Szoke Daniel, Ptak Michelle, Pridgen Sarah, Smith Dale L, Held Philip
Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA.
Department of Psychiatry, University of Illinois-Chicago, Chicago, Illinois, USA.
J Trauma Stress. 2025 Aug;38(4):749-756. doi: 10.1002/jts.23158. Epub 2025 Apr 8.
Clinicians have expressed concerns that symptoms may worsen during evidence-based treatments for posttraumatic stress disorder (PTSD), such as cognitive processing therapy (CPT). The current study examined rates of symptom exacerbation in two samples undergoing massed CPT: veterans (N = 499) and community members (N = 69). The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was administered throughout treatment in both samples, and exacerbation was calculated based on changes from one assessment point to the next during treatment. Clinically reliable exacerbation, defined as a PCL-5 score increase greater than 8.83 points in consecutive measurements taken throughout treatment, was observed at least once in 27.3% of veterans and 21.7% of community members during treatment. Only 1.4% of veterans and 5.8% of community members reported reliably elevated symptoms from baseline at the end of treatment. The findings suggest low rates of clinically meaningful exacerbation during massed CPT, highlighting its utility across diverse populations and treatment formats. These results can inform clinician-patient discussions, alleviate concerns about worsening symptoms, and assuage clinician concerns about symptom exacerbation during CPT.
临床医生担心，在创伤后应激障碍（PTSD）的循证治疗过程中，症状可能会恶化，比如认知加工疗法（CPT）。本研究调查了接受集中式CPT治疗的两个样本中的症状恶化率：退伍军人（N = 499）和社区成员（N = 69）。两个样本在整个治疗过程中均使用《精神疾病诊断与统计手册》第5版创伤后应激障碍检查表（PCL-5），并根据治疗期间从一个评估点到下一个评估点的变化计算恶化情况。在治疗期间，27.3%的退伍军人和21.7%的社区成员至少有一次出现临床可靠的恶化，即整个治疗过程中连续测量的PCL-5分数增加超过8.83分。在治疗结束时，只有1.4%的退伍军人和5.8%的社区成员报告症状从基线水平可靠地升高。研究结果表明，在集中式CPT治疗期间，具有临床意义的恶化率较低，这凸显了其在不同人群和治疗形式中的效用。这些结果可为临床医生与患者的讨论提供参考，减轻对症状恶化的担忧，并缓解临床医生对CPT治疗期间症状恶化的担忧。
