Psychiatry · Medical Literature
Client and therapist experiences with the Processing of Positive Memories Technique (PPMT) in a randomized controlled trial: insights for protocol refinement.
Abstract
Background: The Processing of Positive Memories Technique (PPMT) is a brief, memory-based intervention designed to enhance access to detailed positive autobiographical memories (AMs) in individuals with posttraumatic stress disorder (PTSD). Although research suggests that PPMT is feasible and may reduce PTSD symptoms, little is known about client and therapist experiences with PPMT when delivered to individuals with diagnostic PTSD.Objective: In a pilot randomised controlled trial, PPMT was compared to Supportive Counseling. Seventy clients with PTSD were randomised in a 1:1 ratio to receive five weekly therapy sessions, and then clients in the PPMT arm and study therapists were invited to provide feedback on the format, content, feasibility and acceptability of PPMT.Method: Twenty-six clients with PPMT assigned to the PPMT condition and six therapists who delivered PPMT completed quantitative and qualitative feedback surveys one-week post-treatment.Results: Clients and therapists reported strong feasibility and acceptability of PPMT. Among clients, 52.3% reported that PPMT became easier with practice, 45.5% indicated they would participate in PPMT again, and 38.1% described it as helpful overall. Therapists uniformly endorsed PPMT as a valuable adjunct to trauma-focused treatments (100%) and viewed it as feasible for clinicians to implement due to its structured format (66.7%). Clients described emotional and cognitive benefits of narrating and positive AMs, including increased access to positive emotions, improved self-reflection, and greater present-oriented awareness. Several areas for protocol refinement were identified, including additional support to help retrieve positive AMs, clarifying the rationale for protocol elements such as using the present tense for narration, the exclusion of trauma content, and how recalling positive AMs can help in trauma recovery; as well as greater flexibility in number of sessions.Conclusion: Findings support PPMT as a feasible and acceptable intervention and provide guidance for optimising its clinical implementation.Trial registration: ClinicalTrials.gov identifier: NCT05523453..
Clinical relevance
PTSD is associated with impaired access to positive autobiographical memories (AMs), a deficit that standard trauma-focused therapies do not directly target; PPMT addresses this gap by specifically rehabilitating positive memory retrieval as a therapeutic mechanism. This pilot RCT provides early-phase feasibility and acceptability data for PPMT in adults with diagnostic PTSD — a population in which the intervention had not yet been formally evaluated against an active comparator. Given the high global burden of PTSD and limitations of existing first-line treatments in terms of dropout and partial response, clinicians need data on novel adjunctive strategies such as PPMT.
Key findings
1. Seventy adults with diagnostic PTSD were randomized 1:1 to five weekly sessions of PPMT versus Supportive Counseling, establishing an adequately powered pilot RCT design for feasibility evaluation. 2. Of the 26 clients completing PPMT, 52.3% reported that the technique became easier with repeated practice across sessions, suggesting a learning curve effect relevant to dosing decisions. 3. Only 45.5% of PPMT clients indicated willingness to participate in PPMT again, and 38.1% described it as helpful overall — modest endorsement rates that highlight meaningful room for protocol optimization before definitive efficacy trials. 4. All six study therapists (100%) endorsed PPMT as a valuable adjunct to trauma-focused treatments, and 66.7% rated it as feasible to implement attributable to its structured format — indicating strong provider-side acceptability despite moderate client-side endorsement. 5. Qualitative client data identified three core experiential benefits: increased access to positive emotions, improved self-reflection, and greater present-oriented awareness during positive AM narration. 6. Key protocol gaps identified by both clients and therapists included insufficient scaffolding for positive AM retrieval, unclear rationale for present-tense narration and exclusion of trauma content, inadequate psychoeducation linking positive AM recall to trauma recovery, and inflexibility in session number — all actionable targets for protocol refinement.
Practice implications
Clinicians considering PPMT as an adjunct to established trauma-focused therapies (e.g., Prolonged Exposure, EMDR) should anticipate a patient learning curve and build in explicit psychoeducation early in treatment explaining why recalling positive memories — in present tense and free of trauma content — is mechanistically linked to PTSD recovery, as this rationale gap was a primary source of patient disengagement. Patient selection should prioritize individuals with PTSD who demonstrate at least some capacity for positive AM retrieval at baseline, and additional retrieval-support strategies (e.g., memory specificity training) should be considered as preparatory steps for those with marked positive memory deficits. Given that therapist acceptability was uniformly high but client acceptability was only moderate, future protocol iterations should incorporate flexible session scheduling beyond the fixed five-session format and embed ongoing client feedback loops to improve adherence and perceived therapeutic alliance.