Validating the efficacy of associative therapeutic COPE cards for eliciting distinct psychophysiological states: behavioral and neural evidence from an ERP study

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.