EPV1195
Validating therapeutic COPE cards in sexual assault survivors: converging psychophysiological, behavioral, and neural evidence within the SEE FAR CBT framework for PTSD
S. Raz 1 2,*, M. Lahad 3
1The Center for Psychobiological Research, Yezreel Valley College, Yezreel Valley, 2Psychology, Tel-Hai Collge, Upper Galilee, 3Community Stress Prevention Center, Kiryat Shmona, Israel
Introduction: SEE FAR CBT (Somatic Experience–Fantastic Reality–Cognitive Behavioral Therapy) is an integrative, trauma-focused treatment for PTSD and anxiety disorders. It has been applied in clinical practice for over two decades, with consistent positive feedback from patients and therapists regarding its effectiveness and acceptability. Its Fantastic Reality component refers to the capacity of individuals under extreme stress to enter a protected imaginative space, where traumatic experiences can be externalized and playfully transformed, enabling survivors to engage creatively with difficult material while maintaining emotional safety. This process is activated in therapy through COPE cards—associative artistic drawings—designed to evoke emotional states and facilitate therapeutic engagement. Although used clinically, empirical validation of COPE cards remains limited.
Objectives: To evaluate the efficacy of COPE cards in eliciting differential psychophysiological, behavioral, and neural markers of emotional arousal in women who had experienced sexual assault and consequently presented with symptoms of PTSD.
Methods: Two complementary studies were conducted.
Psychophysiological study: Participants completed baseline recordings of heart rate (HR), blood pressure (BP), and heart rate variability (HRV), then viewed negatively-valenced (arousing) cards followed by positively-valenced (safe) cards, with measures taken after each phase (Fig 1).
Neurocognitive study: Participants viewed negative, ambivalent, and positive cards while providing ratings, mismatch detection, and reaction times (RT), alongside EEG recordings of brain event-related potentials (ERP: P1, P2, P3, LPP).
Results: In study 1, relative to baseline, exposure to negative (stressful/arousing) cards increased HR and BP and reduced HRV, while subsequent exposure to positive (safe) cards produced the opposite pattern, reflecting differential ANS reactivity (Fig 2). In study 2, ratings showed a valence gradient (positive highest, ambivalent intermediate, negative lowest). Ambivalent cards elicited the most mismatches. RTs differed across valence conditions, with ambivalent stimuli eliciting the slowest responses, followed by negative and then positive stimuli. ERP analyses revealed robust modulation by emotional condition, with negative cards eliciting enhanced P1, P2, P3, and LPP amplitudes, consistent with heightened neural sensitivity to negative cues (Fig 3).
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Conclusions: Across physiological, behavioral, and neural domains, COPE cards reliably elicited distinct arousal-affective states, providing empirical support for their use as therapeutic tools. Within the SEE FAR CBT framework, they offer a playful yet safe means of influencing emotional processing and facilitating symbolic transformation of trauma-related material.
Disclosure of Interest: None Declared