Changes in Coping and Negative Cognitions as Mechanisms of Change in Online Treatment for Rape-Related Posttraumatic Stress Disorder

Cognitive behavioral therapy (CBT)-based interventions, including those administered via telepsychology, represent efficacious posttraumatic stress disorder (PTSD) treatments. Despite demonstrated efficacy, limited research has examined mechanisms of change for CBT. We examined trauma-related cognitions and coping as treatment mechanisms among 46 women who completed a randomized clinical trial of a CBT-based, telepsychology-delivered interactive program for rape survivors. The results indicated that both the interactive program, d = 1.5, and the active control condition, a psychoeducational website, d = 1.4, resulted in large reductions in posttest PTSD symptoms. Analysis of residual gain scores showed that reductions in the three types of assessed trauma-related cognitions were strongly related to reductions in PTSD symptoms among women assigned to the interactive program, rs = .60-.79, but only weakly related to symptom reduction among those assigned to active control, rs = .06-.31. The results also suggest that increases in trauma-related approach coping were weakly related to reductions in PTSD symptoms among participants in the interactive program, rs = -.16 and -.17, but, conversely, decreases in trauma-related approach coping were weakly related to reductions in PTSD symptoms among those in the active control group, rs = .07 and .28. Reductions in avoidance coping were modestly related to reductions in PTSD symptoms among women in the interactive program, rs = .38 and .38, but unrelated to changes in PTSD symptoms among those assigned to the active control, rs = .03 and .05. Implications for future work examining mechanisms of change for PTSD treatments are discussed.