Abstract
Trauma-focused cognitive behaviour therapy is effective in treating posttraumatic stress disorder but non-response rates range between 25% and 50%. Results of previous research on patient characteristics predicting outcome are inconsistent and mainly focused on demographic and diagnostic variables. This study examined whether behavioural predictors of poor treatment response can be observed in early sessions. It was predicted that greater patient perseveration, lower expression of thoughts and feelings and weaker therapeutic alliance would be associated with poorer outcomes. We also explored the relationships of patient behaviours with therapeutic alliance and the efficiency and competence of treatment delivery. Audio or video recordings of the initial treatment sessions of 58 patients who had shown either good (n = 34) or poor response (n = 24) to cognitive therapy for PTSD (CT-PTSD, Ehlers & Clark, 2000) were blindly coded for patient perseveration, expression of thoughts and feelings, therapeutic alliance, efficiency and competency of treatment delivery and therapist competence. Poor responders showed more perseveration and less expression of thoughts and feelings in the initial session. Patient perseveration and low expression of thoughts and feelings were associated with poorer therapeutic alliance and compromised treatment delivery. Patients with these behavioural characteristics may benefit from additional treatment strategies. Limitations of the study and implications for clinical practice are discussed.
Highlights
Trauma-focused cognitive behaviour therapy (CBT) is an effective first-line treatment for posttraumatic stress disorder (PTSD) (Bradley, Greene, Russ, Dutra, & Westen, 2005; Cloitre, 2009; National Institute for Health and Care Excellence, 2005)
The present study investigated the influence of observed perseveration on the efficiency and competency of treatment delivery, therapeutic alliance and treatment outcome in another form of trauma-focused CBT, CTPTSD (Ehlers & Clark, 2000; Ehlers, Clark, Hackmann, McManus, & Fennell, 2005)
The findings are in line with the case study of prolonged exposure by Echiverri et al (2011). These findings suggest that perseverative thinking may interfere with treatment response to trauma-focused cognitive behaviour therapy
Summary
Trauma-focused cognitive behaviour therapy (CBT) is an effective first-line treatment for posttraumatic stress disorder (PTSD) (Bradley, Greene, Russ, Dutra, & Westen, 2005; Cloitre, 2009; National Institute for Health and Care Excellence, 2005). Treatment non-response rates range between 25% and 50% (for reviews see Bisson, Roberts, Andrew, Cooper, & Lewis, 2013; Bradley et al, 2005; Schottenbauer, Glass, Arnkoff, Tendick, & Gray, 2008). Evidence regarding patient factors associated with poor treatment outcomes in CBT for PTSD is limited and there is a need for further research to examine indicators of non-response to treatment (Hembree, Marshall, Fitzgibbon, & Foa, 2001). For PTSD treatment, demographic and diagnostic variables, including gender, age, ethnicity, comorbid psychiatric diagnoses and trauma characteristics, predicted outcome in some studies. Few variables consistently predicted outcome across studies (e.g., Ehlers et al, 2013; Schottenbauer et al, 2008; van Minnen, Arntz, & Keijsers, 2002)
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