The role of avoidant coping in the treatment of rape-related posttraumatic stress disorder
Leiner, Amy Selvig
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Although there are a number of empirically supported therapies for posttraumatic stress disorder (PTSD), a large minority of those treated fail to respond. Many researchers have attempted to identify variables (participant variables, trauma variables, and treatment variables) that impact PTSD treatment outcome. A review of this literature suggested that there are few, if any, variables that consistently impact PTSD treatment outcome and that few studies are driven by theoretical models of PTSD or its recovery. The cognitive theory of PTSD suggests that a decrease in the avoidance of trauma-related information is required for successful treatment. The current investigation studies the role of a related construct, avoidant coping, in the treatment of rape-related PTSD. Women with PTSD following rape (N = 62) received nine sessions of an empirically supported PTSD treatment (prolonged exposure or eye movement desensitization and reprocessing). PTSD severity was assessed before, during, and after treatment. Avoidant coping was measured before and after treatment. Results indicated that avoidant coping decreased during the course of treatment and that changes in PTSD symptoms were correlated with changes in avoidant coping. Contrary to hypothesis, pretreatment avoidant coping was negatively associated with posttreatment PTSD severity when pretreatment severity was taken into account. Likewise, high levels of pretreatment avoidant coping were associated with a more rapid decline of PTSD symptoms during treatment. Finally, pretreatment avoidant coping did not predict dropout or posttreatment diagnostic status. This study suggests that PE and EMDR are particularly effective at reducing symptom severity for women with initially high levels of avoidant coping.