Transdiagnostic mechanisms of change and cognitive-behavioral treatments for PTSD

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Highlights

  • Identifying mechanisms of change is crucial for understanding recovery from PTSD.

  • Evidence for transdiagnostic mechanisms, such as hope and neuroticism, is reviewed.

  • Current evidence supports the importance of transdiagnostic mechanisms in PTSD.

  • Transdiagnostic treatments are an important future direction for PTSD treatment.

This paper reviews the current status of transdiagnostic mechanisms of change targeted in cognitive-behavioral interventions, with a focus on mechanisms that are also relevant to emotional disorders that frequently co-occur with PTSD. First, an overview of the rationale for and key features of identifying mechanisms of change is presented, with a discussion of why it is crucial to examine mechanisms that are relevant across diagnostic boundaries. A review of the current evidence for five promising transdiagnostic mechanisms (hope, neuroticism, emotion regulation, cognitive reappraisal, and anxiety sensitivity) is then provided. Finally, the implications of the increasing evidence of transdiagnostic mechanisms of change are discussed in relation to recently developed transdiagnostic treatment protocols that provide an alternative treatment approach for PTSD.

Introduction

Tremendous progress has been made in recent decades in developing cognitive-behavioral treatments for individuals with posttraumatic stress disorder (PTSD). Treatments such as cognitive processing therapy (CPT) [1] and prolonged exposure therapy (PE) [2] have been widely supported and recent years have seen the development of new treatments such as written exposure therapy (WET) [3] that also show great promise as alternative treatments for PTSD. Given extensive evidence for the efficacy of CBT for PTSD, the focus of treatment outcome research for PTSD is increasingly shifting towards the examination of the conditions under which treatments are more or less effective (i.e., moderators), and the processes by which treatments promote recovery from PTSD (i.e., mechanisms).

There has also been an increasing awareness in recent years of the importance and benefits of examining transdiagnostic mechanisms of change that are relevant not only to PTSD, but to other related emotional disorders. PTSD was removed from the anxiety disorders in the most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM) [4]). Nevertheless, there is extensive evidence that the majority of individuals who meet diagnostic criteria for PTSD also meet criteria for one or more additional comorbid emotional disorders (i.e., mood, anxiety, and obsessive-compulsive disorders such as panic disorder, major depressive disorder) [5, 6], and that common mechanisms may underlie both the development of and recovery from many emotional disorders [7••]. Treatments that more intentionally focus on transdiagnostic mechanisms may provide a more efficient and effective alternative to single disorder treatment protocols as they could provide clinicians with a treatment option that could target the full range of comorbid psychiatric conditions that individuals often present with, and could provide a more efficient target for the dissemination of evidence-based treatments.

Multiple transdiagnostic CBT protocols have been developed in recent years that are designed to target emotional disorders and PTSD. To date, there is not yet a transdiagnostic treatment that has accumulated sufficient evidence to be considered an empirically supported treatment for PTSD. The goal of this article is not to compare and contrast various transdiagnostic interventions, and the present article does not represent an exhaustive list of potential transdiagnostic mechanisms of change. The goal is to provide an introduction and brief overview of current knowledge regarding transdiagnostic mechanisms of change by highlighting certain mechanisms of change that have transdiagnostic relevance and that are therefore relevant to current and future cognitive-behavioral treatments for PTSD.

Section snippets

Defining and identifying mechanisms of change

A mechanism of change is a process or psychological construct that causes and explains how an intervention ultimately results in change in the outcome of interest [8]. With the increasing recognition of the importance of studying mechanisms of change for PTSD and other psychological disorders, significant progress has been made in identifying the methodological features of a study that are necessary to identify mechanisms of change [9]. A compelling theoretical rationale for why a construct

Transdiagnostic mechanisms and PTSD

The present review focuses on a select number of mechanisms with promising empirical support and a compelling theoretical rationale for considering the mechanism to be of transdiagnostic importance and also relevant to PTSD. The mechanisms discussed in the present article include hope, neuroticism, emotion regulation, anxiety sensitivity, and cognitive changes. These five mechanisms have all been demonstrated to predict symptomatology across diagnostic boundaries and were chosen to provide

Conclusions

There is promising and rapidly increasing evidence regarding the role that transdiagnostic mechanisms play in promoting recovery from PTSD in empirically supported treatments for PTSD and newer treatments that show great promise. The statistical and methodological features of these studies are also rapidly improving, which strengthens conclusions regarding exactly when and how these constructs function as mechanisms of change. The current evidence suggests that many of the key mechanisms of CBT

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

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