Temporal Stability of Cognitive Functioning and Functional Capacity in Women with Posttraumatic Stress Disorder

Gould, Felicia; Dunlop, Boadie W.; Rosenthal, Jennifer B.; Iosifescu, Dan V.; Mathew, Sanjay J.; Neylan, Thomas C.; Rothbaum, Barbara O.; Nemeroff, Charles B.; Harvey, Philip D.

doi:10.1093/arclin/acy064

Cited by 6 publications

(4 citation statements)

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“…Some results are consistent with prior literature. PTSD is associated with impaired cognitive functioning (12,63,64) and that the association is stable over time (11,39), with the former predicting the latter in the present study. Our results are also in line with prior findings that the symptom domain of 'avoidance' is not (strongly) associated with reduced cognitive functioning (14,22,23,25).…”

Section: Discussionsupporting

confidence: 55%

“…Moreover, the majority of previous (nonnetwork) studies have used cross-sectional designs to examine this association (12). Although existing cohort studies indicate longitudinal associations between the two constructs (11,39), little is known whether PTSD-related cognitive impairment is stable over time. Clarifying the associations of PTSD symptom domains and specific symptoms with cognitive functioning, and their temporal relations, may facilitate future work to identify individuals with PTSD who may be at risk of cognitive decline and guide individualized treatment planning (25,38).…”

Section: Introductionmentioning

confidence: 99%

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Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Günak¹,

Ebrahimi²,

Pietrzak³

et al. 2022

Preprint

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Several studies have identified relationships between cognitive functioning and posttraumatic stress disorder (PTSD). Here, we aimed to elucidate the nature of this relationship by investigating cross-sectional associations between subjective cognitive functioning (SCF) and 1) the PTSD sum score, 2) symptom domains, and 3) individual symptoms. We also investigated temporal stability by testing whether results replicated over a 3-year period. We estimated partial correlation networks of DSM-5 PTSD symptoms (at baseline) and SCF (at baseline and follow-up, respectively), using data from the National Health and Resilience in Veterans Study (NHRVS; N = 1,484; Mdn = 65 years). The PTSD sum score was negatively associated with SCF. SCF was consistently negatively associated with the PTSD symptom domains ‘marked alterations in arousal and reactivity’ and ‘negative alterations in cognitions and mood’, and showed robust relations with the symptoms ‘having difficulty concentrating’ and ‘trouble experiencing positive feelings’. Results largely replicated at the 3-year follow-up, suggesting that PTSD symptoms may play a causal role in the development or maintenance of SCF. We discuss the importance of examining links between specific PTSD domains and symptoms with SCF—relations obfuscated by focusing on PTSD diagnoses or sum scores—as well as investigating mechanisms underlying these relations.

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Section: Discussionsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Günak¹,

Ebrahimi²,

Pietrzak³

et al. 2022

Preprint

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“…(Modified from: The effects of childhood maltreatment on brain structure, function, and connectivity there is evidence to suggest that the earlier ELS is experienced, the more extensive its impact is on development and psychiatric outcomes. Longitudinal clinical studies have shown that childhood maltreatment occurring prior to the age of 5, as compared to individuals with maltreatment occurring later in life, is related to higher levels of psychopathology, including more internalizing and externalizing behaviors, greater emotional dysregulation, decreased neurocognitive functioning (i.e., inhibitory control, working memory), and increased suicidal ideation (Keiley, Howe, Dodge, Bates, & Petti, 2001;Kaplow & Widom, 2007;Lansford, Miller-Johnson, Berlin, Dodge, Bates, & Pettit, 2007;Kim & Cicchetti, 2010;Cowell, Cicchetti, Rogosch, & Toth, 2015;Gould, Dunlop, Rosenthal, Iosifescu, Mathew, Neylan, et al, 2019). This is in line with developmental psychopathology models that posit that because rapid development across various domains occurs during childhood, the earlier the stress occurs, the greater the likelihood of adverse outcomes in childhood, which then further interferes with development during adolescence (Cicchetti & Toth, 1995).…”

Section: Els Timing Duration and Typementioning

confidence: 99%

Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes

2020

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Early life stress (ELS) has been established as a major risk factor for a multitude of psychiatric and medical disorders. ELS is highly prevalent in the general population and constitutes a major public health concern. The current review will focus on the clinical literature that suggests a link between adverse early life experiences and vulnerability for adolescent and adult substance use disorders. It will investigate the characteristics of ELS that appear to increase risk for disorder onset and a more severe disease course, characterized by earlier onset, greater risk of relapse, and treatment resistance. The authors explore how ELS may increase risk for adverse substance use outcomes through long-lasting changes in the HPA axis and development of stress, reward, and executive control brain systems. The review will also discuss potential pathways to substance use disorder following ELS, with a focus on the role of comorbid mood and anxiety disorders and other modifiable traits. Finally, the authors will discuss how the current body of work presents the potential for prevention and intervention strategies to reduce the psychosocial consequences following early life stress and minimize adverse substance use outcomes.

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“…14 Cognitive dysfunction appears to be stable over time among individuals with PTSD, such that although clinical symptoms fluctuate over time, cognitive and functional impairments demonstrate relative stability. 15 However, one study reported improvements in executive functions following psychotherapy for PTSD in a small sample of 15 individuals. 16 Taken together, these findings indicate that cognitive dysfunction in PTSD may interfere with functional recovery and treatment response, even after controlling for TBI.…”

Section: Introductionmentioning

confidence: 99%

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

et al. 2019

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Background Posttraumatic stress disorder (PTSD) is associated with dysfunction across multiple cognitive domains including executive functioning, attention, and verbal memory. This dysfunction is associated with negative impacts on functional outcomes (e.g., work or social functioning) and reduced response to psychotherapy for PTSD. Despite this knowledge, little work has investigated the efficacy of cognitive remediation strategies in improving cognition and functional outcomes among individuals with PTSD. Objective The current study investigated the efficacy of an established cognitive remediation program, Goal Management Training (GMT), in improving cognitive functioning in a pilot sample of individuals with PTSD symptoms in an inpatient treatment setting. Method Thirty-four inpatients with PTSD symptoms participated in either GMT in addition to treatment as usual (TAU; consisting of psychiatric management, group and individual psychotherapy) (TAU+GMT; n = 18) or TAU alone ( n = 16). The TAU+GMT group received neuropsychological assessment at baseline and posttreatment, while both the TAU+GMT and TAU groups received assessment with clinical self-report measures at baseline and posttreatment. Results Paired-sample t-tests revealed significant improvements on measures of executive functioning (e.g., response inhibition, cognitive flexibility), processing speed, sustained attention, and verbal memory in the TAU+GMT group. Mixed-design analyses of variance (ANOVAs) revealed a trend toward an interaction effect indicating potentially greater improvements on a measure of the ability to engage in goal-directed behaviors while highly emotional in the TAU+GMT group as compared to the TAU group. Discussion The results of this small feasibility investigation of GMT in PTSD point toward the potential efficacy of GMT in ameliorating cognitive difficulties in individuals with PTSD.

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Temporal Stability of Cognitive Functioning and Functional Capacity in Women with Posttraumatic Stress Disorder

Cited by 6 publications

References 50 publications

Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Using network models to explore the associations between posttraumatic stress disorder symptoms and subjective cognitive functioning

Early Life Stress and Substance Use Disorders: Underlying Neurobiology and Pathways to Adverse Outcomes

An Open-Label Feasibility Trial Examining the Effectiveness of a Cognitive Training Program, Goal Management Training, in Individuals With Posttraumatic Stress Disorder

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