Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.
Antecedentes: La evaluación desadaptativa del trauma juega un papel importante en el desarrollo y mantenimiento del trastorno de estrés postraumático (TEPT). Si bien los estudios han demostrado la eficacia de los tratamientos cognitivos y de exposición para la sintomatología del trastorno de estrés postraumático, aún no se comprende bien el efecto de dichos tratamientos en valoraciones específicas del trauma.
Objetivo: El estudio investigó el efecto de un tratamiento de exposición y reestructuración cognitiva basado en Internet, sobre las valoraciones específicas del trauma en participantes de habla árabe con TEPT.
Método: 334 participantes recibieron un tratamiento de exposición (n =
Resultados: Ambos tratamientos produjeron cambios significativos en la vergüenza, la culpa, el miedo, la ira y la alienación (todos p < 0,001). Los cambios en la traición sólo fueron significativos en el tratamiento de reestructuración cognitiva (p < 0,001). No hubo evidencia de diferencias entre tratamientos para ninguna valoración específica del trauma. Los cambios en la gravedad de los síntomas del TEPT se asociaron significativamente con cambios en las valoraciones del trauma (todos ps < 0,001). En ambos tratamientos, los participantes que experimentaron una mejora confiable en la severidad de los síntomas de TEPT mostraron cambios significativamente mayores de pre a post tratamiento en valoraciones específicas del trauma comparados con aquellos sin mejora confiable. Nuevamente, las diferencias en la traición sólo fueron significativas en el tratamiento de reestructuración cognitiva.
Conclusiones: Los hallazgos indican que ambos tratamientos son efectivos para reducir las valoraciones del trauma en personas de habla árabe con TEPT. Los cambios en la valoración del trauma parecen estar asociados con cambios en la sintomatología del TEPT.
Keywords: Arabic; ECA; Estrés postraumático; Internet; Posttraumatic stress; RCT; anger; cognitive restructuring; culpa; exposición; exposure; fear; guilt; ira; miedo; reestructuración cognitiva; shame; vergüenza; árabe.
Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.