# Treatment of Stress-Related Psychopathology: Targeting Maladaptive and Adaptive Event Processing

> **NIH NIH R61** · CASE WESTERN RESERVE UNIVERSITY · 2020 · $586,511

## Abstract

PROJECT SUMMARY
Evidence-based psychotherapies for posttraumatic stress disorder (PTSD) and depression consistently
produce strong, clinically meaningful effects for many individuals. However, these interventions also have
significant dropout rates, a large minority of individuals continue to have debilitating symptoms, and even those
who respond may be vulnerable to relapse upon future stressors. More efficient and mechanistically precise
interventions are needed. Consistent with the cross-cutting theme of studying the role of the environment in the
NIMH Strategic Plan, the etiologic role of exposure to destabilizing, stressful life events is common to both
PTSD and depression. Not only do they share common distress-related triggers, symptoms, and maintaining
processes, but they also commonly co-occur (upwards of 60%). Current PTSD and depression treatments
typically focus on their respective disorders rather than on common processes that maintain psychopathology;
and, importantly, they do not explicitly target positive adaptive processes associated with resilience. Decades
of experimental studies, prospective studies, and psychotherapy trials have identified interconnected
maladaptive and adaptive processes associated with persistent psychopathology after stressful, destabilizing
events. These maladaptive processes include: 1) unproductive event processing; 2) avoidance; and 3) reward
sensitivity and processing deficits. These processes prolong negative mood, interfere with adaptive coping and
processing of emotional material, and increase sensitivity to future stressful life events. PATH (Positive
Processes and Transition to Health) directly targets these maladaptive processes while also teaching parallel
adaptive skills (constructive processing, approach, and positive emotion processing and reward seeking). Six,
90-min sessions target individuals who have experienced a destabilizing life event and have persistent
stressor-related symptoms. PATH utilizes life event processing (revisiting, meaning making), focusing
repeatedly on an identified destabilizing life event, positive life events, and future events as a framework to
identify maladaptive processes and teach constructive processing skills. In a small open trial (R61, N = 45), we
will examine whether PATH engages the key targets of unproductive processing, avoidance, and reward
deficits. Next, we will conduct a randomized trial of PATH (R33, N = 135), comparing PATH to a Progressive
Muscle Relaxation, seeking to replicate changes in the targets in a larger sample and examine PATH's impact
on stressor-related psychopathology (PTSD, depression). PATH, a brief and focused treatment that targets key
psychological processes common to PTSD and MDD, has the potential to reduce dropout, improve treatment
engagement and outcomes, identify potential treatment mechanisms, and ultimately reduce the costly human
and economic burden of stressor-related psychopathology.

## Key facts

- **NIH application ID:** 9956200
- **Project number:** 1R61MH118401-01A1
- **Recipient organization:** CASE WESTERN RESERVE UNIVERSITY
- **Principal Investigator:** NORAH C FEENY
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $586,511
- **Award type:** 1
- **Project period:** 2020-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9956200

## Citation

> US National Institutes of Health, RePORTER application 9956200, Treatment of Stress-Related Psychopathology: Targeting Maladaptive and Adaptive Event Processing (1R61MH118401-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9956200. Licensed CC0.

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