Effects of Psychotherapy on Trauma-related Cognitions in Posttraumatic Stress Disorder: A Meta-Analysis

New Study (1)Abstract

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders criteria for posttraumatic stress disorder (PTSD) incorporate trauma-related cognitions. This adaptation of the criteria has consequences for the treatment of PTSD. Until now, comprehensive information about the effect of psychotherapy on trauma-related cognitions has been lacking. Therefore, the goal of our meta-analysis was to determine which psychotherapy most effectively reduces trauma-related cognitions.

Our literature search for randomized controlled trials resulted in 16 studies with data from 994 participants. We found significant effect sizes favoring trauma-focused cognitive-behavioral therapy as compared to nonactive or active nontrauma-focused control conditions of Hedges’ g = 1.21, 95% CI [0.69, 1.72], p < .001 and g = 0.36, 95% CI [0.09, 0.63], p = .009, respectively. Treatment conditions with elements of cognitive restructuring and treatment conditions with elements of exposure, but no cognitive restructuring reduced trauma-related cognitions almost to the same degree. Treatments with cognitive restructuring had small advantages over treatments without cognitive restructuring.

We concluded that trauma-focused cognitive-behavioral therapy effectively reduces trauma-related cognitions. Treatments comprising either combinations of cognitive restructuring and imaginal exposure and in vivo exposure, or imaginal exposure and in vivo exposure alone showed the largest effects.


Diehle, J., Schmitt, K., Daams, J.G., Boer, F., & Lindauer, R.J. (2014). Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: a meta-analysis. Journal of  Traumatic Stress, 27(3), 257-264. doi: 10.1002/jts.21924.

Cognitive Restructuring in Schizophrenia

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck describes how to modify and utilize cognitive restructuring with a schizophrenic client. Using an example, Dr. Beck explains that he will initially focus on the client’s interests to build engagement and self-efficacy. As self-efficacy increases, the client’s problematic and unhelpful behaviors begin to decrease. Dr. Beck emphasizes the use of cognitive conceptualization to target the variables that drive the client’s behavior, which can be used to structure treatment.

For CBT resources, visit our website.

Cognitive Restructuring in CBT

Dr. Aaron Beck reviews cognitive restructuring with a depressed client during a recent Beck Institute Workshop. Dr. Beck describes how he helped the client evaluate evidence for and against his thoughts and his belief that he was a failure. He also explains how cognitive restructuring helps depressed clients access rational thinking that is typically blocked by their cognitive distortions.

For CBT resources, visit our website.

The Utility of Mindfulness-Based CBT Techniques

In this video from a recent Beck Institute Workshop, Dr. Aaron Beck discusses ways to integrate mindfulness-based CBT techniques into treatment. He provides an example to demonstrate how mindfulness techniques can often help bring about symptom relief, while other key CBT techniques, such as cognitive restructuring, target the underlying problem.

For CBT resources, visit our website.

Cognitive Behavior Therapy for Depression

In this clip from a recent 3-day workshop at the Beck Institute for Cognitive Behavior Therapy, Dr. Aaron Beck discusses CBT strategies for suicidal patients facing a number of losses or negative events (e.g., loss of job/family/assets/health/etc.) Dr. Beck explains that depression stems from the meaning one attaches to life events rather than the events themselves. For example, a person who is vulnerable to depression might believe, “Losing my job means I am worthless.” Dr. Beck then uses a patient example to demonstrate cognitive restructuring, a key CBT strategy for treating depression.

To learn more about Cognitive Behavior Therapy, visit our website.

Japan: Social Anxiety Disorder shows positive response to group CBT

A study in BMC Psychiatry reported that the use of cognitive behavioral therapy (CBT) for Social Anxiety Disorder (SAD) was well established in Europe and North America but little was known about its effectiveness in non-Western cultures.

A pilot study of group CBT for SAD was conducted in Japan (groups of 3 or 4; average number of sessions per group was 15). The CBT methods included psychoeducation regarding anxiety, experiments to reduce safety behaviors, cognitive restructuring for dysfunctional assumptions, and others. Where needed, co-administration of antidepressants and benzodiazepines was allowed.

The researchers found a significant reduction in symptoms pre- to post-treatment, and concluded that group CBT “can bring about a similar degree of symptom reduction among Japanese patients with SAD as among Western patients.”

Study authors: J. Chen, Y. Nakano, T. Ietzugu, S. Ogawa, et al.

Adolescents with SSRI-resistant Depression show improved response to treatment that includes CBT

A new study in JAMA reported that approximately 60% of depressed adolescents respond adequately to initial treatments with a selective serotonin reuptake inhibitor (SSRI), but there is a lack of information about subsequent treatment strategies. Four treatment strategies were employed in this study including medication-switching alone (to a different SSRI or to venlafaxine) and medication-switching plus cognitive behavioral therapy (CBT). CBT in this study emphasized cognitive restructuring, behavioral activation, emotion regulation, social skills, and problem solving. Additionally, parent-child sessions emphasized decreasing criticism and improving support, family communication, and problem solving. The authors found that CBT plus a switch to either medication regimen showed a higher response rate than a medication-switch alone (and that there was no difference in response rate between venlafaxine and a second SSRI).

Study authors: D. Brent, G. Emslie, G. Clarke, K. D. Wagner, J. R. Asarnow, M. Keller, et al.

Cognitive Restructuring Group

We recently received the following update from Kevin Benbow about the positive effects of teaching Cognitive Restructuring in a group format:

About six months ago I came up with the idea to create a group based on the premises of Greenberger and Padesky’s “Mind Over Mood.”  This was a pilot program, and the intention of the group was to solely teach the basics of cognitive restructuring to the participants.   This was done via handouts, movie clips, and a power point presentation. The group ran for 12 sessions and we systematically taught all participants to make the connection between situations, moods and automatic thoughts.  The BDI* and BAI* were administered prior to beginning group and were also administered at the last session.

It should be noted that in addition to the teaching of CR techniques these clients would also receive individual therapy as well as psychotropic medication if needed.

While I have seen the power and utility of CR before, I was pleasantly surprised to see how group dynamics can be used to reinforce the completion of homework and normalize symptoms of depression and anxiety.  Once the basic concepts were taught, we would complete thought records on the white board using actual stressors from the clients’ lives.  Read more