Held Philip, Szoke Daniel R, Pridgen Sarah A, Smith Dale L
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):741-748. doi: 10.1002/jts.23155. Epub 2025 May 7.
Cognitive processing therapy (CPT) targets maladaptive beliefs called "stuck points," which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person-specific individualized stuck points (ISPs) were associated with reductions in self-reported and clinician-rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults (N = 57) with PTSD received 1-week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1- and 3-month follow-ups. Linear mixed-effects models examined associations between ISP changes and self-reported (PTSD Checklist for DSM-5 [PCL-5]) and clinician-rated PTSD (Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1-month follow-up, M = 29.4, d = 2.02; M = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1-month follow-up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL-5 scores, p = .021, R = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, ps = .352-.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI-assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.
认知加工疗法（CPT）针对被称为“症结”的适应不良信念，这些信念通常使用标准化测量方法进行评估（例如，创伤后认知量表[PTCI]）。本研究探讨了个体特异性的个性化症结（ISP）的变化是否与自我报告和临床医生评定的创伤后应激障碍（PTSD）症状的减轻相关，以及ISP是否能在使用PTCI测量的一般症结（GSP）之外预测PTSD的严重程度。患有PTSD的成年人（N = 57）通过两项随机对照试验之一接受了为期1周的密集虚拟CPT。对ISP进行跟踪，并在每隔一次治疗后以及1个月和3个月随访时对ISP信念强度进行评级。线性混合效应模型研究了ISP变化与自我报告的（DSM-5创伤后应激障碍检查表[PCL-5]）和临床医生评定的PTSD（DSM-5临床医生管理的创伤后应激障碍量表[CAPS-5]）症状减轻之间的关联，并对基线抑郁、性别、年龄和治疗条件进行了调整。从基线到1个月随访，参与者的PTSD症状大幅减轻，M = 29.4，d = 2.02；M = 10.49，d = 0.72。在治疗期间和长达1个月的随访中，平均ISP信念强度下降了50.2%，d = 2.75。更多数量的ISP也预测PCL-5得分降低，p = 0.021，R = 0.02。然而，在控制PTCI得分后，ISP不再能显著预测PTSD症状变化，ps = 0.352 - 0.534，而PTCI得分仍然是显著的预测因素，p < 0.001。ISP的减少与PTSD症状改善相关，但不能在PTCI评估的GSP之外预测结果。跟踪ISP对于调整治疗方案和提高患者参与度可能仍然有价值。
