Posttraumatic stress disorder and depression residual symptoms among veterans and service members who completed a 3-week cognitive processing therapy-based intensive treatment program.

Abstract

Objective. While previous studies have documented that evidence-based treatments for posttraumatic stress disorder (PTSD) are efficacious, treatment completers often continue to experience residual symptoms. However, no studies to date have assessed residual symptoms following intensive treatment programs (ITPs) for PTSD, which combine evidence-based PTSD treatment along with adjunctive interventions. The present study examined residual symptoms of PTSD and depression in 482 veterans and service members who completed a 3-week Cognitive Processing Therapy-based ITP. Method. Residual symptoms were examined at posttreatment and 3 months following ITP completion. Frequency analyses and logistic regressions were conducted to discern the presence of residual symptoms among (a) the total sample and (b) participants who did and did not experience clinically meaningful change in PTSD symptom severity over the course of treatment. Results. Study results indicated that the majority of participants (80%–87%) reported some PTSD and depression residual symptoms at ITP completion, which commonly continued to be endorsed at 3 months following ITP completion. At both treatment completion and 3 months following treatment, participants who experienced clinically meaningful changes during the ITP exhibited statistically lower odds of PTSD and depression residual symptoms as compared to participants who did not experience clinically meaningful changes. However, regardless of whether clinically meaningful changes in PTSD symptoms were experienced, participants most commonly endorsed residual symptoms in the hyperarousal cluster of PTSD and general depression symptoms at high rates. Conclusions. Findings suggest the need to further examine functional impairment and coping skill use associated with these long-standing residual symptoms.

Residual posttraumatic stress disorder and depression symptoms following a residential posttraumatic stress disorder treatment program for U.S. active duty service members.

“…Understanding environmental impacts on the persistence of symptoms could be an important endeavor in intensive and residential treatment settings. Overall, the consistency in results between the current study and that of Kovacevic et al (2023) provides corroborating evidence of symptoms most likely to persist following intensive PTSD treatments.…”

“…A series of binary logistic regressions examined the effects of clinically significant change on each residual PTSD (i.e., PCL-M) and depression (i.e., PHQ-8) symptom at posttreatment. Given the number of logistic regression tests, Hochberg's step-up procedure (Hochberg, 1988) was applied to reduce Type I error, mirroring prior research on residual symptoms (e.g., Kovacevic et al, 2023). Since data were collected each week in the program, missing data were handled by last observation carried forward (LOCF).…”

“…Additionally, the current study relied on self-report rather than clinician-rated measures. However, these are highly correlated with one another (Monson et al, 2008), and other studies of residual PTSD and depression symptoms have utilized self-report measures (e.g., Kovacevic et al, 2023), and both the PCL-M and PHQ-8 have strong psychometric properties and are routinely used with military populations. Furthermore, overall treatment response in OASIS was modest; residual symptoms will be less prevalent, and therefore potentially even more informative, in residential samples that show a stronger response to treatment.…”

“…In particular, symptoms such as hypervigilance, sleep and concentration difficulties, irritability, and exaggerated startle response frequently persist following evidence-based PTSD treatment. Although the prevalence of residual symptoms following PTSD treatment is well established, most studies to date have focused on outpatient samples, with the exception of one study that evaluated residual symptoms among veterans who received CPT as part of an intensive treatment program (Kovacevic et al, 2023).…”

Peripheral inflammation over the course of a cognitive behavioral intervention in PTSD

“…It has been suggested that this may lead to an impaired feedback regulation in the immune activation in the long run and contribute to stress-related pathology ( Raison and Miller, 2003 ). Interestingly, a number of prior studies have found that after successful treatment, residual symptoms in the hyperarousal cluster of PTSD, for example insomnia, were the most common remaining PTSD symptoms after treatment ( Kovacevic et al, 2022 ; Schnurr and Lunney, 2019 ). As PTSD patients are often predisposed to overreact to subsequent stressors, thereby making them more vulnerable to events ( Kendall-Tackett, 2000 ), it may be important to test the hypothesis of whether these residual symptoms, which frequently remain after successful therapy, are associated with increases in the inflammatory system or with changes in the sympathetic nervous system or HPA axis.…”