Psychophysiological indicators of emotional arousal in sexual assault survivors: Evaluating ANS reactivity to therapeutic COPE cards within the SEE FAR CBT framework for PTSD treatment

OBJECTIVE: SEE FAR CBT is an integrative treatment protocol for PTSD and anxiety disorders, utilizing imagery-based (fantastic reality) methods through associative therapeutic COPE cards. Although preliminary evidence suggests potential impacts, further validation is necessary to confirm their efficacy in eliciting specific arousal-affective states. METHOD: This study assessed the psychophysiological responses to COPE cards among 48 sexual assault (SA) survivors displaying significant symptoms indicative of PTSD, compared to a control group of 44 healthy women. Participants were exposed to both high-arousal, negatively valenced cards and low-arousal, positively valenced cards. Objective measurements of heart rate (HR), blood pressure and heart rate variability (HRV) were recorded at baseline, during the arousal and relaxation phases to assess autonomic nervous system (ANS) activity. RESULTS: Results showed that negatively valenced cards increased HR and blood pressure and decreased HRV, while positively valenced cards had the opposite effect in both groups. The SA group consistently displayed higher HR and lower HRV across all phases, indicating increased psychophysiological arousal compared to the control group. HR analysis revealed a significant Group × Phase interaction, with pronounced disparities during the arousal and relaxation phases. The SA group experienced marked HR fluctuations between phases, underscoring their increased sensitivity and ANS reactivity to emotional stimuli. Conversely, the normative group showed no significant HR changes. CONCLUSIONS: These findings underscore the utility of COPE cards in both clinical and experimental settings, emphasizing their capacity to influence emotional processing, fundamental to the therapeutic process within the SEE FAR CBT framework.