1 - (SYM 69) Code-switching as a Novel Method for Reducing Dropout in Prolonged Exposure Therapy: Psychological and Physiological Results

Prolonged Exposure Therapy (PET) has been deemed as one of the gold standard treatments for Posttraumatic Stress Disorder (PTSD). However, while its effectiveness has been extensively supported, the distress experienced during trauma exposure can significantly increase the probabilities of abandoning treatment prematurely or dropout. If left untreated, PTSD can lead to medical and mental conditions, disrupt familial relationships, and even increase the risk of suicide. Given the higher rates of trauma exposure, and the increased rates of dropout, members of minoritized populations are at higher risk of suffering the consequences of this disorder. However, members of some of these groups, such as the Latine population, might also possess a skill that reduces the levels of distress experienced in exposure-based interventions and thus reduce the probability of dropout: their bilingualism. Bilinguals tend to express themselves more emotionally in their first language than in their second. In trauma-focused treatment, recalling the traumatic memory in their first language produces more vivid narratives, but also increases the levels of distress and re-experiencing symptoms. For this reason, we hypothesized that the interchange between first and second language (known as code-switching) during the trauma narrative would reduce the levels of distress experienced, thus reducing the probabilities of dropout.

Integrating insights from the Emotional Processing Theory, fear inhibition learning mechanisms and the bilingualism and emotion literature, we developed a modification of the PET protocol that integrates code-switching into trauma exposure. While administering the protocol to a preliminary sample (n = 7), we collected several psychological (e.g., Clinician-Administered PTSD Scale for DSM-5, PTSD Checklist for DSM-5) and physiological measures (e.g., heart rate reactivity and galvanic skin response) and obtained significant reductions across almost all measures collected, with the PTSD assessments showing the highest effect sizes of all measures.

In this presentation, we (1) describe the theoretical basis for the development of the treatment protocol, (2) examine results of the psychological and physiological measures analyzed, (3) discuss common reactions to the protocol such as how it differs from avoidance and (4) present potential implications of this research such as integrating Code-Switching into other exposure-based treatments.