Temporal Sequencing of Change in Posttraumatic Cognitions and PTSD Symptom Reduction During Prolonged Exposure Therapy

Kumpula, Mandy J.; Pentel, Kimberly Z.; Foa, Edna B.; LeBlanc, Nicole J.; Bui, Éric; McSweeney, Lauren B.; Knowles, Kelly A.; Bosley, Hannah G.; Simon, Naomi M.; Rauch, Sheila A. M.

doi:10.1016/j.beth.2016.02.008

Cited by 81 publications

(80 citation statements)

References 44 publications

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“…As such, our findings do not speak to potential differences by subscales or symptom clusters, as highlighted by a recent study showing stronger effects for self-relevant trauma beliefs on PTSD gains (Kumpula et al, 2016). However, testing all possible combinations of PTCI subscales and PSS-SR clusters across our four main models would greatly raise the risk of a Type I error.…”

Section: Discussioncontrasting

confidence: 71%

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Cooper¹,

Zoellner²,

Roy‐Byrne³

et al. 2017

Journal of Consulting and Clinical Psychology

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Objective Negative trauma-related belief change has been found to predict subsequent improvement in symptoms of posttraumatic stress disorder (PTSD) in prolonged exposure (PE) and other therapies, consistent with several psychological theories of treatment change (e.g., Foa & Kozak, 1986). However, belief change has not been examined in selective serotonin reuptake inhibitors such as sertraline. We examined processes associated with symptom improvement in two treatments for PTSD, hypothesizing that belief change would robustly predict PTSD improvement in patients treated with PE but not those treated with sertraline, reflecting moderation by treatment. Method Patients with chronic PTSD (N = 134; 78% female, 71.6% Caucasian, M = 38.1 years, SD = 11.8) received 10 weeks of PE or sertraline in a randomized controlled trial. Patients reported PTSD and depression symptoms, and trauma-related beliefs (Post-Traumatic Cognitions Inventory; Foa et al., 1999) at pre-treatment, every treatment session, and post-treatment. Results Using time-lagged mixed regression models, change in trauma-related beliefs predicted subsequent PTSD symptom improvement, an effect moderated by treatment and particularly strong in PE (d = 0.93) compared to sertraline (d = 0.35). Belief change also predicted depressive symptom improvement but more modestly and bi-directionally, with no difference by treatment modality. Conclusions Trauma-related belief change precedes PTSD improvement more robustly in PE than sertraline and with greater specificity compared to depressive symptoms. These findings highlight potentially divergent processes contributing to symptom change in these PTSD treatments, with belief change as a key mechanism of PE.

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Section: Discussioncontrasting

confidence: 71%

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Cooper¹,

Zoellner²,

Roy‐Byrne³

et al. 2017

Journal of Consulting and Clinical Psychology

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“…All five studies found evidence that belief change significantly predicted subsequent PTSD symptom improvement in PE treatments. Three studies also convincingly demonstrated a unidirectional relationship, with belief change preceding symptom change more robustly than the reverse relationship (Cooper et al, in press; Øktedalen et al, 2015; Zalta et al, 2014), with the remaining studies suggesting a more equivocal relationship (Kumpula et al, 2016; McLean et al, 2015). Several of these studies also included important comparisons between PE and other treatments in terms of this relationship.…”

Section: Psychological Mediators and Mechanisms Of Exposure Therapy Fmentioning

confidence: 89%

“…Another study also showed that PTCI change was uncorrelated with between-session habituation ( r =.01) and both were trend level predictors of PTSD symptom improvement, which the authors interpreted as evidence that cognitive change and between-session habituation might be separate processes or indicators of improvement (Nacasch et al, 2015). Five recent studies have examined the temporal relation between belief change and PTSD symptom change in exposure therapies for adults with PTSD (Cooper, Zoellner, Roy-Byrne, Mavissakalian & Feeny, in press; Kumpula et al, 2016; McLean, Su & Foa, 2015; Øktedalen, Hoffart & Formo-Langkaas, 2015; Zalta et al, 2014). These studies used various robust statistical methods (e.g., lagged mixed effects regression) to estimate the magnitude of association between belief change and PTSD improvement while accounting for missing data, controlling for the influence of prior symptom levels, and testing temporal sequence (i.e., is belief change a predictor or product of symptom change?).…”

Section: Psychological Mediators and Mechanisms Of Exposure Therapy Fmentioning

confidence: 99%

An empirical review of potential mediators and mechanisms of prolonged exposure therapy

Cooper

Clifton

Feeny

2017

Clinical Psychology Review

114

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Prolonged exposure (PE) is an empirically-supported treatment for posttraumatic stress disorder (PTSD), but the precise mechanism(s) by which PE promotes symptom change are not well established. Understanding how PE works is critical to improving clinical outcomes, advancing dissemination efforts, and enhancing transdiagnostic models of psychopathology. However, mechanisms research conducted in clinical treatment settings is complex, and findings may be difficult to interpret without appropriate context. This is the first review of potential mechanisms of PE to provide such context, by rigorously evaluating empirical findings in line with essential criteria for effective research on mechanisms (or mediators). We begin by describing six putative mechanisms identified by emotional processing theory and contemporary models of fear extinction, before thoroughly reviewing empirical findings from clinical research on PE and similar PTSD treatments. We provide a detailed description of each study and mechanism test, as well as ratings of strength of evidence and quality of evaluation based on a novel rating scheme. We highlight variables with strong evidence (belief change and between-session habituation), intermediate evidence (inhibitory learning and emotional engagement), and minimal support (narrative organization and within-session habituation). After discussing limitations of the extant literature and this review, we summarize specific challenges for research on PE mechanisms and highlight directions for future study based on clinical and research implications.

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“…The researchers assessed PTSD symptoms related to both HIV-and non-HIV-related traumas and found that PE was superior to waitlist for both. PE was also associated with better end-state functioning (i.e., minimal PTSD and depression symptoms) and greater reductions in negative trauma-related cognitions at posttreatment, which are theorized to maintain PTSD symptoms [40, 41] and have been found to mediate changes in PTSD in several studies [42–45]. …”

Section: Resultsmentioning

confidence: 99%

Treating Posttraumatic Stress Symptoms Among People Living with HIV: a Critical Review of Intervention Trials

McLean

Fitzgerald

2016

Curr Psychiatry Rep

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The prevalence rate of posttraumatic stress disorder (PTSD) among people living with HIV (PLWH) is significantly higher than the rate among the general population. Moreover, PTS symptoms have been linked with numerous negative health-related outcomes in PLWH. While these findings suggest that studies evaluating the efficacy of treatments for PTS symptoms among PLWH are sorely needed, according to prior reviews, such studies are lacking. The purpose of the present systematic review was to provide an updated critical evaluation of treatment studies that targeted PTS among PLWH. Following PRIMSA guidelines, we searched PubMed and PsycINFO and identified eight articles (representing seven studies) evaluating the impact of various individual and group treatments on PTS symptoms. The limited evidence base to date precludes clinical recommendations for this population. Future studies should examine the efficacy of existing evidence-based treatments for PTSD among PLWH and then, if necessary, evaluate the impact of any treatment modifications for this population.

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Temporal Sequencing of Change in Posttraumatic Cognitions and PTSD Symptom Reduction During Prolonged Exposure Therapy

Cited by 81 publications

References 44 publications

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

Do changes in trauma-related beliefs predict PTSD symptom improvement in prolonged exposure and sertraline?

An empirical review of potential mediators and mechanisms of prolonged exposure therapy

Treating Posttraumatic Stress Symptoms Among People Living with HIV: a Critical Review of Intervention Trials

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