Change in posttraumatic stress disorder symptoms: Do clinicians and patients agree?

Abstract

This study assessed the longitudinal association between clinician and patient ratings of posttraumatic stress disorder (PTSD) symptoms over the course of 2 different randomized clinical trials of veterans with chronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N = 360) compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitive processing theory and a waitlist control condition (N = 60). Linear mixed effects modeling revealed significant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D. Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers, B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD. Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviations for every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated in the trauma-focused vs. present-centered treatment condition in CSP 420, and especially regarding hyperarousal symptoms. When comparing categorization of clinically significant change on the CAPS and PCL, the authors found no differences in the percentages of agreement between clinicians and patients in improvement and exacerbation. The value of multimodal assessment of PTSD treatment outcomes is discussed.

Treatment of OSA with CPAP Is Associated with Improvement in PTSD Symptoms among Veterans

“…19 The mean change observed reached statistical significance for the PCL-S survey instrument (decrease of at least 5 points), but was less than the threshold often cited for clinical significance (decrease of at least 10 points). 20 Nonetheless, PAP therapy is a therapy with few downsides, and thus the benefit observed in this study is encouraging.…”

Significant Improvements in Cognitive Performance Post-Transcranial, Red/Near-Infrared Light-Emitting Diode Treatments in Chronic, Mild Traumatic Brain Injury: Open-Protocol Study

“…Results showed a significant linear trend for the effect of LED treatment over time for the following NP tests: inhibition (Stroop test for Using PTSD criteria established by Monson,56,57 only four participants initially reported symptoms suggestive of PTSD (scores ‡ 36/85; for specialized medical clinics, such as TBI or pain). All four cases showed a clinically meaningful decrease or a reliable decrease post-LED (Supplementary Table 7)(see online supplementary material at http://www.liebertonline.com).…”

“…Four participants entered the study with PCL-C scores suggestive of PTSD (scores ‡ 36/85; for specialized medical clinics, such as TBI or pain). 56,57 Using criteria established by Monson, 56,57 a clinically meaningful decrease in PTSD severity is defined as a change of 10-20 points, and a reliable decrease is defined as a change of 5-10 points. All four participants who initially reported symptoms suggestive of PTSD showed a clinically meaningful decrease or a reliable decrease post-LED, however, data were available for only three of these participants at 2 months post-LED (Supplementary Tables 7 and 8).…”

The Air Force Deployment Transition Center: Assessment of Program Structure, Process, and Outcomes

“…Moreover, the size of this effect, even among those with high combat exposure, was small. For example, soldiers who received the Battlemind debriefing scored three points lower on the PTSD Checklist (Weathers et al, 1993), a drop that is not considered to be a clinically significant change (Monson et al, 2008;National Center for PTSD, 2012).…”

“…For example, at follow-up, soldiers in the Battlemind debriefing scored three points lower on the PTSD Checklist (Weathers et al, 1993) than soldiers in the standard stress reduction group. A threepoint drop on in this scale score is not considered a clinically significant change (Monson et al, 2008;National Center for PTSD, 2012). In addition, it is not clear whether DTC participants have high levels of combat exposure as defined in the 2009 Adler and colleagues evaluation.…”