Putting it into Words: A Clinical and Linguistic Analysis of Trauma Narratives in Two Short-Term Exposure Therapies for Co-Morbid PTSD and SUD.

Nearly half of the individuals who experience Posttraumatic Stress Disorder (PTSD) will also have a Substance Use Disorder (SUD) in their lifetimes. Prolonged Exposure Therapy (PE), considered the "gold standard" in treating PTSD, has been increasingly used and studied as an intervention for PTSD, yet little is known about the mechanisms of change in this type of treatment. In PE for PTSD, participants tell and re-tell the story of their primary trauma many times over. This re-telling is called an "Imaginal Exposure." When efficacious, this type of treatment allows for habituation, and PTSD symptom severity begins to dissipate. This paper seeks to better understand the psychological and linguistic processes that occur in such a treatment in order to contemplate for whom such a treatment might be beneficial, and why, (This article is a distillation of the doctoral dissertation by Zachary Kahn, "Words of Change: How Linguistic Shifts Over the Course of a Short-Term Exposure Therapy Represent Movement Towards Psychological Health" (2017).) by exploring the clinical and linguistic differences in the narratives of a treatment responder (decreased PTSD and SUD severity) and a treatment non-responder. A qualitative analysis of portions of the narratives (which were recorded and transcribed) demonstrated that there were clear clinical differences between the responder and non-responder. A linguistic analysis of the narratives using measures of the referential process showed that the treatment responder increasingly engaged in the referential process during exposures over the course of treatment, whereas the non-responder engaged in the referential process less frequently over the course of the treatment and less consistently throughout.