Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder

Abstract

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n=145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to drop out of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.

A Randomized Controlled Clinical Trial of Dialogical Exposure Therapy versus Cognitive Processing Therapy for Adult Outpatients Suffering from PTSD after Type I Trauma in Adulthood

“…This ties in with earlier results: in a study comparing CPT to prolonged exposure, younger patients profited more from CPT than older ones while the reverse was true for prolonged exposure [56]. In a different set of analyses with our sample, we also found that the efficacy of DET was less dependent on patient characteristics: while pre-post differences in CPT were correlated with patient interpersonal dominance, this was not true for DET [57].…”

Predictors of dropout in concurrent treatment of posttraumatic stress disorder and alcohol dependence: Rate of improvement matters

“…Female gender was associated with dropout in one study (e.g., Eftekhari, Ruzek, Crowley, Rosen, Greenbaum, & Karlin, 2013) and unrelated to dropout in other studies (e.g., Hagenaars, van Minnen & Hoogduin, 2010). Younger age has predicted dropout in some studies (e.g., Rizvi, Vogt, & Resick, 2009) but not others (e.g., van Minnen, Arntz, & Keijsers, 2002). Inconsistent findings have been reported for employment status (e.g., Foa et al, 1999; but see Taylor et al, 2003), education (e.g., Rizvi, Vogt, & Resick, 2009; but see Hagenaars, van Minnen, & Hoogduin, 2010), depressive symptoms (e.g., Garcia, Kelley, Rentz, & Lee, 2011; but see Hagenaars, van Minnen, & Hoogduin, 2010), experience of childhood abuse (e.g., van Minnen, Arntz, & Keijsers, 2002; but see Zayfert et al, 2005), and greater PTSD severity (e.g., Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; but see Eftekhari et al, 2013).…”

“…Younger age has predicted dropout in some studies (e.g., Rizvi, Vogt, & Resick, 2009) but not others (e.g., van Minnen, Arntz, & Keijsers, 2002). Inconsistent findings have been reported for employment status (e.g., Foa et al, 1999; but see Taylor et al, 2003), education (e.g., Rizvi, Vogt, & Resick, 2009; but see Hagenaars, van Minnen, & Hoogduin, 2010), depressive symptoms (e.g., Garcia, Kelley, Rentz, & Lee, 2011; but see Hagenaars, van Minnen, & Hoogduin, 2010), experience of childhood abuse (e.g., van Minnen, Arntz, & Keijsers, 2002; but see Zayfert et al, 2005), and greater PTSD severity (e.g., Marks, Lovell, Noshirvani, Livanou, & Thrasher, 1998; but see Eftekhari et al, 2013). An exception to these mixed findings is that comorbid SUDs have been predictive of dropout from PTSD treatment with some consistency (e.g., Najavits, 2015; Szafranski, Gros, Menefee, Wanner, & Norton, 2014; van Minnen et al, 2002).…”

Integrated, exposure-based treatment for PTSD and comorbid substance use disorders: Predictors of treatment dropout

“…Studies examining dropout from PTSD treatment show that demographic and clinical predictors of dropout include younger age (Gros, Yoder, Tuerk, Lozano, & Acierno, 2011), male gender (van Minnen Arntz, & Keijsers, 2002), African American race (Lester, Artz, Resick, & Young-Xu, 2010), lower levels of education (Rizvi et al, 2009), higher military rank (Szafranski et al, 2016), greater concurrent drug use (Szafranski, Gros, Menefee, Wanner, & Norton, 2014), lower income (Galovski, Blain, Mott, Elwood, & Houle, 2012), greater disability status and lower social support (Gros, Price, Yuen, & Acierno, 2013), and higher pretreatment symptom severity (Garcia, Kelley, Rentz, & Lee, 2011). Similarly, studies examining dropout from SUD treatment include younger age, lower income, being unemployed (Mertens & Weisner, 2000), African American race (Milligan, Nich, & Carroll, 2004), lower education level (Mammo & Weinbaum, 1993), female gender (Arfken, Klein, di Menza, & Schuster, 2001) and more frequent drug use (McKellar et al, 2006).…”