Changes in trauma-related cognitions predict subsequent symptom improvement during prolonged exposure in patients with childhood abuse-related PTSD

Marike J Kooistra; Chris M Hoeboer; Danielle A C Oprel; Maartje Schoorl; Willem van der Does; Jackie June Ter Heide; Agnes van Minnen; Rianne A de Kleine

doi:10.1016/j.brat.2023.104284

Changes in trauma-related cognitions predict subsequent symptom improvement during prolonged exposure in patients with childhood abuse-related PTSD

Behav Res Ther. 2023 Apr:163:104284. doi: 10.1016/j.brat.2023.104284. Epub 2023 Feb 24.

Authors

Marike J Kooistra¹, Chris M Hoeboer², Danielle A C Oprel³, Maartje Schoorl⁴, Willem van der Does⁵, Jackie June Ter Heide⁶, Agnes van Minnen⁷, Rianne A de Kleine⁸

Affiliations

¹ Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: [email protected].
² Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands. Electronic address: [email protected].
³ Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: [email protected].
⁴ Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Leiden University Treatment Center (LUBEC), Leiden, the Netherlands. Electronic address: [email protected].
⁵ Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands; Leiden University Treatment Center (LUBEC), Leiden, the Netherlands. Electronic address: [email protected].
⁶ ARQ Centrum'45, Nienoord 5, 1112 XE, Diemen, Oegstgeest, the Netherlands. Electronic address: [email protected].
⁷ PSYTREC, Bronkhorststraat 2, 3723 MB, Bilthoven, the Netherlands; Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands. Electronic address: [email protected].
⁸ Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: [email protected].

PMID: 36870242
DOI: 10.1016/j.brat.2023.104284

Abstract

Change in negative posttraumatic cognitions is a proposed mechanism through which Prolonged Exposure (PE) leads to symptom reduction of posttraumatic stress disorder (PTSD). A strong case for posttraumatic cognitions as a change mechanism in PTSD treatment can be made by establishing temporal precedence of change in cognitions. The current study examines the temporal relationship between change in posttraumatic cognitions and PTSD symptoms during PE, using the Posttraumatic Cognitions Inventory. Patients with DSM-5 defined PTSD following childhood abuse (N = 83) received a maximum of 14-16 sessions of PE. Clinician-rated PTSD symptom severity and posttraumatic cognitions were assessed at baseline, week 4, 8, and 16 (post-treatment). Using time-lagged mixed effect regression models, we found that posttraumatic cognitions predicted subsequent PTSD symptom improvement. Notably, when using the items of an abbreviated version of the PTCI (PTCI-9), we found a mutual relationship between posttraumatic cognitions and PTSD symptom improvement. Crucially, the effect of change in cognitions on PTSD symptom change was greater than the reverse effect. The current findings corroborate change in posttraumatic cognitions as a change process during PE, but cognitions and symptoms cannot be completely separated. The PTCI-9 is a short instrument that appears suitable to track cognitive change over time.

Keywords: Mechanisms of change; Posttraumatic cognitions; Posttraumatic stress disorder; Prolonged exposure therapy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Cognition
Diagnostic and Statistical Manual of Mental Disorders
Humans
Implosive Therapy*
Stress Disorders, Post-Traumatic* / psychology
Treatment Outcome