Examining cognitive emotion regulation strategies and symptom improvement during a 2-week cognitive processing therapy-based intensive treatment programme for PTSD

<b>Background:</b> Cognitive emotion regulation (ER) strategies refer to cognitive processes used to regulate emotions. Maladaptive cognitive ER has been associated with higher posttraumatic stress disorder (PTSD) symptoms. The present study examined whether cognitive ER strategies changed during a 2-week Cognitive Processing Therapy (CPT)-based intensive treatment programme (ITP) and whether these changes were associated with improvements in PTSD and depression symptoms.<b>Methods:</b> Data were collected from 269 military service members and veterans.<b>Results:</b> Results revealed large effect sizes for self-blame (<i>d</i> = 0.93), moderate effect sizes for catastrophizing (<i>d</i> = 0.65), and small effect sizes for acceptance (<i>d</i> = 0.24), positive refocusing (<i>d</i> = 0.22), and other-blame (<i>d</i> = 0.26). Of these ER strategies, linear mixed effects regression models indicated that decreases in self-blame (<i>p</i> < .001) and catastrophizing (<i>p</i> < .001), and increases in positive refocusing (<i>p</i> = .005) were associated with reductions in PTSD severity during the programme. Similarly, decreases in self-blame (<i>p</i> < .001) and catastrophizing (<i>p</i> < .001), and increases in positive refocusing (<i>p</i> < .001) were associated with decreases in depression severity.<b>Conclusions:</b> Findings indicate that CPT-based ITPs may improve cognitive ER strategies among veterans and service members and that changes in some cognitive ER strategies are associated with reductions in PTSD and depression symptoms. Based on these results, clinicians are advised to prioritize targeting cognitive ER strategies, such as self-blame and catastrophizing. Future studies should use multiple assessment methods of cognitive ER within different treatment settings to determine the generalizability of study results.