Schemas and coping strategies in cognitive-behavioral therapy for PTSD: A systematic review

Abstract Introduction Although cognitive-behavioral therapy (CBT) is effective in treating post-traumatic stress disorder (PTSD), some clients remain symptomatic after treatment. Some individuals with PTSD may present more severe dysfunctional cognitive schemas and use dysfunctional coping strategies. Objectives The review aims to answer the following questions: 1) Is there a relation between pre-treatment core beliefs or coping strategies and PTSD outcomes following CBT? 2) Are core beliefs or coping strategies modified following CBT for PTSD? Method PsycNet, PubMed, Cinahl, Embase, Web of Science, Scopus, Cochrane, ProQuest and EBSCO were systematically searched for the literature published between 1975 and May 2015, for papers including adults with PTSD, CBT for PTSD, and quantitative measures of cognitive schemas or coping strategies. Results, study characteristics and risks of bias were examined for the included studies. Results The search led to the inclusion of 10 studies. Regarding schemas, the only study included shows that they change positively with psychotherapy and that some of these changes predict changes in symptoms after treatment. Regarding coping, four studies report either positive or negative links between dysfunctional coping strategies and post-treatment symptoms, six studies report a positive change in coping strategies, and one study does not report any change. Conclusion Although more studies are needed to unequivocally answer the research questions, this systematic review demonstrates the relevance of considering coping strategies, and possibly schemas, in CBT studies in the context of PTSD.