Cognitive processes in the maintenance and treatment of posttraumatic stress disorder and social phobia. (360G-Wellcome-069777_Z_02_C)

The proposed research aims: 1) to improve understanding of the factors involved in maintaining post-traumatic stress disorder and social phobia, and 2) to develop more effective and efficient psychological interventions for these disorders. An integrated programme of prospective longitudinal studies, experiments, treatment development studies, and randomised controlled trials is proposed. A cognitive model of the maintenance of each disorder is outlined. The longitudinal and experimental studies investigate maintaining factors specified in the models. In posttraumatic stress disorder, the proposed maintaining factors include: excessively negative appraisals o the trauma and its sequelae (including the initial PTSD symptoms); data-driven processing and lack of self-referential processing; a characteristic autobiographical memory disturbance; and problematic behavioural and cognitive strategies that are used to reduce current distress but have the long-term effect of maintaining the disorder. In social phobia, the proposed maintaining factors include: using internal information (especially observer-perspective images) to make excessively negative inferences about how one appears to others; safety behaviours; and negative biased post-event rumination. In both disorders, the information obtained from the longitudinal and experimental studies, from recent pilot work, and from planned analyses of treatment tapes, is used to develop and refine cognitive therapy programmes that specifically target the maintaining processes. The new, more efficient programmes include a one week intensive treatment for PTSD and a self-study augmented programme for social phobia. The effectiveness of the cognitive therapy programmes is assessed in two randomised controlled trials. The overall strategy proposed for investigating the two disorders is one that has proved successful in the applicants' current programme grant.