Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA.
Department of Psychology, National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA.
J Affect Disord. 2021 Mar 1;282:561-573. doi: 10.1016/j.jad.2020.12.067. Epub 2020 Dec 24.
Patients with PTSD often voice concern over their perceived change in cognitive functioning. However, these negative appraisals do not always align with objective neuropsychological performance, yet are strongly predictive of PTSD symptom severity and self-reported functional impairment.
The present study involves a secondary analysis examining the role of appraisals of a subsample of 81 adults with full or subthreshold PTSD on treatment outcomes in a randomized controlled trial investigating the effectiveness of a cognitive rehabilitation treatment, Strategic Memory and Reasoning Training (n = 38), compared to a psychoeducation control arm, the Brain Health Workshop (n = 43). Neither condition addressed PTSD symptoms, focusing instead on cognitive skills training and psychoeducation about the brain.
Intent-to-treat models showed statistically significant improvements for both groups on composite scores of executive functioning and memory. Additionally, both groups experienced clinically significant reductions in PTSD symptoms (assessed via the Clinician-Administered PTSD Interview) and the SMART group showed fewer negative appraisals about cognitive functioning following training. Change in appraisals of cognitive functioning was associated with change in PTSD as well as change in quality of life, with no differential associations based on group status. In contrast, neurocognitive test score changes were not associated with change in symptoms or functional outcomes.
We did not collect data on other appraisals (e.g., self-efficacy), which could have further elucidated pathways of change.
Our findings suggest that interventions that do not directly target PTSD symptoms can lead to PTSD symptom change via change in appraisals of functioning.
创伤后应激障碍（PTSD）患者常常对自身认知功能的变化表示担忧。然而，这些负面评估并不总是与客观神经心理学表现一致，但与 PTSD 症状严重程度和自我报告的功能障碍高度相关。
本研究涉及对一项随机对照试验中一个亚组患者的评估的二次分析，该研究旨在调查认知康复治疗（策略性记忆和推理训练，SMART）对治疗效果的影响，与心理教育对照组（大脑健康工作坊，BHW）相比，该亚组包括 81 名 PTSD 患者（完全或亚临床 PTSD）。两种治疗方案都没有针对 PTSD 症状，而是侧重于认知技能训练和关于大脑的心理教育。
意向治疗模型显示，两组在执行功能和记忆的综合评分上均有统计学意义的改善。此外，两组 PTSD 症状（通过临床医生管理的 PTSD 量表评估）均显著减轻，SMART 组在训练后对认知功能的负面评估也有所减少。认知功能评估的变化与 PTSD 变化以及生活质量变化相关，而与组间状态无关。相比之下，神经认知测试评分的变化与症状或功能结果的变化无关。
我们没有收集其他评估（例如自我效能）的数据，这些数据可能进一步阐明了变化的途径。
我们的研究结果表明，即使干预方案不直接针对 PTSD 症状，也可以通过改变对功能的评估来导致 PTSD 症状的改变。
