Abstract
COPE cards are a critical element of the SEE FAR CBT protocol, designed for the treatment of PTSD and anxiety disorders. Utilizing associative artistic paintbrush drawings, COPE cards facilitate the therapeutic process by aiding in the re-narration of traumatic narratives. Despite promising subjective evidence from the field, an objective examination of the cards' behavioral and neurophysiological effects is necessary. The primary goal was to assess the efficacy of COPE cards in eliciting distinct emotional/arousal states through objective neurophysiological measures, focusing on brain Event-Related Potentials (ERPs). The study engaged 92 undergraduate participants from the general population, evaluating their behavioral responses and neural activity in reaction to cards categorized by negative, ambivalent, and positive emotional valences. Analysis demonstrated distinct differences in subjective ratings among the various conditions. Emotional conditions diverged in terms of response times (RTs) and RT variability; ambivalent cards resulted in the slowest RTs and highest RT variability, whereas positively valenced cards led to the fastest RTs and the least RT variability. Electrophysiological brain responses to different cards varied significantly, with negative images producing markedly greater mean amplitudes of the P1, P2, and P3 ERP components than ambivalent and positive ones, providing direct evidence of differential neural processing of cards with varying emotional content. These findings contribute to the ongoing validation of COPE cards, reinforcing their potential value for modulating emotional experiences and internal psychophysiological/neural states not only in therapeutic settings but also as a novel tool for investigating emotions and emotional arousal within the wider field of psychology research.
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Data availability
The datasets generated and/or analyzed during the current study are not publicly available; However, the data are available from the corresponding author upon reasonable request, subject to any necessary permissions or ethical approvals.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Publishing.
Ayalon, O., & Siso-Ayalon, B. (2006). “Metaphoric cards” An effective tool in therapy. Retrieved from: https://www.oh-cards-institute.org/wp-content/uploads/2012/07/Ofra-Ayalon-Metaphoric-Cards-An-Effective-Tool-in-Therapy.pdf
Ayalon, O. (2003). Cope cards for trauma and healing. Community Stress Prevention, 5, 82–94.
Ayalon, O. (2007). Healing trauma with metaphoric cards. Therapy Today, 18(7), 22–24.
Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British Journal of Psychiatry, 190(2), 97–104. https://doi.org/10.1192/bjp.bp.106.021402
Calvo, M. G., & Avero, P. (2009). Reaction time normative data for the IAPS as a function of display time, gender, and picture content. Behavior Research Methods, 41(1), 184–191. https://doi.org/10.3758/BRM.41.1.184
Carretié, L., Hinojosa, J. A., Albert, J., & Mercado, F. (2006). Neural response to sustained affective visual stimulation using an indirect task. Experimental Brain Research, 174(4), 630–637. https://doi.org/10.1007/s00221-006-0510-y
Carretié, L., Hinojosa, J. A., Martín-Loeches, M., Mercado, F., & Tapia, M. (2004). Automatic attention to emotional stimuli: Neural correlates. Human Brain Mapping, 22(4), 290–299. https://doi.org/10.1002/hbm.20037
Cohen, R., Leykin, D., Aviv, Y., Kukis, A., & Lahad, M. (2015). Affective dimensions of COPE cards: Preliminary evidence of the affective ratings of valence, arousal and dominance of associative cards for psychotherapeutic purposes. The Arts in Psychotherapy, 45, 36–46. https://doi.org/10.1016/j.aip.2015.04.004
Crawford, L. E., & Cacioppo, J. T. (2002). Learning where to look for danger: Integrating affective and spatial information. Psychological Science, 13(5), 449–453. https://doi.org/10.1111/1467-9280.00479
Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., ..., & Gaynes, B. N. (2016). Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis. Clinical Psychology Review, 43, 128–141. https://doi.org/10.1016/j.cpr.2015.10.003
Dan, O., Zreik, G., & Raz, S. (2020). The relationship between individuals with fearful-avoidant adult attachment orientation and early neural responses to emotional content: An event-related potentials (ERPs) study. Neuropsychology, 34(2), 155–167. https://psycnet.apa.org/buy/2019-66179-001
Dan-Glauser, E. S., & Scherer, K. R. (2011). The Geneva affective picture database (GAPED): A new 730-picture database focusing on valence and normative significance. Behavior Research Methods, 43(2), 468–477. https://doi.org/10.3758/s13428-011-0064-1
Delplanque, S., Lavoie, M. E., Hot, P., Silvert, L., & Sequeira, H. (2004). Modulation of cognitive processing by emotional valence studied through event-related potentials in humans. Neuroscience Letters, 356(1), 1–4. https://doi.org/10.1016/j.neulet.2003.10.014
Delplanque, S., Silvert, L., Hot, P., Rigoulot, S., & Sequeira, H. (2006). Arousal and valence effects on event-related P3a and P3b during emotional categorization. International Journal of Psychophysiology, 60(3), 315–322. https://doi.org/10.1016/j.ijpsycho.2005.06.006
Dickey, L., Politte-Corn, M., & Kujawa, A. (2021). Development of emotion processing and regulation: Insights from event-related potentials and implications for internalizing disorders. International Journal of Psychophysiology, 170, 121–132. https://doi.org/10.1016/j.ijpsycho.2021.10.003
Gupta, R. S., Kujawa, A., & Vago, D. R. (2019). The neural chronometry of threat-related attentional bias: Event-related potential (ERP) evidence for early and late stages of selective attentional processing. International Journal of Psychophysiology, 146, 20–42. https://doi.org/10.1016/j.ijpsycho.2019.08.006
Hajcak, G., Weinberg, A., MacNamara, A., & Foti, D. (2012). ERPs and the study of emotion. In S. J. Luck & E. S. Kappenman (Eds.), The Oxford handbook of event-related potential components (pp. 441–472). Oxford University Press. https://psycnet.apa.org/record/2013-01016-016
Hajcak, G., MacNamara, A., & Olvet, D. M. (2010). Event-related potentials, emotion, and emotion regulation: An integrative review. Developmental Neuropsychology, 35(2), 129–155. https://doi.org/10.1080/87565640903526504
Hopfinger, J. B., & Mangun, G. R. (2001). Tracking the influence of reflexive attention on sensory and cognitive processing. Cognitive, Affective, & Behavioral Neuroscience, 1(1), 56–65. https://doi.org/10.3758/CABN.1.1.56
Keil, A., Bradley, M. M., Hauk, O., Rockstroh, B., Elbert, T., & Lang, P. J. (2002). Large-scale neural correlates of affective picture processing. Psychophysiology, 39(5), 641–649. https://doi.org/10.1017/S0048577202394162
Lahad, M., & Doron, M. (2010). Protocol for treatment of post-traumatic stress disorder: SEE FAR CBT model: Beyond cognitive behavior therapy (Vol. 70). IOS Press.
Lahad, M., & Leykin, D. (2012). The healing potential of imagination in the treatment of psychotrauma: An alternative explanation for the effectiveness of the treatment of PTSD using fantastic reality. In: Cognitive behavioral therapy: Applications, methods and outcomes (pp. 71–92). Nova Science Publishers, Inc.
Lahad, M. (2005). Transcending into fantastic reality: Story making with adolescents in crisis. In M. D. Lanham (Ed.), International handbook of play therapy: Advances in assessment, theory, research and practice (pp. 133–157). Jason Aronson.
Lahad, M., Farhi, M., Leykin, D., & Kaplansky, N. (2010). Preliminary study of a new integrative approach in treating post-traumatic stress disorder: SEE FAR CBT. The Arts in Psychotherapy, 37(5), 391–399. https://doi.org/10.1016/j.aip.2010.07.003
Lahad, M., Leykin, D., Farchi, M., Doron, M., Gidron, Y., Rozenblat, O., & Fajerman, Z. (2016). SEE FAR CBT therapy for children with Post-Traumatic Stress Disorder under prolonged political conflict. Journal of Psychology and Psychotherapy Research, 3(1), 1–12.
Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (2008). International affective picture system (IAPS): Affective ratings of pictures and instruction manual. Technical Report A-8. University of Florida.
Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1709709. https://doi.org/10.1080/20008198.2019.1709709
Luck, S. J., & Kappenman, E. S. (Eds.). (2011). The Oxford handbook of event-related potential components. Oxford University Press.
Luck, S. J. (2012). Event-related potentials. In D. L. Long (Ed.), APA handbook of research methods in psychology (pp. 1–18). American Psychological Association.
Luck, S. J., Woodman, G. F., & Vogel, E. K. (2000). Event-related potential studies of attention. Trends in Cognitive Sciences, 4(11), 432–440. https://doi.org/10.1016/S1364-6613(00)01545-X
Marchewka, A., Żurawski, Ł, Jednoróg, K., & Grabowska, A. (2014). The Nencki Affective Picture System (NAPS): Introduction to a novel, standardized, wide-range, high-quality, realistic picture database. Behavior Research Methods, 46(2), 596–610. https://doi.org/10.3758/s13428-013-0379-1
OH Publishing. (2012). COPE cards. Retrieved from https://oh-cards.com/index.php?article_id=64&clang=2
Olofsson, J. K., Nordin, S., Sequeira, H., & Polich, J. (2008). Affective picture processing: An integrative review of ERP findings. Biological Psychology, 77(3), 247–265. https://doi.org/10.1016/j.biopsycho.2007.11.006
Pourtois, G., Grandjean, D., Sander, D., & Vuilleumier, P. (2004). Electrophysiological correlates of rapid spatial orienting towards fearful faces. Cerebral Cortex, 14(6), 619–633. https://doi.org/10.1093/cercor/bhh023
Raz, S., & Lahad, M. (2022). Physiological indicators of emotional arousal related to ANS activity in response to associative cards for psychotherapeutic PTSD treatment. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.933692
Raz, S., Dan, O., Arad, H., & Zysberg, L. (2013). Behavioral and neural correlates of emotional intelligence: An Event-Related Potentials (ERP) study. Brain Research, 1526, 44–53. https://doi.org/10.1016/j.brainres.2013.05.048
Seidler, G. H., & Wagner, F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine, 36(11), 1515–1522. https://doi.org/10.1017/S0033291706007963
Shubina, I. (2015). Cognitive-behavioral therapy of patients with PTSD: Literature review. Procedia-Social and Behavioral Sciences, 165, 208–216. https://doi.org/10.1016/j.sbspro.2014.12.624
Smith, M. W., Schnurr, P. P., & Rosenheck, R. A. (2005). Employment outcomes and PTSD symptom severity. Mental Health Services Research, 7(2), 89–101. https://doi.org/10.1007/s11020-005-3780-2
Smith, N. K., Cacioppo, J. T., Larsen, J. T., & Chartrand, T. L. (2003). May I have your attention, please: Electrocortical responses to positive and negative stimuli. Neuropsychologia, 41(2), 171–183. https://doi.org/10.1016/S0028-3932(02)00147-1
Thomas, S. J., Johnstone, S. J., & Gonsalvez, C. J. (2007). Event-related potentials during an emotional stroop task. International Journal of Psychophysiology, 63(3), 221–231. https://doi.org/10.1016/j.ijpsycho.2006.10.002
Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389/fnbeh.2018.00258
Yuan, J., Zhang, Q., Chen, A., Li, H., Wang, Q., Zhuang, Z., & Jia, S. (2007). Are we sensitive to valence differences in emotionally negative stimuli? Electrophysiological evidence from an ERP study. Neuropsychologia, 45(12), 2764–2771. https://doi.org/10.1016/j.neuropsychologia.2007.04.018
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This study was supported by the Tel-Hai College research authority.
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Raz, S., Lahad, M. Validating the efficacy of associative therapeutic COPE cards for eliciting distinct psychophysiological states: behavioral and neural evidence from an ERP study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05833-9
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DOI: https://doi.org/10.1007/s12144-024-05833-9