Cognitive Therapy and Research

, Volume 36, Issue 6, pp 750–755 | Cite as

Mechanisms of Change in Cognitive Processing Therapy and Prolonged Exposure Therapy for PTSD: Preliminary Evidence for the Differential Effects of Hopelessness and Habituation

  • Matthew W. GallagherEmail author
  • Patricia A. Resick
Brief Report


The present study examined two potential mechanisms of change, hopelessness cognitions and habituation, in a randomized controlled trial of cognitive processing therapy (CPT) and prolonged exposure therapy (PE) for posttraumatic stress disorder (PTSD). Participants were 171 adult women with a current primary diagnosis of sexual assault related PTSD. The potential mechanisms were examined by evaluating the intraindividual change in hopelessness within the course of both treatments and subjective units distress (SUDS) ratings (a proxy for habituation) within the course of PE. The effects of intraindividual change in the proposed mechanisms were then examined on within-treatment changes in PTSD symptoms. Findings indicated that the participants assigned to the CPT treatment had significantly greater pre-post reductions in hopelessness than those assigned to PE and that the changes in hopelessness predicted changes in PTSD symptoms (R 2  = .24). Intraindividual changes in SUDS ratings for participants in the PE treatment condition also predicted changes in PTSD symptoms and did so independently of the effect of changes in hopelessness. Future research should examine these mechanisms using more intensive methods of data collection that would permit the demonstration of temporality of change.


PTSD Trauma Mechanism Mediation Hopelessness Habituation 



This work was supported by Grant NIH-1 R01-MH51509 from the National Institute of Mental Health, awarded to Patricia A. Resick.


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Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011

Authors and Affiliations

  1. 1.National Center for PTSD at VA Boston Healthcare SystemBoston UniversityBostonUSA
  2. 2.Center for Anxiety and Related DisordersBoston UniversityBostonUSA

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