What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors

Abstract

Objective: Therapeutic process factors including alliance and motivation are considered to play a key role in the treatment of post-traumatic stress disorder (PTSD). Yet, our understading of change processes in therapy is mostly based on theoretical considerations with limited empirical evidence. In order to identify process characteristics of successful inpatient treatments of PTSD, we investigated the intraindividual, interindividual, and temporal associations of daily assessments of therapy process factors like motivation, alliance, and insight.Methods: Therapy Process Questionnaire (TPQ) assessments were collected from 101 inpatients with PTSD over 50 days, resulting in 5050 assessments. Multilevel Vector Autoregressive (mlVAR) modelling was applied to investigate the networks of the TPQ factors in a subgroup with good outcome regarding PTSD symptomatology and a subgroup with less favourable outcome.Results: The two subgroups differed markedly in their network models, suggesting that therapy processes might be different for those with good and those with poor treatment outcomes. Conclusions: Our results suggest that good treatment outcome is linked to a specific therapy process dynamic where mindfulness and insight lead to the kind of temporary well-being required to effectively engage with problems and negative emotions, while motivation to change ensures the continuity of confronting negative emotions and problems.

How Important Is Reprocessing in Personalized Multicomponent Therapy? Analyzing Longitudinal Data of Inpatients With Severe PTSD

“…In particular, there is dire need of process research in this area. In a similar study, it was found that a temporal dynamic of motivation to change and engagement with aversive emotions was associated with better outcome (Kratzer et al, 2022c). Hence, associations of general process dynamics with effective treatments and specific interventions such as EMDR or exposure should be the subject of future research.…”

“…Network-informed diagnoses and interventions might prove to be particularly helpful in coping with cases of high complexity and comorbidity (Roefs et al, 2022). However, a personalized treatment of PTSD will not only have to encompass treatment modules to choose from, but also strategies to enhance common factors such as alliance and motivation to change (Kratzer et al, 2022c). Furthermore, future studies should investigate the role of therapist factors such as warmth and competence (Seewald and Rief, 2022), as well as their ability to repair ruptures (Haugen et al, 2017).…”

“…For example, real-time monitoring may be used to track dysfunctional behavior using a diary card, thereby facilitating therapist behavior in accordance to the target hierarchy. Furthermore, using self-ratings such as the therapy process questionnaire (Schiepek et al, 2019), real-time monitoring may be used to monitor treatment process factors such as alliance or motivation to change with high relevance in the treatment of PTSD (Kratzer et al, 2022c). This is of particular importance as the effective repair of ruptures in general and attention for disagreements regarding goals and tasks in specific have been shown to be linked to outcome in the treatment of PTSD (Haugen et al, 2017; McLaughlin et al, 2014).…”

Change motivation and mindfulness in individual psychotherapy: Examining a sample of adult outpatients with depression and/or anxiety

“…Mindfulness (together with insight) fostered well‐being to engage in problems and motivation to change promoted the continuity to confront oneself with one's problems. This pattern was especially apparent in patients with favorable outcomes (Kratzer et al, 2022). In a recent study by Abo Hamza et al (2023), trait mindfulness was associated with readiness to change (which is related to motivation to change) in a sample of alcohol drinkers.…”

“…Positive effects of a combination of motivational (such as motivational interviewing, MI) and mindfulness interventions (such as MBCT, dialectical behavior therapy) were demonstrated in patients with marijuana use (de Dios et al, 2012), chronic pain (Malins et al, 2020), borderline personality disorder (Soler et al, 2008), internet addiction (Siste et al, 2022), and eating disorders (Scanferla et al, 2022). A study examining therapy process factors in inpatient trauma-focused psychotherapy for PTSD emphasized the relevance of different factors involved in the therapeutic process (Kratzer et al, 2022). Mindfulness (together with insight) fostered well-being to engage in problems and motivation to change promoted the continuity to confront oneself with one's problems.…”