Predicting Response to Exposure Treatment in PTSD

The Role of Mental Defeat and Alienation

Published in: Journal of Traumatic Stress, v. 11, no. 3, 1998, p. 457-471

Posted on RAND.org on December 31, 1997

by Anke Ehlers, David M. Clark, Emma Dunmore, Lisa H. Jaycox, Elizabeth A. Meadows, Edna B. Foa

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Not all patients with posttraumatic stress disorder benefit from exposure treatment. The present paper describes two cognitive dimensions that are related to inferior response to exposure in rape victims. First, individuals whose memories during reliving of the trauma reflected mental defeat or the absence of mental planning showed little improvement. Second, inferior outcome was correlated with an overall feeling of alienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions from 10 women with good outcomes and 10 women with inferior outcome. Patients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. Patients who experienced mental defeat, alienation, or permanent change may require cognitive restructuring in addition to exposure.

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