Young people’s trauma‐related cognitions before and after cognitive processing therapy for post‐traumatic stress disorder

OBJECTIVES: Cognitive processing therapy (CPT) is a psychotherapy for post-traumatic stress disorder (PTSD) with a broad evidence base. Change in trauma-related cognitions is considered its primary working mechanism. When trying to integrate a traumatic event into existing cognitive schemas, the adaptive mechanism is changing the schema (accommodation). However, PTSD patients frequently either change their schemas too much (over-accommodation), or cognitively distort the event (assimilation). We aimed to test the hypothesized connections between the three types of cognition and symptom load. DESIGN: This study adds to the literature using 'impact statements', essays on their trauma-related thoughts written by patients at the beginning and end of CPT, to investigate cognitive change and its relationship to symptomatic outcome. METHODS: We analysed statements written by 31 adolescents and young adults who received developmentally adapted CPT (a longer treatment where CPT is the core component) in a randomized controlled trial. RESULTS: As expected, post-CPT statements contained more accommodated and fewer over-accommodated and assimilated clauses than pre-CPT statements. Correlations between cognition frequencies and concurrent symptom load were as expected for assimilation, and, in part, over-accommodation and accommodation. Decreased PTSD and depressive symptoms were correlated with increased accommodated thoughts. For over-accommodation and assimilation, however, expected correlations could not be shown. CONCLUSIONS: Our results support the notion that cognitive change is an important mechanism of change in CPT in a sample of younger, non-English-speaking clients. Practitioner points Knowledge about the working mechanisms of psychotherapies (in addition to knowledge about their efficacy) is important for psychoeducation, motivating clients, and clinical decision-making. In accordance with the theory behind cognitive processing therapy, young clients' cognitions changed over the course of therapy in the predicted ways. For some types of cognition, the change was related to PTSD and/or depressive symptoms, supporting the notion that cognitive change is an important working mechanism of cognitive processing therapy.