Schemas and coping strategies in cognitive-behavioral therapy for PTSD: A systematic review

Introduction. - Although cognitive-behavioral therapy (CBT) is effective in treating post-traumatic stress disorder (PTSD), some clients remain symptomatic after treatment. Some individuals with PTSD may present more severe dysfunctional cognitive schemas and use dysfunctional coping strategies. Objectives. - The review aims to answer the following questions: 1) Is there a relation between pretreatment core beliefs or coping strategies and PTSD outcomes following CBT? 2) Are core beliefs or coping strategies modified following CBT for PTSD? Method. - PsycNet, PubMed, Cinahl, Embase, Web of Science, Scopus, Cochrane, ProQuest and EBSCO were systematically searched for the literature published between 1975 and May 2015, for papers including adults with PTSD, CBT for PTSD, and quantitative measures of cognitive schemas or coping strategies. Results, study characteristics and risks of bias were examined for the included studies. Results. - The search led to the inclusion of 10 studies. Regarding schemas, the only study included shows that they change positively with psychotherapy and that some of these changes predict changes in symptoms after treatment. Regarding coping, four studies report either positive or negative links between dysfunctional coping strategies and post-treatment symptoms, six studies report a positive change in coping strategies, and one study does not report any change. Conclusion. - Although more studies are needed to unequivocally answer the research questions, this systematic review demonstrates the relevance of considering coping strategies, and possibly schemas, in CBT studies in the context of PTSD. (C) 2018 Elsevier Masson SAS. All rights reserved.