Durham Veterans Affairs Medical Center and Duke University Medical Center.
University of Texas at San Antonio and University of Texas Health Science Center at San Antonio.
Behav Ther. 2020 May;51(3):386-400. doi: 10.1016/j.beth.2019.06.008. Epub 2019 Jun 28.
Both negative posttraumatic cognitions and posttraumatic stress disorder (PTSD) symptoms decrease over the course of cognitive-behavior therapy for PTSD; however, further research is needed to determine whether cognitive change precedes and predicts symptom change. The present study examined whether weekly changes in blame predicted subsequent changes in PTSD symptoms over the course of cognitive processing therapy (CPT). Participants consisted of 321 active duty U.S. Army soldiers with PTSD who received CPT in one of two clinical trials. Symptoms of PTSD and blame were assessed at baseline and weekly throughout treatment. Bivariate latent difference score modeling was used to examine temporal sequential dependencies between the constructs. Results indicated that changes in self-blame and PTSD symptoms were dynamically linked: When examining cross-construct predictors, changes in PTSD symptoms were predicted by prior changes in self-blame, but changes in self-blame were also predicted by both prior levels of and prior changes in PTSD. Changes in other-blame were predicted by prior levels of PTSD, but changes in other-blame did not predict changes in PTSD symptoms. Findings highlight the dynamic relationship between self-blame and PTSD symptoms during treatment in this active military sample.
创伤后负性认知和创伤后应激障碍（PTSD）症状都会随着 PTSD 的认知行为治疗而逐渐减轻；然而，仍需要进一步的研究来确定认知变化是否先于症状变化并预测症状变化。本研究探讨了在认知加工治疗（CPT）过程中，每周的自责变化是否可以预测 PTSD 症状的后续变化。参与者包括 321 名接受 CPT 的现役美国陆军 PTSD 士兵，他们参加了两项临床试验中的一项。在基线和治疗期间的每周都会评估 PTSD 症状和自责。采用双变量潜变量差分数模型来检验两个结构之间的时间顺序依赖关系。结果表明，自责和 PTSD 症状的变化是动态关联的：在考察跨结构预测因子时，PTSD 症状的变化由先前的自责变化所预测，而自责的变化也同时由先前的 PTSD 水平和 PTSD 的先前变化所预测。他人责备的变化由先前的 PTSD 水平所预测，但他人责备的变化并不预测 PTSD 症状的变化。研究结果突出了在这个现役军人样本中，治疗过程中自责和 PTSD 症状之间的动态关系。
