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Psychological Mechanisms of Effective Cognitive–Behavioral Treatments for PTSD

  • Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)
  • Published:
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Abstract

Several psychotherapies have been established as effective treatments for posttraumatic stress disorder (PTSD) including prolonged exposure, cognitive processing therapy, and cognitive therapy for PTSD. Understanding the key mechanisms of these treatments, i.e., how these treatments lead to therapeutic benefits, will enable us to maximize the efficacy, effectiveness, and efficiency of these therapies. This article provides an overview of the theorized mechanisms for each of these treatments, reviews the recent empirical evidence on psychological mechanisms of these treatments, discusses the ongoing debates in the field, and provides recommendations for future research. Few studies to date have examined whether changes in purported treatment mechanisms predict subsequent changes in treatment outcomes. Future clinical trials examining treatments for PTSD should use study designs that enable researchers to establish the temporal precedence of change in treatment mechanisms prior to symptom reduction. Moreover, further research is needed that explores the links between specific treatment components, underlying change mechanisms, and treatment outcomes.

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Notes

  1. Eye Movement Desensitization and Reprocessing has also been established as an effective treatment for PTSD and is recommended by practice guidelines. To date, no studies have examined the underlying mechanisms of EMDR; rather, research has focused heavily on identifying the importance of specific treatment techniques (i.e., whether bilateral stimulation is a necessary component of treatment). Given that there are no empirical studies on the underlying mechanisms of EMDR, this treatment is not discussed in the current review.

  2. Doss refers to treatment components as “change processes,” therapy techniques as “therapy change processes,” and patient events as “client change processes” in his article. The terms “process” and “mechanism” are often used interchangeably in the psychotherapy literature. Because Doss’ original terms may be confusing for readers, I have modified these terms to more closely reflect the nature of these constructs.

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Acknowledgments

The author would like to thank Nicole Heath and Rebecca Blais for the feedback on a draft of this manuscript.

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Conflict of Interest

Alyson K. Zalta receives grant support from NIH (K23 MH103394).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Departments of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 400, Chicago, IL, 60612, USA

    Alyson K. Zalta

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Correspondence to Alyson K. Zalta.

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This article is part of the Topical Collection on Disaster Psychiatry: Trauma, PTSD, and Related Disorders

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Zalta, A.K. Psychological Mechanisms of Effective Cognitive–Behavioral Treatments for PTSD. Curr Psychiatry Rep 17, 23 (2015). https://doi.org/10.1007/s11920-015-0560-6

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