The intersection of trauma and eating disorders: evaluating cognitive processing therapy through qualitative analysis

Area of Science:

• Psychiatry
• Clinical Psychology
• Trauma Studies

Background:

• Eating disorders (EDs) frequently co-occur with Post-Traumatic Stress Disorder (PTSD), termed ED-PTSD.
• Cognitive Processing Therapy (CPT) is used for ED-PTSD, but qualitative evidence of its effectiveness is limited.

Purpose of the Study:

• To qualitatively assess the impact of 12 sessions of CPT on trauma-related cognitions in patients with ED-PTSD.
• To explore changes in beliefs about trauma causation, responsibility, control, and safety.

Main Methods:

• Ten patients with ED-PTSD underwent 12 CPT sessions during residential treatment.
• Impact statements written before and after therapy were analyzed using structured coding to assess cognitive shifts.
• MAXQDA2020 software facilitated the qualitative analysis of trauma-related cognitions.

Main Results:

• CPT led to a shift from self-blame towards externalizing fault in trauma appraisal.
• Perceptions of control and safety were linked to increased references to EDs and body image.
• Trauma cognitions became more realistic and adaptive, with reduced assimilated/overaccommodated and increased accommodated cognitions.

Conclusions:

• CPT facilitates significant improvements in trauma-related cognitions for individuals with ED-PTSD.
• Therapy promotes a more adaptive appraisal of trauma, reducing self-blame and enhancing perceived control and safety.
• Qualitative findings support CPT's utility in addressing complex trauma and eating disorder comorbidities.