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Patterns and temporal precedence of symptom change during cognitive processing therapy for military sexual trauma-related posttraumatic stress disorder

Published online by Cambridge University Press:  12 March 2019

Nicholas Holder*
Affiliation:
Veterans Affairs North Texas Health Care System; Research Service (151), Dallas, TX 75216, USA Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9070, USA
Ryan Holliday
Affiliation:
Rocky Mountain Mental Illness, Education, and Clinical Center for Suicide Prevention, Mental Health, Aurora, CO 80045, USA Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
Jessica Wiblin
Affiliation:
Veterans Affairs North Texas Health Care System; Research Service (151), Dallas, TX 75216, USA Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9070, USA
Alina Surís
Affiliation:
Veterans Affairs North Texas Health Care System; Research Service (151), Dallas, TX 75216, USA Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9070, USA
*
*Corresponding author. Email: [email protected]

Abstract

Background:

Cognitive processing therapy (CPT) is an effective treatment for posttraumatic stress disorder (PTSD), including for veterans with military sexual trauma (MST)-related PTSD. Most CPT research to date has focused on pre- to post-treatment change in total PTSD symptoms; however, PTSD symptom criteria may not change equivalently over the course of treatment. For example, changes in re-experiencing symptoms have been shown to precede changes in other PTSD criteria during other PTSD treatments (i.e. virtual reality exposure therapy, venlafaxine ER). An improved understanding of the mechanism of change in PTSD symptoms during CPT may assist in optimizing treatment.

Aims:

The purpose of this study was to identify the pattern and temporal precedence of change in PTSD symptom criteria during and after CPT using cross-lagged panel analyses.

Method:

Data from veterans (n = 32) enrolled in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD were utilized for this secondary analysis. Using hierarchical linear modelling, each symptom criterion was entered as a predictor of subsequent change in the other PTSD symptom criteria.

Results:

All symptom criteria followed a logarithmic pattern of change. Hyperarousal symptoms were found to both predict and temporally precede change in avoidance symptoms, but not re-experiencing symptoms. Re-experiencing and avoidance symptoms did not predict change in other PTSD symptom criteria.

Conclusions:

These findings provide initial support that targeting and reducing hyperarousal symptoms may be a key component of PTSD intervention with CPT. Additional research is needed to identify factors that predict change in PTSD-related re-experiencing symptoms.

Type
Main
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

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Footnotes

§

Nicholas Holder is currently affiliated with the San Francisco Veterans Affairs Health Care System, Sierra Pacific Mental Illness Research, Education, and Clinical Center, and University of California San Francisco School of Medicine.

References

American Psychiatric Association (2000). Diagnostic and Statistical Manual for Mental Disorders (4th edn, text revision). Washington DC: American Psychiatric Association.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington DC: American Psychiatric Association.Google Scholar
Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D. and Charney, D. S. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 7590. doi: 10.1002/jts.2490080106.CrossRefGoogle ScholarPubMed
Haagen, J. F., Smid, G. E., Knipscheer, J. W. and Kleber, R. J. (2015). The efficacy of recommended treatments for veterans with PTSD: a metaregression analysis. Clinical Psychology Review, 40, 184194. doi: 10.1016/j.cpr.2015.06.008 CrossRefGoogle ScholarPubMed
Holder, N., Holliday, R., Williams, R. C., Mullen, K. and Surís, A. (2018a). A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD. Cognitive Behaviour Therapy, 47, 7689. doi: 10.1080/16506073.2017.1357750.CrossRefGoogle ScholarPubMed
Holder, N., Holliday, R., Williams, R. C. and Surís, A. (2018b). Differences in posttraumatic stress disorder symptom severity for military veterans with combat vs. military sexual trauma. The Military Psychologist, 33, 610.Google Scholar
Holliday, R., Holder, N. and Surís, A. (2018). Reductions in self-blame cognitions predict PTSD improvements with cognitive processing therapy for military sexual trauma-related PTSD. Psychiatry Research, 263, 181184. doi: 10.1016/j.psychres.2018.03.007 CrossRefGoogle ScholarPubMed
Macdonald, A., Monson, C. M., Doron-Lamarca, S., Resick, P. A. and Palfai, T. P. (2011). Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Traumatic Stress, 24, 268276. doi: 10.1002/jts.20642 CrossRefGoogle ScholarPubMed
Maples-Keller, J. L., Price, M., Rauch, S., Gerardi, M. and Rothbaum, B. O. (2017). Investigating relationships between PTSD symptom clusters within virtual reality exposure therapy for OEF/OIF veterans. Behavior Therapy, 42, 147155. doi: 10.1016/j.beth.2016.02.011 CrossRefGoogle Scholar
McCoach, D. B. (2010). Hierarchical linear modeling. In Hancock, G. R., and Mueller, R. O. (eds), Quantitative Methods in the Social and Behavioral Sciences: A Guide for Researchers and Reviewers (pp. 123–40). New York, NY: Routledge.Google Scholar
Military Sexual Trauma Support Team (2017). Military Sexual Trauma (MST) Screening Report: Fiscal Year 2017. Washington DC: Department of Veterans Affairs.Google Scholar
Nishith, P., Resick, P. A. and Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880886. doi: 10.1037/0022-006X.70.4.880.CrossRefGoogle ScholarPubMed
Raudenbush, S., Bryk, A., Cheong, Y., Congdon, R. and du Toit, M. (2011). HLM 7.0: Hierarchical Linear and Nonlinear Modeling. Lincolnwood, IL: Scientific Software International.Google Scholar
Resick, P. A., Monson, C. M. and Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. New York, NY: Guilford Press.Google Scholar
Schell, T. L., Marshall, G. N. and Jaycox, L. H. (2004). All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. Journal of Abnormal Psychology, 113, 189197. doi: 10.1037/0021-843X.113.2.189.CrossRefGoogle Scholar
Schumm, J. A., Dickstein, B. D., Walter, K. H., Owens, G. P. and Chard, K. M. (2015). Changes in posttraumatic cognitions predict changes in posttraumatic stress disorder symptoms during cognitive processing therapy. Journal of Consulting and Clinical Psychology, 83, 11611166. doi: 10.1037/ccp0000040 CrossRefGoogle ScholarPubMed
Stein, D. J., Pedersen, R., Rothbaum, B. O., Baldwin, D. S., Ahmed, S., Musgnung, J. and Davidson, J. (2009). Onset of activity and time to response on individual CAPS-SX17 items in patients treated for post-traumatic stress disorder with venlafaxine ER: a pooled analysis. International Journal of Clinical Neuropsychopharmacology, 12, 2331. doi: 10.1017/S1461145708008961 CrossRefGoogle ScholarPubMed
Surís, A. and Lind, L. (2008). Military sexual trauma: a review of prevalence and associated health consequences in veterans. Trauma, Violence, and Abuse, 9, 250269. doi: 10.1177/1524838008324419 CrossRefGoogle ScholarPubMed
Surís, A., Link-Malcolm, J., Chard, K., Ahn, C. and North, C. (2013). A randomized clinical trial of cognitive processing therapy for veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress, 26, 2837. doi: 10.1002/jts.21765 CrossRefGoogle ScholarPubMed
Weathers, F. W., Litz, B. T., Herman, D., Huska, J. and Keane, T. (1993, October). The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. Annual Meeting of the International Society of Traumatic Stress Studies. San Antonio, TX.Google Scholar
Wilkins, K. C., Lang, A. J. and Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28, 596606. doi: 10.1002/da.20837.CrossRefGoogle ScholarPubMed
Zalta, A. K., Held, P., Smith, D. L., Klassen, B. J., Lofgreen, A. M., Normand, P. S., et al. (2018). Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD. BMC Psychiatry, 18, 242. doi: 10.1186/s12888-018-1816-6 CrossRefGoogle ScholarPubMed
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