Does physiologic response to loud tones change following cognitive–behavioral treatment for posttraumatic stress disorder?

Abstract

This study examined responses to loud tones before and after cognitive–behavioral treatment for posttraumatic stress disorder (PTSD). Seventy-four women in a PTSD treatment outcome study for rape-related (n = 54) or physical assault-related PTSD (n = 20) were assessed in an auditory loud tone paradigm. Assessments were conducted before and after a 6-week period of cognitive–behavioral therapy. Physiologic responses to loud tones included heart rate (HR), skin conductance (SC), and eye-blink electromyogram (EMG). Groups were formed based upon treatment outcome and included a treatment responder group (no PTSD at posttreatment) and a nonresponder group (PTSD-positive at posttreatment). Treatment was successful for 53 of 74 women (72%) and unsuccessful for 21 women (28%). Responders and nonresponders were not significantly different from each other at pretreatment on the main outcome variables. Treatment responders showed a significant reduction in loud tone-related EMG, HR, and SC responses from pre- to posttreatment (partial η2 = .243, .308, and .365, respectively; all p < .001) and the EMG and HR responses were significantly smaller than nonresponders at posttreatment (partial η22 = .107, p = .004 and .193, p < .001, respectively). Successful cognitive–behavioral treatment of PTSD is associated with a quantifiable reduction in physiological responding to loud tones.

Positive Association Between Nightmares and Heart Rate Response to Loud Tones

“…Future research should consider obtaining HRV prior to presenting the loud tone stimuli, so as to allow for an examination of the relationship between HRV and heart rate reactivity to the loud tones. From prior research, it is known that decreased parasympathetic tone is associated with PTSD and that this changes with treatment (Griffin et al, 2012). Experiments in which parasympathetic tone were to be modified, e.g., by drugs, and the effect on nightmares measured, could help clarify causation.…”

“…Data were obtained in the context of a cognitive behavioral therapy study of women with PTSD resulting from rape or physical assault (n=150) (Griffin, Resick, & Galovski, 2012; Resick et al, 2008). A subset of these women (n=73) were tested in the psychophysiology laboratory prior to beginning therapy by measuring their HR, SC and EMG responses during exposure to a series of loud tones.…”

“…Clinicians with master’s degree or above served as diagnostic raters, as described in prior publications (Griffin et al, 2012). All individual items are scored as the sum of intensity (0–4) and frequency (0–4) of the symptom, yielding a nine-point (0–8) severity score (Weathers, Keane, & Davidson, 2001).…”

“…Peak R-wave signals were detected, and interbeat intervals were converted to HR. Heart rate response was calculated as the maximum HR achieved during the period from 0.5–6 s after tone onset minus the average level during the 5 s immediately prior to tone onset (Griffin et al, 2012). …”

Biological studies of post-traumatic stress disorder

“…13 A recent study that examined psychophysiological responses before and after cognitive-behavioral therapy for PTSD found that treatment responders showed a significant reduction in eye-blink EMG, heart rate, and skin conductance responses to loud tones, whereas treatment non-responders did not. 14 Understanding discordances between psychophysiological and subjective measures of treatment outcome will require further research. Pre-treatment psychophysiological assessments might be examined for their usefulness in guiding treatment selection.…”