Internet-Delivered Cognitive Processing Therapy for Individuals with a History of Bullying Victimization: A Randomized Controlled Trial

Date
2019-09
Authors
Thorisdottir, Audur Sjöfn
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Publisher
Faculty of Graduate Studies and Research, University of Regina
Abstract

Bullying victimization is directly associated with a wide array of longstanding psychological problems (e.g., Takizawa Maughan, & Arseneault, 2014; Vaillancourt et al., 2013). Nevertheless, few comprehensive victim-tailored interventions exist that explicitly target the negative impact of bullying. Evidence from both neurobiological and psychological research suggests that victims experience bullying as trauma; therefore, treating the distress associated with bullying victimization using trauma-focused intervention may be beneficial. The purposes of this randomized controlled trial were to: (a)test an internet-delivered, therapist-guided (i.e., therapist monitored client progressthrough the treatment modules and provided feedback and support through secure e-mail messaging) and content-modified (i.e., to fit the experience of bullying victimization) version of cognitive processing therapy (CPT) for the psychological distress associated with bullying victimization, and (b) to examine risk and protective factors in the pathways from bullying victimization to psychological adjustment. The sample comprised 52 adults who self-identified as victims of bullying. Participants were randomized into internet-delivered CPT, an active control group of internet-delivered stress management (SM), or a waitlist. Treatment outcomes included maladaptive appraisals, symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, anger, and related latent constructs (e.g., distress tolerance). Secondary measures examining risk and protective factors included assessment of coping styles, social support, and resilience. Treatment outcome and secondary measures were administered pre-treatment, post-treatment, and at one-month follow-up. Symptoms of depression, anxiety, and anger were, further, monitored with weekly measures. Hierarchical linear modeling and multiple regressions were used to analyse the data. Results indicated that CPT was effective in reducing maladaptive self-appraisals related to bullying victimization and symptoms of PTSD compared to the waitlist and SM, whereas SM outperformed CPT and the waitlist in reducing general psychological distress. Event centrality (i.e., the extent to which an experience has become central to identity and understanding of the world) led to stronger maladaptive appraisals for participants with a tendency to engage in catastrophizing. Number of reported lifetime bullying victimization experiences and anger also predicted stronger maladaptive appraisals. The overall findings of this trial suggest that internet-delivered CPT is effective for the psychological distress and maladaptive appraisals associated with bullying victimization, but adaptions might be needed to target more effectively symptoms of general distress and latent constructs related to anxiety and depression.

Description
A Thesis Submitted to the Faculty of Graduate Studies and Research In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Clinical Psychology, University of Regina. xii, 199 p.
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