Objective Analysis of Language Use in Cognitive-Behavioral Therapy: Associations with Symptom Change in Adults with Co-Occurring Substance Use Disorders and Posttraumatic Stress

What People Say: A Study of the Predictive Value of Language Use on Cognitive-Behavioral Therapy Outcomes among Individuals with Substance Use Disorders and Posttraumatic Stress

Substance use disorders (SUD) rarely manifest in isolation. People with substance use disorder (SUD) often struggle with symptoms of posttraumatic stress disorder (PTSD). The most effective paths to recovery and wellness for these individuals require the treatment of both SUD and PTSD. The best available psychotherapy treatments for SUD/PTSD are cognitive-behavioral therapies (CBTs) that include addiction-focused and trauma-focused therapy components. However, we know very little about the impact of an individual’s language use during CBT on substance use and PTSD outcomes at the end of treatment.

This study used specialized software to objectively analyze language use during one psychotherapy session of a 12-session program. The study was based on data gathered in the context of a randomized clinical trial comparing two different CBTs for SUD. One treatment condition focused on CBT for SUD only; the other approach integrated cognitive processing therapy for PTSD with CBT for SUD. In this research study, we asked: Does what people say during CBT for SUD have meaningful impacts on treatment outcomes?

Our sample was comprised of 37 treatment-seeking adults with SUD and at least four symptoms of PTSD. In short, yes, what people say during psychotherapy can impact symptoms at the conclusion of treatment. We analyzed language use across multiple categories. Specifically, we evaluate participants’ use of “I” pronouns, positive emotion words, negative emotion words, and cognitive processing words during a single matched treatment session. Compared to standard CBT for SUD, participants in the novel, integrated CBT for SUD/PTSD used more negative emotion words, possibly indicating greater emotional engagement, but they also used fewer positive emotion words. Participants who used more positive emotion language reported lower PTSD symptoms at the end of treatment. Furthermore, we found an association between participants’ use of cognitive processing words and reduction in PTSD symptoms, regardless of treatment condition. Language may measure ingredients important to psychotherapy, such as level of analytical thinking, emotional engagement, and ability to re-balance negative thinking related to oneself or the world. This study offers an important, initial step to understanding what is happening “in the room” during psychotherapy that can be used to improve outcomes of individuals with co-occurring SUD/PTSD, a historically difficult-to-treat population.

Read the full paper: Jennings, A. N., Soder, H. E., Wardle, M. C., Schmitz, J. M., & Vujanovic, A. A. (in press). Objective Analysis of Language Use in Cognitive-Behavioral Therapy: Associations with Symptom Change in Adults with Co-Occurring Substance Use Disorders and Posttraumatic Stress. Cognitive Behaviour Therapy. doi:10.1080/16506073.2020.1819865

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