Rape Survivors Who Rely on Avoidant Coping May Respond Better to Exposure-Based Treatment
One of the hardest things to predict in psychotherapy is how well someone will respond to a particular treatment. A brief report in an upcoming issue of Journal of Consulting and Clinical Psychology by Leiner and colleagues offers some insight into this question. The researchers look at the impact of avoidant coping on PTSD treatment.
What’s Avoidant Coping?
As defined in this article, avoidant coping involves attempts to reduce or block out distress and discomfort. Although not directly referenced in this article, there’s an interesting research literature that suggests avoidance behaviors may maintain PTSD symptoms over time, and that reliance on these strategies is related to greater PTSD symptom severity above and beyond the severity of the original trauma (see Batten, Follette, & Aban, 2001; Polusny & Follette, 1995; Rosenthal, Hall, Palm, Batten, & Follette, 2005). Not wanting to engage painful memories and triggers is very natural, but it may exacerbate and prolong posttraumatic stress symptoms in the long run.
What the Researchers Found
The researchers used data from a previous study comparing Prolonged Exposure (PE) therapy and Eye Movement Desensitization and Reprocessing (EMDR) for adult women rape survivors with PTSD. Both PE and EMDR are exposure-based treatments. (Some EMDR proponents would object to being classified as exposure-based treatments, but that’s another debate entirely.)
The researchers found that greater use of avoidant coping strategies at pretreatment was related to lower PTSD severity after treatment. The researchers then divided up the sample according to greater and lesser scores on a measure of avoidant coping (i.e., Coping Strategies Inventory – Disengagement subscale). They found that women who scored higher in avoidant coping were much more likely to respond to treatment. Conversely, women with lower scores in avoidant coping were less likely to respond to treatment.
What Does This Mean?
The results make sense conceptually. Exposure-based therapists structure treatment so that clients safely and collaboratively confront memories and triggers they typically avoid. Although it makes sense that people with greater avoidance benefit from a treatment that focuses on confronting the avoided experiences, I find it comforting that there doesn’t appear to be a ceiling effect. That is, the researchers didn’t find that too much avoidance negatively impacted treatment.
The study leaves me with the following questions: What about women with PTSD who are low in avoidant coping? Is there another treatment that works better for them? This remains unanswered.
It also makes me wonder what other variables might be important in predicting response to treatment in PTSD. After all, avoidant coping is only one variable. There may be others that are also important. Nevertheless, this is important work that could have real-world implications for therapists who are trying to figure out who may benefit most from exposure-based treatment for PTSD. Although it’s too early to say definitively, these findings suggest that clients who are relatively more avoidant may be the best candidates for exposure therapy.