Williams M Wright, Hunt Christopher, Graham David P, Estey Matt, Smith Lia, McCurry Katherine, King-Casas Brooks, Chiu Pearl
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
J Clin Psychol. 2025 Nov;81(11):1118-1128. doi: 10.1002/jclp.70020. Epub 2025 Jul 22.
Group cognitive processing therapy (GCPT) is frequently utilized to treat PTSD within the VA healthcare system, but its mechanisms are not well understood. Interpersonal trust could be an important change process in GCPT given its relevance to group-based therapy and its role in CPT, but self-report measures are inadequate for capturing the dynamic interplay that defines interpersonal trust. Here, we examined the degree to which interpersonal could predict and account for PTSD symptom change in GCPT using the iterated trust game (ITG)-a behavioral task used to approximate real-world trust behavior.
Participants were Veterans with PTSD who participated in an effectiveness trial comparing a 12-week course of GCPT (n = 37) to a treatment-as-usual (TAU) waitlist condition (n = 23) of equivalent length. Both groups completed the ITG and measures of PTSD before and after treatment as well as a pencil-paper measure of interpersonal trust before treatment. Participants in GCPT completed measures of PTSD severity, group relationship quality, and therapist relationship quality at each treatment session.
Pre-post changes in ITG-measured trust behavior did not differ between GCPT and TAU (p = 0.075). However, improvements in ITG scores partially accounted for decreased PTSD symptoms in GCPT, as demonstrated by a more modest change in PTSD symptoms when ITG was in, b = -5.95, p = 0.032, versus not in the model, b = -9.05, p = 0.001. Additionally, higher ITG scores, but not self-reported trust, predicted steeper reductions in PTSD symptoms, b = -0.50, p = 0.042, and improvements in group relationship quality, b = 0.28, p = 0.037, across GCPT sessions.
Interpersonal trust improvement may predict and account for symptom change in GCPT. Targeting interpersonal trust during GCPT could render the treatment more effective.
团体认知加工疗法（GCPT）在退伍军人事务部（VA）医疗系统中常用于治疗创伤后应激障碍（PTSD），但其作用机制尚不清楚。鉴于人际信任与团体治疗的相关性及其在认知加工疗法（CPT）中的作用，人际信任可能是GCPT中一个重要的改变过程，但自我报告测量方法不足以捕捉定义人际信任的动态相互作用。在此，我们使用迭代信任博弈（ITG）——一种用于近似现实世界信任行为的行为任务，研究人际信任在多大程度上能够预测和解释GCPT中PTSD症状的变化。
参与者为患有PTSD的退伍军人，他们参与了一项有效性试验，将为期12周的GCPT课程（n = 37）与同等时长的常规治疗（TAU）等待列表对照条件（n = 23）进行比较。两组在治疗前后均完成了ITG和PTSD测量，以及治疗前的人际信任纸笔测量。GCPT组的参与者在每次治疗 session 时完成PTSD严重程度、团体关系质量和治疗师关系质量的测量。
GCPT组和TAU组在ITG测量的信任行为上的前后变化无差异（p = 0.075）。然而，ITG分数的改善部分解释了GCPT中PTSD症状的减轻，当ITG纳入模型时，PTSD症状变化更为适度，b = -5.95，p = 0.032，而未纳入模型时，b = -9.05，p = 0.001。此外，在GCPT各 session 中，较高的ITG分数而非自我报告的信任预测了PTSD症状更显著的减轻，b = -0.50，p = 0.042，以及团体关系质量的改善，b = 0.28，p = 0.037。
人际信任的改善可能预测并解释GCPT中的症状变化。在GCPT中针对人际信任可能会使治疗更有效。
