The type of language used during psychotherapy plays an important role in the success of treatment, according to a study published in Cognitive Behaviour Therapy. The study, conducted among individuals with substance dependence and co-occurring trauma, found that patients who used more cognitive processing words showed reduced PTSD symptoms at the end of treatment.
The authors of the new research were motivated to explore factors that might influence treatment outcomes among a particularly tough-to-treat population. Patients suffering from substance use disorders (SUDs) often suffer accompanying posttraumatic stress disorder (PTSD) symptoms, making treatment among this subgroup rather complex.
“We were interested in whether we could predict treatment outcomes based on the language that people used during cognitive-behavioral therapy,” said study author Anka A. Vujanovic, an associate professor and director of the Trauma and Stress Studies Center at the University of Houston.
“If we are able to develop a fine-grained understanding of the impact of language on psychotherapy outcomes, providers could be trained in detecting the types of language most related to symptomatic improvement and use that for individualized treatment planning throughout the course of psychotherapy.”
The researchers say there is evidence that the type of language used during the processing of trauma influences real-world outcomes. For example, the use of emotion words has been linked to the decreased presentation of symptoms among individuals with trauma. This is not surprising, given that the successful processing of trauma requires acknowledging and experiencing an array of emotions.
In the first study of its kind, Vujanovic and colleagues objectively analyzed the influence of language on treatment outcomes while comparing two psychotherapies — a traditional cognitive-behavioral therapy (CBT) for SUD and a novel approach called Treatment of Integrated Posttraumatic Stress and Substance Use (TIPSS). The TIPSS program was designed to address both SUD and PTSD symptoms by integrating cognitive processing therapy (CPT) with CBT. It also includes a trauma narrative session, which the authors speculated would lead to improved emotional expression among patients and, therefore, better outcomes.
The researchers recruited patients who were seeking treatment for both substance dependence and trauma, resulting in a total of 37 participants. All patients met criteria for substance dependence and reported at least four PTSD symptoms within the past month. The patients attended two therapy sessions a week for six weeks — 23 patients were enrolled in CBT for SUD, and 14 were enrolled in TIPSS.
During the seventh session, the two therapies differed in a critical way. The patients in the CBT for SUD condition were coached on active cognitive restructuring, while those in the TIPSS condition were asked to process their trauma narrative alongside their therapist. In both cases, the seventh session was entirely transcribed.
Using the Linguistic Inquiry and Word Count program, the researchers analyzed the words used by the patients according to various categories. The analysis partially supported the hypothesis that the TIPSS therapy patients would use more emotion words, finding that these patients used more negative emotion words. However, those in the CBT for SUD group used more positive emotion words. Moreover, those who used more positive emotion words showed significantly reduced self-reported PTSD symptoms at the end of the therapy.
The CBT for SUD group also used more cognitive processing words during their seventh session, although personal pronoun use was comparable between the two groups. “These results suggest that language may measure other mechanisms potentially important to psychotherapy,” Vujanovic and colleagues remark, “such as the analytical engagement necessary for cognitive restructuring, or greater self-focus when emotionally recounting a trauma narrative and re-balancing maladaptive thoughts related to the self.”
When it came to PTSD outcomes as assessed by the clinician, only cognitive processing words were linked to reduced PTSD symptom severity. This was true for both treatment groups.
“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 diagnoses, a historically difficult-to-treat population,” Vujanovic told PsyPost.
The authors note that their study only analyzed language used during one of 12 therapy sessions, and a larger analysis including all the sessions may have revealed additional findings.
“This was a preliminary study,” Vujanovic explained. “We used a specialized software program to objectively analyze language use during only one session of a 12-session program. It is possible that language changes through the course of psychotherapy and based on the topics being discussed at each session. The sample was relatively small.”
Still, they say their findings offer an interesting direction for future research that underscores the importance of studying language use during psychotherapy.
“While this type of research is time-intensive, it can provide a more in-depth analysis of the power of language, one barometer of key ingredients related to therapeutic outcomes, aside from the treatment program administered or the skills being learned,” Vujanovic said. “We viewed this study as hypothesis-generating, in the sense that it posed more questions that it necessarily answered. The hope is that there will be larger-scale studies to follow.”
The study, “Objective analysis of language use in cognitive-behavioral therapy: associations with symptom change in adults with co-occurring substance use disorders and posttraumatic stress“, was authored by Anthony N. Jennings, Heather E. Soder, Margaret C. Wardle, Joy M. Schmitz, and Anka A. Vujanovic.
