Targeting Trauma-Related Beliefs in PTSD with Behavioral Experiments: Illustrative Case Study

Abstract

Cognitive Processing Therapy (CPT) with traditional written thought records is an effective treatment for posttraumatic stress disorder (PTSD). A potential barrier to targeting trauma-related beliefs with traditional thought records is that typically the resulting behavioral avoidance from the trauma-related belief limits the experiences (i.e., evidence) which are available to draw from when evaluating a thought—there can be an absence of discrepant experiences due to avoidance. Another major approach to cognitive restructuring in the cognitive and behavioral therapies is through behavioral experiments (BE) which can be used to gather new evidence and form new experiences. Extant literature suggests there are some preliminary indications that BE may have a slight clinical advantage over traditional thought records as they are associated with a faster treatment response and better generalizing of new learning. There is also evidence that BE may have a slight advantage over traditional exposure for treating anxiety disorders. An illustrative case example of an active duty soldier with PTSD stemming from multiple combat- and non-combat-related traumas is presented. Standard CPT was modified to include BE as opposed to standard thought records to treat his PTSD. Treatment was effective as the soldier demonstrated reliable change and clinically significant change on the PTSD Checklist-5 (PCL-5). Further research is needed to better understand the role of BE in treating PTSD.