Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
Department of Psychiatry, Rush University Medical Center, 325 S. Paulina St., 2nd Floor, Chicago, IL, 60612, USA.
BMC Psychiatry. 2022 Nov 4;22(1):683. doi: 10.1186/s12888-022-04296-1.
A wealth of evidence has illustrated that reductions in negative posttrauma cognitions (NPCs) predict improvement in posttraumatic stress disorder (PTSD) symptoms during treatment. Yet, the specific temporal arrangement of changes in these constructs is less well understood. This study examined the temporal association between NPC changes and PTSD symptom changes in two distinct intensive PTSD treatment samples.
Data from 502 veterans who completed a 3-week CPT-based intensive PTSD treatment program was used to test the extent to which lagged NPC measurement predicted the next occurring PTSD severity measurement using linear mixed effects regression models. PTSD severity was assessed every other day during treatment. NPCs were assessed at three treatment timepoints. A second sample of 229 veterans who completed a 2-week CPT-based intensive PTSD treatment program was used to replicate these findings.
Across both intensive PTSD treatment programs, NPCs generally increased from intake the end of the first treatment week, which was followed by gradual decreases in NPCs throughout the rest of both programs. Change in NPCs during both the 3-week (b = .21, p < .001, R = .38) and the 2-week programs (b = 0.20, p < .001, R = .24) were significant predictors of change in PTSD symptom severity. However, the reverse was true as well, with change in PTSD severity predicting latter change in NPCs during both the 3-week (b = 1.51, p < .001, R = .37) and 2-week (b = 1.37, p < .001, R = .33) programs, further raising questions about temporality of the association between NPCs and PTSD symptom severity during treatment.
The present study demonstrated that changes in NPCs may not temporally precede changes in PTSD symptom severity in PTSD treatment samples. Instead, we observed earlier PTSD symptom changes and a bidirectional association between the two constructs across both samples. Clinically, the study supports the continued focus on NPCs as an important treatment target as they are an important indicator of successful PTSD treatment, even if they may not be a direct mechanism of treatment-based changes in PTSD severity. Future research should attempt to identify alternative mechanisms of change in CPT.
大量证据表明，减少消极创伤后认知（NPC）可预测创伤后应激障碍（PTSD）症状在治疗过程中的改善。然而，这些结构变化的具体时间安排还不太清楚。本研究在两个不同的密集型 PTSD 治疗样本中，考察了 NPC 变化与 PTSD 症状变化之间的时间关联。
使用完成为期 3 周的基于 CPT 的密集型 PTSD 治疗计划的 502 名退伍军人的数据，通过线性混合效应回归模型，检验 NPC 滞后测量对下一次 PTSD 严重程度测量的预测程度。在治疗期间，每隔一天评估 PTSD 严重程度。在三个治疗时间点评估 NPC。第二项研究使用完成为期 2 周的基于 CPT 的密集型 PTSD 治疗计划的 229 名退伍军人的样本来复制这些发现。
在两个密集型 PTSD 治疗计划中，NPC 通常从摄入开始到第一治疗周结束时增加，随后在两个计划的其余时间里逐渐减少。在 3 周（b = 0.21，p < 0.001，R = 0.38）和 2 周（b = 0.20，p < 0.001，R = 0.24）计划中，NPC 变化是 PTSD 症状严重程度变化的显著预测因子。然而，情况正好相反，在 3 周（b = 1.51，p < 0.001，R = 0.37）和 2 周（b = 1.37，p < 0.001，R = 0.33）计划中，PTSD 严重程度的变化预测了 NPC 后期的变化，这进一步引发了治疗过程中 NPC 和 PTSD 症状严重程度之间关联的时间性问题。
本研究表明，在 PTSD 治疗样本中，NPC 的变化可能不会先于 PTSD 症状严重程度的变化。相反，我们观察到两个样本中，PTSD 症状的早期变化和两个结构之间的双向关联。临床上，该研究支持继续将 NPC 作为一个重要的治疗目标，因为它们是 PTSD 治疗成功的重要指标，即使它们可能不是 PTSD 严重程度基于治疗的变化的直接机制。未来的研究应该尝试确定 CPT 中变化的替代机制。
