Document Type



Doctor of Philosophy


Psychology, Clinical-Community

Date of Defense


Graduate Advisor

Zoe D. Peterson, PhD


Tara Galovski, Ph.D.

Michael Griffin, Ph.D.

Amy Williams, Ph.D.


The accumulation of randomized controlled trials (RCTs) for the treatment of posttraumatic stress disorder (PTSD) over the past few decades has contributed to the development of clinical treatment guidelines (Chambless & Ollendick, 2001; Forbes et al., 2010; Truax & Thomas, 2003). Two treatments that have gained substantial support are Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). Although these treatments result in most participants losing their PTSD diagnosis and obtaining meaningful reductions in symptoms, some clients remain refractory to treatment. Researchers have worked to identify predictors of treatment outcome, but have given minimal attention to aspects of client avoidance as process variables that could impact recovery. The current paper evaluates the role of client avoidance process variables on PTSD treatment outcome. Using therapy session tapes and client chart files for 70 participants who underwent CPT in two NIH-funded trials, the role of in-session avoidance, homework noncompliance, and irregular attendance were evaluated. Among in-session avoidance variables, greater avoidance of the trauma memory was negatively correlated with a reduction in posttraumatic symptoms. However, due to lack of variability in in-session engagement variables, few meaningful correlations were obtained for other in-session avoidance variables and PTSD and depression treatment outcome. Among the homework variables, perceived helpfulness of homework among completers was the only significant predictor of PTSD symptom change. Finally, attendance compliance and irregular session attendance did not significantly predict PTSD and depression change scores. Implications of these findings are discussed.

OCLC Number


Included in

Psychology Commons