PREDICTING RESPONSE TO EXPOSURE TREATMENT IN PTSD - THE ROLE OF MENTAL DEFEAT AND ALIENATION

Not all patients with posttraumatic stress disorder benefit from expos ure treatment. The present paper describes two cognitive dimensions th at are related to inferior response to exposure in rape victims First individuals whose memories during reliving of the trauma reflected men tal defeat or the absence of mental planning showed little improvement . Second, inferior outcome was correlated with an overall feeling of a lienation or permanent change following the trauma. These results are based on blind ratings of transcripts of exposure treatment sessions f rom 10 women with good outcome and 10 women with inferior outcome. pat ients in the two groups were matched for initial symptom severity and were comparable in many aspects of the assault. patients who experienc ed mental defeat, alienation, or permanent change may require cognitiv e restructuring in addition to exposure.