Department of Psychology, Ludwig Maximilians University Munich.
Institute of Psychology, Westfalische Wilhelms University Munster.
J Consult Clin Psychol. 2023 Jul;91(7):438-444. doi: 10.1037/ccp0000817. Epub 2023 May 8.
In recent years, it has been suggested that the modification of dysfunctional posttraumatic cognitions plays a central role as a mechanism of change in cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). Indeed, several studies have shown that changes in dysfunctional posttraumatic cognitions precede and predict symptom change. However, these studies have investigated the influence on symptom severity-despite the well-known multidimensionality of PTSD. The present study therefore aimed to explore differential associations between change in dysfunctional conditions and change in PTSD symptom clusters.
As part of a naturalistic effectiveness study evaluating trauma-focused cognitive behavioral therapy for PTSD in routine clinical care, 61 patients with PTSD filled out measures of dysfunctional posttraumatic cognitions and PTSD symptom severity every five sessions during the course of treatment. Lagged associations between dysfunctional cognitions and symptom severity at the following timepoint were examined using linear mixed models.
Over the course of therapy, both dysfunctional cognitions and PTSD symptoms decreased. Posttraumatic cognitions predicted subsequent total PTSD symptom severity, although this effect was at least partly explained by the time factor. Moreover, dysfunctional cognitions predicted three out of four symptom clusters as expected. However, these effects were no longer statistically significant when the general effect for time was controlled for.
The present study provides preliminary evidence that dysfunctional posttraumatic cognitions predict PTSD symptom clusters differentially. However, different findings when employing a traditional versus a more rigorous statistical approach make interpretation of findings difficult. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
近年来，有人提出，改变创伤后功能失调的认知在认知行为疗法（CBT）治疗创伤后应激障碍（PTSD）中作为一种变化机制起着核心作用。事实上，多项研究表明，创伤后功能失调认知的改变先于并预测症状的变化。然而，这些研究调查了对症状严重程度的影响——尽管 PTSD 是众所周知的多维性。因此，本研究旨在探索功能失调条件的变化与 PTSD 症状群变化之间的差异关联。
作为评估创伤聚焦认知行为疗法治疗 PTSD 在常规临床护理中的自然有效性研究的一部分，61 名 PTSD 患者在治疗过程中每五次就诊时填写创伤后功能失调认知和 PTSD 症状严重程度的量表。使用线性混合模型检查下一个时间点的功能失调认知和症状严重程度之间的滞后关联。
在治疗过程中，创伤后认知和 PTSD 症状均有所下降。创伤后认知预测了随后的 PTSD 总症状严重程度，尽管这种影响至少部分是由时间因素解释的。此外，功能失调认知预测了四个症状群中的三个，这是符合预期的。然而，当控制时间的一般效应时，这些效应不再具有统计学意义。
本研究初步提供了证据表明，创伤后功能失调认知可以预测 PTSD 症状群的差异。然而，传统方法和更严格的统计方法得出的不同发现使得解释结果变得困难。
