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European Journal of Psychotraumatology logoLink to European Journal of Psychotraumatology
. 2026 Jan 21;17(1):2607191. doi: 10.1080/20008066.2025.2607191

Hope enhances treatment outcome of intensive trauma-focused treatment for PTSD

La esperanza mejora los resultados del tratamiento intensivo centrado en trauma para el TEPT

Riane C M Kuijpers-Van Ommen a,b, Cis Vrijmoeth a,c, Ad De Jongh d,e,f,g,h,i, Hanneke Schaap-Jonker a,j, Emma S Rijk d,k, Eline M Voorendonk d,l,CONTACT
PMCID: PMC12825587  PMID: 41563752

ABSTRACT

Background: Hope has been found to positively influence trauma-focused treatment outcomes and is associated with post-traumatic growth (PTG), which contributes to improved treatment efficacy.

Objective: This observational study examined the extent to which hope predicts a decline in post-traumatic stress disorder (PTSD) symptoms and whether an increase in the level of hope predicts changes in PTSD symptoms. This study also investigated whether PTG mediates the relationship between hope and PTSD symptoms.

Method: The sample included 339 participants (82.9% female) who were diagnosed with PTSD and underwent an intensive eight-day trauma-focused treatment programme consisting of eight sessions of prolonged exposure, eight sessions of EMDR therapy, physical activity, and psychoeducation. Assessments were performed pre-, mid-, and post-treatment using the PCL-5, HHI and PTGI. Linear Mixed and mediation models were used.

Results: Hope significantly increased (Cohen’s d = 0.47 at mid-treatment and post-treatment), and PTSD symptoms significantly decreased (Cohen’s d = 1.72 at mid-treatment and 2.04 at post-treatment) during treatment. Both hope levels at the start of treatment and subsequent changes in hope during treatment significantly predicted a decline in PTSD symptoms (p < .01 and p < .001) and vice versa (p < .001). Pre-treatment PTG mediated the relationship between pre-treatment hope and mid-treatment PTSD symptoms but did not mediate the relationship between pre-treatment hope and post-treatment PTSD symptoms.

Conclusions: These outcomes emphasise the critical importance of hope in PTSD treatment, highlighting its potential to bolster mental well-being and enhance the overall quality of life. More research is needed to gain more insight into the exact mechanisms underlying the interactions between hope, PTG and PTSD symptoms during treatment.

KEYWORDS: Hope, post-traumatic stress disorder, post-traumatic growth, intensive trauma-focused treatment

HIGHLIGHTS

  • Hope enhanced treatment outcome of intensive trauma-focused treatment for PTSD.

  • The relationship between hope and PTSD symptoms proved reciprocal in nature.

  • Pre-treatment PTG mediated the relationship between pre-treatment hope and mid-treatment PTSD symptoms but did not mediate the relationship between pre-treatment hope and post-treatment PTSD symptoms.

After exposure to traumatic events, one may develop post-traumatic stress disorder (PTSD) (American Psychiatric Association [APA], 2013) and experience profound disruption of fundamental beliefs about safety, control, and self-worth (Brown et al., 2019; Olff et al., 2019), which can result in a loss of perspective and hope (Beder, 2005). Hope has been examined in mental and physical health care among different populations (Doe, 2020) using different theories and definitions. Here, we refer to hope as a dynamic and multidimensional construct consisting of cognitive, temporal, affective, behavioural, affiliative, and contextual dimensions (Haugan & Eriksson, 2021).

A heightened sense of hope is linked to greater well-being (Pleeging et al., 2021), increased life satisfaction (Mefford et al., 2021), enhanced personal recovery (Lim et al., 2019), and a more distinct sense of purpose (Varahrami et al., 2010). Hope may also lead to fewer physical (Lancaster & Van Allen, 2023) and psychological problems, including PTSD-related symptoms (Capone & Cameron, 2020; Gallagher et al., 2020). Conversely, more hopelessness is associated with increased depression and anxiety (Raman et al., 2021; Ribeiro et al., 2018), as well as increased avoidance behaviours, which in turn are related to elevated PTSD symptoms (Glass et al., 2009; Hassija et al., 2012).

The current literature highlights the restoration of hope and meaning in life as vital factors for clinical improvement (Baert et al., 2020; Schaap-Jonker, 2019), such as effective management of stressful and traumatic situations (Wang et al., 2019). Several studies have demonstrated that hope has a positive effect on veterans’ trauma-focused treatment (Gilman et al., 2012) and daily functioning (Capone & Cameron, 2020). Moreover, incorporating existential elements, such as hope, into treatment aligns with the contemporary definition of health (Huber et al., 2011), in which health is no longer solely determined by the absence of disease but rather by the capacity to navigate challenging situations with resilience and lead a meaningful life.

Although traumatic events may lead to a loss of hope, these can also catalyse post-traumatic growth (PTG). PTG is a positive psychological change that occurs when dealing with traumatic events (Michélsen et al., 2017; Zoellner & Maercker, 2006). Both hope and PTG are intertwined with optimism, a sense of purpose in life, and feelings of interconnectedness with others. PTG also seems to be negatively related to PTSD symptoms (Nijdam et al., 2018), thereby leading to more favourable treatment outcomes in individuals with PTSD (Hagenaars & Van Minnen, 2010). Furthermore, hope and PTG share a positive relationship with one another (Senger et al., 2023; Wang et al., 2021). Hope has been shown to contribute to PTG (Long et al., 2020), suggesting that an optimistic perspective contributes to the ability to experience positive outcomes. However, this has not yet been studied in the context of intensive trauma-focused treatments.

Growing evidence suggests a negative association between hope and PTSD symptoms (Capone & Cameron, 2020; Gallagher et al., 2020). However, numerous studies were cross-sectional in nature or did not investigate the effect of hope in the setting of PTSD treatment (Gallagher et al., 2020). To our knowledge, this is the first study to investigate the role of hope in the recovery of PTSD in a Dutch patient sample receiving intensive trauma-focused treatment. This study aimed to determine whether hope is indeed an important element in trauma-focused treatment. First, we aimed to investigate the changes in the levels of PTSD symptoms and hope during treatment. We hypothesised that the level of hope would significantly increase during treatment, whereas the level of PTSD symptoms would significantly decrease. Second, this study examined the extent to which the pre-treatment level of hope predicted the level of PTSD symptoms measured at mid-treatment and immediately after treatment. We hypothesised that a higher initial level of hope would be related to lower levels of PTSD symptoms at mid- and post-treatment. Third, we hypothesised that the change in the level of hope from pre- to mid-treatment, in addition to the effect of pre-treatment levels of hope, would predict the level of PTSD symptoms at mid- and post-treatment. Finally, overlap with PTG was studied by examining whether pre-treatment PTG mediated the relationship between pre-treatment hope and PTSD symptoms at mid- and post-treatment. Because hope and PTG are overlapping constructs, our hypothesis was that more pre-treatment hope would be related to fewer PTSD symptoms through more PTG.

1. Method

1.1. Design and participants

This was a longitudinal and observational study in the setting of a (clinical) trauma-focused treatment of two weeks with three moments of measurement: at intake, mid-treatment, and at the end of treatment. The study included 339 participants (82.9% female) with a mean age of 38.6 (SD = 12.09) who were referred to the Psychotrauma Expertise Centre (PSYTREC, the Netherlands), between September 2021 and February 2022. Inclusion criteria were: 18 years or older, a PTSD diagnosis per DSM-5 (APA, 2013), sufficient Dutch language proficiency, and no record of suicidal tendencies or attempts in the last three months. Six participants had previously followed treatment at PSYTREC. Table 1 shows the characteristics of all the included participants.

Table 1.

Descriptive statistics of the total sample (n = 339).

Variable n (%)
Sex at birth  
Male 58 (17.1)
Female 281 (82.9)
Trauma type  
Physical abuse 320 (94.4)
Sexual abuse 295 (87.0)
Early childhood sexual abuse (<12) 151 (44.5)
Accident 180 (53.1)
Other trauma 250 (73.7)
Comorbid mood or anxiety disorder  
Anxiety disorder 113 (33.3)
Mood disorder 184 (54.3)
Suicide risk  
No 88 (26.0)
Low 122 (36.0)
Medium 46 (13.6)
High 74 (21.8)
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1.2. Treatment

The therapy programme consisted of four treatment days within two weeks, either face-to-face in the clinic (four days at the clinic and at home on the weekend), online at home or blended (first week face-to-face and second week online). Distant-delivered intensive trauma-focused treatments have demonstrated viability, safety, and efficacy (Bongaerts et al., 2022). Participants received eight sessions of Eye Movement Desensitisation and Reprocessing (EMDR) therapy and eight sessions of prolonged exposure combined with psycho-education and various physical activities. See Van Woudenberg et al. (2018) and Voorendonk et al. (2020) for details regarding the treatment programme.

1.3. Procedure

Pre-treatment, the inclusion and exclusion criteria were verified, and several interviews and questionnaires were administered. All participants were informed about the study and provided written informed consent. The Medical Ethics Review Committee of VU University Medical Centre granted ethical exemptions (registered with the US Office for Human Research Protection (OHRP) IRB00002991, FWA number FWA00017598). A treatment plan was formulated if the inclusion criteria were met. The mean waiting time before starting was 6 weeks. At mid-treatment, after the first four treatment days, participants were asked to complete the questionnaires through an online platform. One week after treatment, the participants returned for evaluation and post-treatment assessments. Trained psychologists administered all interviews and questionnaires.

1.4. Measures

1.4.1. PTSD symptoms

The primary outcome measure was the severity of PTSD symptoms pre-, mid-, and post-treatment, evaluated using the Dutch version of the PTSD Checklist for DSM-5 (PCL-5; Blevins et al., 2015; Boeschoten et al., 2014b). The PCL-5 is a 20-item self-report questionnaire corresponding to the DSM-5 criteria for PTSD (APA, 2013). Items are rated on a scale from 0 (‘not at all’) to 4 (‘extremely’), giving a total score ranging from 0 to 80. The PCL-5 demonstrates a strong internal consistency (this study: α = .86) and good validity (Bovin et al., 2016).

1.4.2. Hope

Hope was the primary predictor and was assessed using the Dutch version of the Hope Herth Index (HHI-Dutch; Herth, 1992; Van Gestel-Timmermans et al., 2010) pre-, mid-, and post-treatment. The HHI is a 12-item self-report questionnaire (α = .81) consisting of three subscales: sense of temporality and future (for example, ‘I believe that each day has potential’), positive readiness, and expectancy (for example, ‘I feel my life has value and worth’), and interconnectedness with the self and others (e.g. ‘I have deep inner strength’). Items are scored on a scale from 1 (‘strongly disagree’) to 4 (‘strongly agree’). The total score ranges from 12 to 48. The HHI-Dutch demonstrates sufficient psychometric properties (Van Gestel-Timmermans et al., 2010).

1.4.3. Post-traumatic growth

PTG was used as a mediator and assessed pre- and post-treatment using the Dutch version of the Post-traumatic Growth Inventory (PTGI; Jaarsma et al., 2006). The PTGI consists of 21 items (this study: α = .925) across five subscales: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. Items are scored on a scale from 0 (‘I did not experience this change as a result of my crisis’) to 5 (‘I experienced this change to a very great degree as a result of my crisis’). The total PTGI score ranges from 0 to 105. The Dutch PTGI shows good psychometric qualities (Jaarsma et al., 2006).

1.4.4. Other measures at pre-treatment

The Clinician Administered PTSD Scale for DSM-5 (CAPS-5; i.e. month edition; Boeschoten et al., 2018) was used to establish a PTSD diagnosis based on DSM-5 and to measure the severity (American Psychiatric Association, 2013). Next, the Life Events Checklist for DSM-5 (LEC-5) (Boeschoten et al., 2014a; Weathers et al., 2013) was used to determine the specific type of traumatic event. To assess comorbidity and suicidality, participants completed the Dutch version of the Mini International Neuropsychiatric Interview (MINI; Overbeek et al., 1999). As a potential covariate, we included treatment expectancy for the participants’ perception of treatment credibility (measured using the Dutch Treatment Credibility Questionnaire TCQ; Devilly & Borkovec, 2000).

1.5. Statistical analyses

Power analysis with G*power 3.1 (Faul et al., 2009) prior to the analysis (linear multiple regression, deviation from zero; with three predictors, power of 0.80, an effect size of 0.30, and α = .05) indicated a required sample size of 92. To account for data dependency, this was multiplied by 1.7 (70% extra cases), resulting in a sample size of 157. To identify potential covariates, we conducted Pearson correlation analyses to examine the correlations between hope, treatment expectancy, age, sex at birth, and PTSD symptoms. The first hypothesis (i.e. the levels of hope and PTSD symptoms will significantly change) was tested using a linear mixed model (LMM) with time as the independent variable (i.e. categorical with pre-treatment as the reference category) and hope and PTSD symptoms over time as dependent variables. Effect sizes (Cohens d) were calculated using the pooled SD (i.e. B / (√ (SDpre-treatment2 + SDmid- or post treatment2 / 2)). The second hypothesis (i.e. a higher level of hope at pre-treatment is related to lower levels of PTSD symptoms at mid- and post-treatment) was tested in another LMM, controlling for the level of PTSD symptoms at pre-treatment. To test the third hypothesis (i.e. an increase in hope between pre- and mid-treatment is related to lower levels of PTSD symptoms at mid- and post-treatment, even when accounting for the effect of hope at pre-treatment), another LMM was conducted. For both hypotheses 2 and 3, we first estimated the overall effect over time and then added an interaction with time, the effect for mid- and post-treatment separately. The fourth hypothesis (i.e. the relationship between the level of hope at pre-treatment and the level of PTSD symptoms at mid-and post-treatment is mediated by PTG at pre-treatment, controlling for PTSD symptoms at pre-treatment) was assessed using two mediation models (Model 4, for mid- and post-treatment PTSD symptoms separately) with the PROCESS macro for SPSS (Hayes, 2022).

For each LMM, we checked whether it was necessary to include a random slope next to a random intercept to account for repeated measures within the same person. All analyses were performed using SPSS v25. The hypotheses were tested one-sided (α < .025). There were no extreme outliers; therefore, all cases were retained in the analysis. Assumptions were met unless otherwise specified. Within-subject effect sizes were calculated using Cohen’s d.

2. Results

2.1. Patient flow and missing data

Figure 1 illustrates the flowchart of the participants and the amount of missing data for each measurement. No dropouts were reported. Finally, the study included participants who had completed at least one measurement of hope and PTSD symptoms. Overall, 111 participants demonstrated one or more missing values, mainly at mid-treatment. We retained all participants with missing data because of the LMM’s robustness against missing data (Twisk, 2019) and because they still contributed to the moments of measurement that they completed. No significant differences between participants without missing data (n = 228) and participants with missing data (n = 111) were found with respect to the CAPS-5 score at pre-treatment, distribution of men and women, type of trauma, and percentage of comorbid mood disorders, anxiety disorders, and/or suicide risk. Participants without missing data (M = 40.28, SD = 12.16) were significantly older than those with missing data (M = 35.23, SD = 11.27; t(337) = 3.68, p < .001).

Figure 1.

Flowchart of the participants and the amount of missing data for each measurement.

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Flowchart of the participants.

2.2. Potential covariates

A Pearson’s correlation analysis between treatment expectancy and hope at pre-treatment indicated a significant but low correlation coefficient (r = .20, p < .001, n = 337). Regarding age, we identified a significant negative correlation with PTSD symptoms (r = −.23, p < .001, n = 337), but no correlation with hope. Regarding sex assigned at birth, there were no significant differences between men and women in levels of hope and PTSD symptoms at pre-treatment. Age was included as a covariate in all analyses, whereas treatment expectancy and sex were not.

2.3. Hope and PTSD symptoms over time

Table 2 presents the scores on hope, level of PTSD symptoms, and PTG. In accordance with the first hypothesis, we found significantly higher levels of hope and significantly lower levels of PTSD symptoms at mid- and post-treatment than at pre-treatment (see Table 3). Cohen’s d revealed small effect sizes for hope and large effect sizes for PTSD symptoms.

Table 2.

Descriptive statistics of the primary, secondary measures and covariates.

Variables Pre-treatment Mid-treatment Post-treatment
M (SD) n M (SD) n M (SD) n
PCL-5 54.24 (10.72) 339 28.84 (17.65) 267 22.08 (19.38) 276
HHI total score 29.61 (5.29) 337 32.35 (5.97) 250 32.43 (6.30) 261
HHI subscale 1 9.85 (2.17) 337 10.97 (2.26) 250 11.07 (2.49) 261
HHI subscale 2 9.94 (2.11) 337 10.82 (2.26) 250 10.90 (2.28) 261
HHI subscale 3 9.83 (1.91) 337 10.57 (2.10) 250 10.46 (2.24) 261
PTGI 33.73 (21.32) 335     43.44 (26.61) 255
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Note. PCL-5 = PTSD Checklist for DSM-5; HHI = Hope Herth Index; HHI subscale 1 = Temporality and future; HHI subscale 2 = Positive readiness and expectancy; HHI subscale 3 = Interconnectedness with self and others; PTGI = Posttraumatic Growth Inventory.

Table 3.

Hope and PTSD over time.

Measurement B (SE) t-value p 95% CI Cohens d
        Lower bound Upper bound  
Hope            
Mid-treatment 2.63 (0.33) 7.88 <.001 1.98 3.29 0.47
Post-treatment 2.74 (0.33) 8.31 <.001 2.09 3.39 0.47
PTSD symptoms            
Mid-treatment −25.10 (1.00) −25.12 <.001 −27.06 −23.14 1.72
Post-treatment −31.88 (0.99) −32.26 <.001 −33.82 −29.94 2.04
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Note. Models with random intercept. Cohens d = B / (√ (SDpre-treatment2 + SDmid- or post treatment2 / 2))

2.4. The effect of hope at pre-treatment

Table 4 illustrates that the level of PTSD symptoms was predicted by the level of pre-treatment hope, represented by both a significant overall effect and significant effects on mid- and post-treatment separately. Post-hoc, we conducted an LMM in which we examined the effect of PTSD symptoms at pre-treatment on the level of hope at mid- and post-treatment. However, the inverse relationship was not statistically significant.

Table 4.

Effect of pre-treatment level of hope on level of PTSD symptoms.

Measurement B (SE) t-value p 95% CI
        Lower bound Upper bound
Overall effect estimate          
  −0.73 (0.19) −3.96 <.001 −1.10 −0.37
Effect at different follow-up          
Mid-treatment −0.65 (0.20) −3.21 <.01 −1.05 −0.25
Post-treatment −0.81 (0.20) −4.08 <.001 −1.21 −0.42
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Note. Model with random intercept and without random slope. Covariates: pre-treatment PTSD, age

2.5. The additional effect of Δhope

The results regarding the additional effect of the change in level of hope (Δ) between mid- and pre-treatment on PTSD symptoms at mid- and post-treatment are presented in Table 5. Both the level of hope at pre-treatment and Δhope (mid-pre) had a significant overall effect as well as a significant effect on PTSD symptoms at mid- and post-treatment separately. Post-hoc, we ran another LMM in which we added ΔPTSD symptoms between pre- and mid-treatment to the previous post-hoc model. Both PTSD symptoms and ΔPTSD between and pre- and mid-treatment significantly predicted the level of hope at mid- and post-treatment. When ΔPTSD was added to the model, both predictors were significant (Table 6).

Table 5.

Effect of pre-treatment level of hope and effect of change in level of hope on level of PTSD symptoms.

Measurement B (SE) t-value p 95% CI
        Lower bound Upper bound
Overall effect estimate (change in level of hope)
  −1.95 (0.12) −16.24 <.001 −2.19 −1.72
Overall effect estimate (pre-treatment level of hope)
  −.1.54 (0.14) −11.22 <.001 −1.81 −1.27
Effect at different follow-up (change in level of hope)
Mid-treatment −2.18 (0.16) −13.32 <.001 −2.50 −1.86
Post-treatment −1.73 (0.17) −10.47 <.001 −2.05 −1.40
Effect at different follow-up (pre-treatment level of hope)
Mid-treatment −1.58 (0.19) −8.51 <.001 −1.94 −1.21
Post-treatment −1.50 (0.19) −8.02 <.001 −1.87 −1.13
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Note. Model without random intercepts and without random slopes.

Table 6.

Effect of pre-treatment level of PTSD symptoms and effect of change in level of PTSD symptoms on level of hope.

Measurement B (SE) t-value p 95% CI
        Lower bound Upper bound
Overall effect estimate (change in level of PTSD symptoms)          
  −0.20 (0.01) −19.54 <.001 −0.22 −0.18
Overall effect estimate (pre-treatment level of PTSD symptoms)          
  −0.12 (0.02) −5.96 <.001 −0.16 −0.08
Effect at different follow-up (change in level of PTSD symptoms)          
Mid-treatment −0.22 (0.02) −14.71 <.001 −0.25 −0.19
Post-treatment −0.19 (0.01) −14.15 <.001 −0.22 −0.16
Effect at different follow-up (pre-treatment level of PTSD symptoms)          
Mid-treatment −0.13 (0.03) −4.70 <.001 −0.18 −0.07
Post-treatment −0.12 (0.03) −4.59 <.001 −0.17 −0.07
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2.6. Mediation effect of PTG

Figures 2 and 3 show the outcomes of the mediation analyses. As hypothesised, we found a significant mediational effect of PTG at pre-treatment on the relationship between hope at pre-treatment and PTSD symptoms at mid-treatment. Contrary to our hypothesis, PTG pre-treatment did not mediate the relationship between hope at pre-treatment and post-treatment PTSD symptoms. We performed additional analyses, see supplemental material.

Figure 2.

A path model illustrating the relationship between the independent variable (Pre-treatment hope), Mediator (Pre-treatment PTG) and the dependent variable (mid-treatment PTSD). There is a mediation effect.

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Mediation analysis pre-treatment hope, pre-treatment PTG and mid-treatment PTSD.

Figure 3.

A path model that illustrates the relationship between the independent variable (Pre-treatment hope), Mediator (Pre-treatment PTG) and the dependent variable (post-treatment PTSD). No mediation effect was found.

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Mediation analysis pre-treatment hope, pre-treatment PTG and post-treatment PTSD.

3. Discussion

This study aimed to investigate the effects of hope during intensive trauma-focused treatment. First, the results showed a significant decline in the level of PTSD symptoms and concurrent increases in hope during treatment, with large and small effect sizes respectively. Second, in line with our hypotheses, both pre-treatment hope and the subsequent change in hope significantly predicted a reduction in PTSD symptoms. Finally, mediation analyses examining whether PTG mediated the relationship between hope and PTSD symptom levels partially supported our hypotheses.

The findings of this study demonstrate the effectiveness of intensive trauma-focused treatment, which is consistent with prior research outcomes (De Jongh et al., 2020; Gielkens et al., 2021; Kolthof et al., 2022). More importantly, this study also shows that, although not a specific treatment objective, hope levels were, on average, higher at mid- and post-treatment. The observed elevation in hope levels corresponds with the conclusions drawn by Capone and Cameron (2020), whose study on combat veterans undergoing PTSD treatment showed an increase in hope and adaptive behaviours. However, it should be noted that the most substantial change in hope and PTSD symptoms occurred within the first half of treatment. While Gilman et al. (2012) suggested that a change in hope may precede a change in PTSD symptoms, the results of our (post-hoc) analyses suggest that a reciprocal effect is more likely. The reduction in PTSD symptoms and other elements within the treatment process, such as learning adaptive skills and coping strategies, may contribute to generating hope and fostering a positive perspective (Capone & Cameron, 2020; Gilman et al., 2012). The precise underlying mechanism of how hope operates remains to be studied into more detail. It is worth noting that hope is not the sole driver of change, as avoidance may also play a role. Hope might increase the effect of trauma-focused treatment because clients are less likely to avoid difficult aspects of treatment, such as the intense emotions of disturbing thoughts (Glass et al., 2009; Hassija et al., 2012).

Further analyses demonstrated that pre-treatment hope mediates the relationship between pre-treatment PTG and mid-treatment PTSD (but not post-treatment PTSD), which is consistent with the conclusions drawn by Stermac et al. (2014), who found that people with fewer PTSD symptoms achieved greater levels of PTG. Our hypothesis that a higher level of hope would lead to a better outcome from intensive trauma-focused treatment through PTG is partially confirmed.

Our findings suggest that the influence of hope on PTSD treatment outcomes is different from that of PTG. Although hope and PTG exert reciprocal effects, they maintain their distinct identities with varying implications. PTG is a positive outcome of traumatic events, whereas hope is not exclusively linked to traumatic experiences. No comparisons were made between the pre- and post-trauma periods. Nevertheless, the reasons and mechanisms underlying the distinct interactions between hope, PTG, and PTSD symptoms during the various stages of intensive trauma-focused treatment remain ambiguous.

To our knowledge, this is one of the first studies to investigate hope during an intensive trauma-focused treatment programme. The strengths of this study include the multiple measurements of hope and PTSD in a relatively large sample of patients, which allowed us to follow these variables during the course of therapy. Furthermore, this study considered the potential overlap between hope and PTG. However, there are several limitations worth mentioning. First, the uncontrolled nature of this study is an important limitation. There was no comparison with a waitlist group, so we lack insight into the development of hope while waiting for treatment. Second, the study was restricted to measurements of hope before, during, and immediately after the treatment. This lack of follow-up measurements impedes our insight into the trajectory of hope, PTSD symptoms, and PTG over a longer period. Second, we noted that participants with missing data were somewhat younger than those without. It is conceivable that older individuals were more motivated to complete questionnaires. Finally, this study exclusively focused on individuals who were motivated to undergo intensive trauma-focused treatment, a circumstance that may have inherently fostered hope. This limits our ability to make inferences about the relationship between hope and PTSD symptoms in people with subclinical trauma-related problems or those not yet ready for treatment.

Future studies should investigate the extent to which a hope intervention adds value to treatment, which is supported by prior research (Chan et al., 2019). Follow-up research could also investigate whether coping style affects the relationship between hope and treatment effects to better understand this mechanism. Furthermore, it would be useful to add follow-up measurements to assess the long-term effects of the relationship between hope and PTSD symptoms and their implications beyond the immediate treatment period.

In conclusion, the results of this study underscore the significance of hope in influencing the treatment outcomes of intensive trauma-focused treatment. Remarkably, even in the absence of interventions specifically targeting hope, hope was present before treatment and increased during the course of treatment. Hope plays a significant role in the recovery process, aligning with other studies that emphasise hope as a crucial element not only in alleviating PTSD symptoms, but also in enhancing overall mental well-being (Lim et al., 2019; Mefford et al., 2021; Pleeging et al., 2021) and even influencing physical health (Lancaster & Van Allen, 2023). To deal with setbacks in life resiliently and to be able to cope, having trust and hope that eventually things will get better is essential and maybe even more important than symptom reduction itself. The contemporary definition of health necessitates dedicated emphasis on these fundamental existential components (Huber et al., 2011). Thus, the quality of life improves even in the presence of lingering symptoms.

Supplementary Material

Supplemental material.docx
ZEPT_A_2607191_SM8243.docx (363KB, docx)

Funding Statement

This work was supported in part by the EMDR Research Foundation, Vereniging EMDR Nederland (VEN), which covered the Article Publishing Charge. The EMDR Research Foundation had no involvement in any aspect of the study, including its design, data collection, management, analysis, interpretation, or review.

Data availability statement

The data that support the findings of this study are not publicly available because of privacy restrictions, but are available from the corresponding author upon reasonable request.

Discosure statement

AdJ receives income from published books on EMDR therapy and the training of postdoctoral professionals in this method. AdJ and EV are employed at PSYTREC. The other authors have no conflicts of interest to declare.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2025.2607191.

References

  1. American Psychiatric Association . (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 10.1176/appi.books.9780890425596 [DOI] [Google Scholar]
  2. Baert, T., Duppen, Z. V., & Wachter, D. D. (2020). Existentiële hoop: Een fenomenologisch leidmotief in het verstaan van depressie? Tijdschrift voor Psychiatrie. [PubMed]
  3. Beder, J. (2005). Loss of the assumptive world—How we deal with death and loss. OMEGA - Journal of Death and Dying, 50(4), 255–265. 10.2190/GXH6-8VY6-BQ0R-GC04 [DOI] [Google Scholar]
  4. Blevins, C. A., Weathers, F. W., Davis, M. T., Witte, T. K., & Domino, J. L. (2015). The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. Journal of Traumatic Stress, 28(6), 489–498. 10.1002/jts.22059 [DOI] [PubMed] [Google Scholar]
  5. Boeschoten, M. A., Bakker, A., Jongedijk, R. A., & Olff, M. (2014a). Life Events Checklist for DSM-5: Nederlandstalige versie. Arq Psychotrauma Expert Groep. https://psychotraumanet.org/nl/life-events-checklist-dsm-5-nederlandstalige-versie. [Google Scholar]
  6. Boeschoten, M. A., Bakker, A., Jongedijk, R. A., & Olff, M. (2014b). PTSD checklists for DSM-5 (PCL-5) Nederlandstalige versie. Arq Psychotrauma Expert Groep. https://psychotraumanet.org/nl/ptsd-checklists-dsm-5-nederlandstalige-versie. [Google Scholar]
  7. Boeschoten, M. A., Van Der Aa, N., Bakker, A., Ter Heide, F. J. J., Hoofwijk, M. C., Jongedijk, R. A., Van Minnen, A., Elzinga, B. M., & Olff, M. (2018). Development and evaluation of the Dutch clinician-administered PTSD scale for DSM-5 (CAPS-5). European Journal of Psychotraumatology, 9(1), 1546085. 10.1080/20008198.2018.1546085 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., & De Jongh, A. (2022). Fully remote intensive trauma-focused treatment for PTSD and complex PTSD. European Journal of Psychotraumatology, 13(2), 2103287. 10.1080/20008066.2022.2103287 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., Schnurr, P. P., & Keane, T. M. (2016). Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders–fifth edition (PCL-5) in veterans. Psychological Assessment, 28(11), 1379–1391. 10.1037/pas0000254 [DOI] [PubMed] [Google Scholar]
  10. Brown, L. A., Belli, G. M., Asnaani, A., & Foa, E. B. (2019). A review of the role of negative cognitions about oneself, others, and the world in the treatment of PTSD. Cognitive Therapy and Research, 43(1), 143–173. 10.1007/s10608-018-9938-1 [DOI] [Google Scholar]
  11. Capone, C., & Cameron, A. Y. (2020). An examination of hope, symptom severity, and functioning Among combat veterans after participation in an intensive outpatient program for PTSD. Journal of Contemporary Psychotherapy, 50(2), 143–150. 10.1007/s10879-019-09440-9 [DOI] [Google Scholar]
  12. Chan, K., Wong, F. K. Y., & Lee, P. H. (2019). A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: A feasibility test. SAGE Open Nursing, 5, 1–13. 10.1177/2377960819844381 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. De Jongh, A., Groenland, G. N., Sanches, S., Bongaerts, H., Voorendonk, E. M., & Van Minnen, A. (2020). The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder. European Journal of Psychotraumatology, 11(1), 1721142. 10.1080/20008198.2020.1721142 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Devilly, G. J., & Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire. Journal of Behavior Therapy and Experimental Psychiatry, 31(2), 73–86. 10.1016/S0005-7916(00)00012-4 [DOI] [PubMed] [Google Scholar]
  15. Doe, M. J. (2020). Conceptual foreknowings: An integrative review of hope. Nursing Science Quarterly, 33(1), 55–64. 10.1177/0894318419881805 [DOI] [PubMed] [Google Scholar]
  16. Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. 10.3758/BRM.41.4.1149 [DOI] [PubMed] [Google Scholar]
  17. Gallagher, M. W., Long, L. J., & Phillips, C. A. (2020). Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies. Journal of Clinical Psychology, 76(3), 329–355. 10.1002/jclp.22882 [DOI] [PubMed] [Google Scholar]
  18. Gielkens, E. M. J., De Jongh, A., Sobczak, S., Rossi, G., Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & Van Alphen, S. P. J. (2021). Comparing intensive trauma-focused treatment outcome on PTSD symptom severity in older and younger adults. Journal of Clinical Medicine, 10(6), 1246. 10.3390/jcm10061246 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Gilman, R., Schumm, J. A., & Chard, K. M. (2012). Hope as a change mechanism in the treatment of posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 4(3), 270–277. 10.1037/a0024252 [DOI] [Google Scholar]
  20. Glass, K., Flory, K., Hankin, B. L., Kloos, B., & Turecki, G. (2009). Are coping strategies, social support, and hope associated With psychological distress Among hurricane Katrina survivors? Journal of Social and Clinical Psychology, 28(6), 779–795. 10.1521/jscp.2009.28.6.779 [DOI] [Google Scholar]
  21. Hagenaars, M. A., & Van Minnen, A. (2010). Posttraumatic growth in exposure therapy for PTSD. Journal of Traumatic Stress, 23(4), 504–508. 10.1002/jts.20551 [DOI] [PubMed] [Google Scholar]
  22. Hassija, C. M., Luterek, J. A., Naragon-Gainey, K., Moore, S. A., & Simpson, T. (2012). Impact of emotional approach coping and hope on PTSD and depression symptoms in a trauma exposed sample of veterans receiving outpatient VA mental health care services. Anxiety, Stress & Coping, 25(5), 559–573. 10.1080/10615806.2011.621948 [DOI] [PubMed] [Google Scholar]
  23. Haugan, G., & Eriksson, M. (2021). Health promotion in health care–vital theories and research. Springer. [PubMed] [Google Scholar]
  24. Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). The Guilford Press. [Google Scholar]
  25. Herth, K. (1992). Abbreviated instrument to measure hope: Development and psychometric evaluation. Journal of Advanced Nursing, 17(10), 1251–1259. 10.1111/j.1365-2648.1992.tb01843.x [DOI] [PubMed] [Google Scholar]
  26. Huber, M., Knottnerus, J. A., Green, L., Horst, H. V. D., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., Meer, J. W. M. V. D., Schnabel, P., Smith, R., Weel, C. V., & Smid, H. (2011). How should we define health? BMJ, 343(jul26 2), d4163–d4163. 10.1136/bmj.d4163 [DOI] [PubMed] [Google Scholar]
  27. Jaarsma, T. A., Pool, G., Sanderman, R., & Ranchor, A. V. (2006). Psychometric properties of the Dutch version of the posttraumatic growth inventory among cancer patients. Psycho-Oncology, 15(10), 911–920. 10.1002/pon.1026 [DOI] [PubMed] [Google Scholar]
  28. Kolthof, K. A., Voorendonk, E. M., Van Minnen, A., & De Jongh, A. (2022). Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder. European Journal of Psychotraumatology, 13(2), 2143076. 10.1080/20008066.2022.2143076 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Lancaster, B. D., & Van Allen, J. (2023). Hope and pediatric health. Current Opinion in Psychology, 49, 101500. 10.1016/j.copsyc.2022.101500 [DOI] [PubMed] [Google Scholar]
  30. Lim, M., Li, Z., Xie, H., Tan, B. L., & Lee, J. (2019). An Asian study on clinical and psychological factors associated with personal recovery in people with psychosis. BMC Psychiatry, 19(1), 256. 10.1186/s12888-019-2238-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Long, L. J., Bistricky, S. L., Phillips, C. A., D’Souza, J. M., Richardson, A. L., Lai, B. S., Short, M., & Gallagher, M. W. (2020). The potential unique impacts of hope and resilience on mental health and well-being in the wake of hurricane harvey. Journal of Traumatic Stress, 33(6), 962–972. 10.1002/jts.22555 [DOI] [PubMed] [Google Scholar]
  32. Mefford, L. C., Phillips, K. D., & Chung, M. L. (2021). Childhood loss experiences, religiousness/spirituality, and hope as predictors of adult life satisfaction. Issues in Mental Health Nursing, 42(7), 649–659. 10.1080/01612840.2020.1828514 [DOI] [PubMed] [Google Scholar]
  33. Michélsen, H., Therup-Svedenlöf, C., Backheden, M., & Schulman, A. (2017). Posttraumatic growth and depreciation six years after the 2004 tsunami. European Journal of Psychotraumatology, 8(1), 1302691. 10.1080/20008198.2017.1302691 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Nijdam, M. J., Van Der Meer, C. A. I., Van Zuiden, M., Dashtgard, P., Medema, D., Qing, Y., Zhutovsky, P., Bakker, A., & Olff, M. (2018). Turning wounds into wisdom: Posttraumatic growth over the course of two types of trauma-focused psychotherapy in patients with PTSD. Journal of Affective Disorders, 227, 424–431. 10.1016/j.jad.2017.11.031 [DOI] [PubMed] [Google Scholar]
  35. Olff, M., Amstadter, A., Armour, C., Birkeland, M. S., Bui, E., Cloitre, M., Ehlers, A., Ford, J. D., Greene, T., Hansen, M., Lanius, R., Roberts, N., Rosner, R., & Thoresen, S. (2019). A decennial review of psychotraumatology: What did we learn and where are we going? European Journal of Psychotraumatology, 10(1), 1672948. 10.1080/20008198.2019.1672948 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Overbeek, T., Schruers, K., & Griez, E. (1999). MINI: Mini International Neuropsychiatric Interview: Dutch version 5.0.0, DSM-(IV) . Internal publication University of Maastricht. https://www.scienceopen.com/document?vid = 6b1daf18-54b2-44ed-b461-62349229b96c. [Google Scholar]
  37. Pleeging, E., Burger, M., & Van Exel, J. (2021). The relations between hope and subjective well-being: A literature overview and empirical analysis. Applied Research in Quality of Life, 16(3), 1019–1041. 10.1007/s11482-019-09802-4 [DOI] [Google Scholar]
  38. Raman, U., Bonanno, P. A., Sachdev, D., Govindan, A., Dhole, A., Salako, O., Patel, J., Noureddine, L. R., Tu, J., Guevarra-Fernández, J., Leto, A., Nemeh, C., Patel, A., Nicheporuck, A., Tran, A., & Kennedy, C. A. (2021). Community violence, PTSD, hopelessness, substance Use, and perpetuation of violence in an urban environment. Community Mental Health Journal, 57(4), 622–630. 10.1007/s10597-020-00691-8 [DOI] [PubMed] [Google Scholar]
  39. Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: Meta-analysis of longitudinal studies. British Journal of Psychiatry, 212(5), 279–286. 10.1192/bjp.2018.27 [DOI] [PubMed] [Google Scholar]
  40. Schaap-Jonker, H. (2019). Herstel, hoop en compassie: Contouren van een hedendaagse klinische godsdienstpsychologie. De Psycholoog, 54(12), 10–20. https://research.vu.nl/ws/portalfiles/portal/95980414/de_psycholoog_herstel_hoop_compassie.pdf [Google Scholar]
  41. Senger, A. R., McGrew, S. J., Gallagher, M. W., & Vujanovic, A. (2023). Associations of resilience and hope with mental and physical health among firefighters. Journal of Clinical Psychology, 79(9), 2124–2136. 10.1002/jclp.23534 [DOI] [PubMed] [Google Scholar]
  42. Stermac, L., Cabral, C. M., Clarke, A. K., & Toner, B. (2014). Mediators of posttraumatic mental health in sexual assault survivors. Journal of Aggression, Maltreatment & Trauma, 23(3), 301–317. 10.1080/10926771.2014.881948 [DOI] [Google Scholar]
  43. Twisk, J. W. (2019). Applied mixed model analysis: A practical guide. Cambridge University Press. [Google Scholar]
  44. Van Gestel-Timmermans, H., Van Den Bogaard, J., Brouwers, E., Herth, K., & Van Nieuwenhuizen, C. (2010). Hope as a determinant of mental health recovery: A psychometric evaluation of the Herth Hope Index-Dutch version. Scandinavian Journal of Caring Sciences, 24, 67–74. 10.1111/j.1471-6712.2009.00758.x [DOI] [PubMed] [Google Scholar]
  45. Van Woudenberg, C., Voorendonk, E. M., Bongaerts, H., Zoet, H. A., Verhagen, M., Lee, C. W., Van Minnen, A., & De Jongh, A. (2018). Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder. European Journal of Psychotraumatology, 9(1), 1487225. 10.1080/20008198.2018.1487225 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Varahrami, A., Arnau, R., Rosen, D., & Mascaro, N. (2010). The relationships between meaning, hope, and psychological development. International Journal of Existential Psychology & Psychotherapy, 3(1), 1–12. [Google Scholar]
  47. Voorendonk, E. M., De Jongh, A., Rozendaal, L., & Van Minnen, A. (2020). Trauma-focused treatment outcome for complex PTSD patients: Results of an intensive treatment programme. European Journal of Psychotraumatology, 11(1), 1783955. 10.1080/20008198.2020.1783955 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Wang, J., She, Y., Wang, M., Zhang, Y., Lin, Y., & Zhu, X. (2021). Relationships among hope, meaning in life, and post-traumatic growth in patients with chronic obstructive pulmonary disease: A cross-sectional study. Journal of Advanced Nursing, 77(1), 244–254. 10.1111/jan.14605 [DOI] [PubMed] [Google Scholar]
  49. Wang, Q., Xu, W., Ren, L., Wang, W., & Wang, Y. (2019). The relationship between hope and post-traumatic stress disorder in Chinese shidu parents: The mediating role of perceived stress. Journal of Affective Disorders, 251, 23–30. 10.1016/j.jad.2019.03.049 [DOI] [PubMed] [Google Scholar]
  50. Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013). Life events checklist for DSM-5 (LEC-5). Scale Available from the National Center for PTSD. https://www.ptsd.va.gov.
  51. Zoellner, T., & Maercker, A. (2006). Posttraumatic growth in clinical psychology — A critical review and introduction of a two component model. Clinical Psychology Review, 26(5), 626–653. 10.1016/j.cpr.2006.01.008 [DOI] [PubMed] [Google Scholar]

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Supplementary Materials

Supplemental material.docx
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Data Availability Statement

The data that support the findings of this study are not publicly available because of privacy restrictions, but are available from the corresponding author upon reasonable request.

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