Narrative Exposure Based Intervention For Post-Traumatic Stress Disorder

Post-traumatic Stress Disorder (PTSD) is a debilitating mental disorder that affects
approximately 7% of the general population. This project's aim is to develop a greater
understanding of the efficacy and underlying mechanisms of narrative exposure based
treatments for PTSD. Adult participants (N=162) who meet DSM-5 criteria for PTSD will be
enrolled in a 3-arm randomized clinical trial consisting of trauma-related expressive
writing, trauma-related expressive speaking, or a factual expressive writing control
condition. Treatments will be manualized and conducted entirely through the Qualtrics survey
platform. Treatment will consist of six sessions, three per week over two weeks, taking place
via the internet. Assessments will be conducted pre-treatment, post-treatment, and at 1-month
follow-up in the lab. Assessments will be comprised of symptom self-report measures as well
as two tasks completed in an eye tracker: a reading task to evaluate mechanisms underlying
trauma narrative processing and a sentence production task to evaluate attentional shifts
when producing verbal information

Specific Aims and Hypotheses:

1. Develop and test the relative efficacy of two cost-effective internet-based expressive
trauma therapies (written vs. spoken) relative to a non-trauma writing control for PTSD.
We hypothesize that both trauma-focused expressive therapies will achieve more favorable
outcomes at posttreatment and follow-up on measures of PTSD and depression symptoms,
posttraumatic growth, and quality of life compared to the writing control.

2. Conduct exploratory analyses testing baseline PTSD severity, depression severity, trauma
type, time since trauma, and emotional engagement in moderating the differential effects
of the selected expressive therapies.

3. Test the mediational effects of pre- to posttreatment changes in (1) active language
processing with eye tracking (i.e. how long certain words are fixated on). (2) selected
linguistic elements (i.e., frequency of emotional words, frequency of the pronoun "I"),
(3) perceived self-efficacy to cope with trauma memories; (4) perceived threat
appraisals associated with intrusive trauma memories on treatment outcome at follow-up.
We hypothesize that (1) fewer and shorter fixations on ideographic (i.e. personally
relevant) trauma words when reading the trauma narrative in the eye tracker will be
associated with reductions in PTSD symptoms at follow-up. (2) increased use of emotional
words over the course of writing sessions will be associated with reductions in PTSD and
depression symptoms at follow-up; (3) pre- to posttreatment increases in trauma memory
acceptance self-efficacy; and (4) pre- to posttreatment reductions in trauma memory
threat appraisals will be associated with greater symptom reduction at the follow-up
assessment.