components other than exposure. We examined trajectories of physiological arousal and their relation to PTSD treatment outcome in a randomized controlled trial of written exposure treatment, a protocol focused on exposure to trauma memories. Hierarchical linear modeling was used to model reduction in Clinician Administered PTSD Scale score as a predictor of initial activation and within- and between-session change in physiological arousal. Treatment gains were significantly associated with initial physiological activation, but not with within- or between-session changes in physiological arousal. Treatment gains were associated with larger between-session reductions in self-reported arousal. These findings highlight the importance of multimethod arousal assessment and add to a growing literature suggesting refinements of EPT.

Discussion

We tested four indices of EPT and their relation to PTSD treatment response. Two indices, BSC in selfreported arousal and initial activation of physiological arousal, were positively associated with treatment gains. Neither WSC nor BSC in physiological arousal was related to treatment response. Our self-report findings are consistent with prior research demonstrating that BSC in self-reported arousal predicts treatment gains among individuals who receive PE. To our knowledge, our results are the first to provide support for an association between BSC in self-reported arousal and changes in PTSD severity in a treatment package other than PE. Unlike PE, which includes several treatment components, the central feature of the treatment in this study is a written form of trauma memory exposure with minimal therapist instruction. Our findings therefore increase confidence that BSC of self-reported arousal can be attributed to trauma memory exposure specifically. These findings also indicate that selfreports of arousal offer potential clinical utility as a means of tracking treatment response.