Traveling the Road to Healing: An Examination of the Relationships between Psychotherapeutic Technique and Cognitive, Emotional and Physiological Outcomes in Women Exposed to Violence.

Abstract

Contemporary research on therapy for trauma survivors has favored the approach of manipulating therapy interventions with highly structured protocols, rather than measuring therapy as it naturally occurs. Thus, we know much about treatments for trauma-related symptoms that are rarely practiced. We know much less about the real world effectiveness of the treatments that are most commonly practiced. Both randomized trials and naturalistic studies have been criticized for over-reliance on self-report. Laboratory-based, objective assessments have demonstrated that interpersonal violence survivors have alterations in cognition and physiological arousal that correlate with their psychopathology. This study examined the relationship between psychotherapy processes and changes in both self-reported symptoms and laboratory measures in 27 female interpersonal violence survivors who received 3 months of therapy in the community. Therapists treated patients using their normal practices and no effort was made to get therapists to adhere to a structured protocol. Participants were assessed in the lab and completed self-report measures before and after three months of therapy. Attentional biases for trauma-related material were assessed using the Stroop task. Implicit memory for trauma-related material was assessed using a Word-Stem Completion Task. Physiological arousal was assessed while participants viewed trauma-related slides. Therapists used a modified version of the Psychotherapy Process Q-Set (PQS) to quantify their choice of psychotherapy techniques. The PQS ratings were reduced to well-established scales reflecting general psychodynamic and cognitive-behavioral therapeutic techniques and newly derived scales assessing trauma-focused work on shame, guilt and meaning; stress inoculation (SIT); and prolonged exposure (PE). Improvements in self-reported symptoms, attentional biases, and physiological arousal were related to greater presence of techniques associated with psychodynamic therapy; trauma-related work on shame, guilt and meaning; and SIT, but not with techniques associated with PE therapy. Contrary to prior research, working alliance was not related to symptom improvements. These findings suggest that psychodynamic techniques; work on guilt, shame and meaning; and SIT techniques can play a role in both symptom alleviation and improvements in cognition and physiology in significantly traumatized women. These results are limited by the correlational nature of the data and the unknown validity of some of the new therapy process measures.