Predictors of Quality of Life Following Cognitive Processing Therapy Among Women and Men With Post-Traumatic Stress Disorder

Abstract

Introduction The effect of evidence-based post-traumatic stress disorder (PTSD) treatments on quality of life (QOL) is not well understood. In light of mixed findings on QOL after PTSD interventions, little is known about why some individuals experience functional and QOL improvements while others do not. This study examined treatment-related changes in depression, anger, and PTSD following cognitive processing therapy (CPT) as potential predictors of QOL change. Materials and Methods Data from two randomized controlled trials, one examining CPT among female civilians and veterans (women’s study NCT02362477; n = 126) and the other on CPT delivered to male veterans (men’s study NCT00879255; n = 125), were used to test study aims. Linear mixed modeling examined changes in depression, anger, and PTSD as predictors of post-treatment QOL while controlling for baseline QOL. The VA Pacific Island Health Care System’s Institutional Review Board approved all study procedures. Results Among women, reductions in depression from pre- to post-treatment had the strongest predictive value of post-treatment QOL (B = −1.15, 95% confidence interval (−1.71, −0.60), t = −4.07, P < .001). For men, reductions in trait anger from pre- to post-treatment predicted post-treatment QOL (B = −0.55, 95% confidence interval (−0.90, −0.19), t = −3.00, P = .003). Conclusions Improvements in QOL may be predicted by different symptoms for men and women following evidence-based PTSD treatment. Our findings suggest that change in depression symptoms is an important predictor of post-treatment QOL among women, while anger symptoms are more influential for men. QOL and functioning is underresearched within the context of PTSD treatment, and this study suggests that these domains should be examined within the context of gender.

Feasibility, acceptability, and preliminary efficacy of cognitive processing therapy in Japanese patients with posttraumatic stress disorder

“…Large effect sizes after treatment were also observed in the severity of depressive symptoms, subjective QOL, and anxiety symptoms. This is consistent with previous studies (Glassman et al, 2020) showing reductions in depressive and anxiety symptoms and improvement in QOL. Improvements in participants' trauma-related cognitions were also observed after treatment.…”

Baseline executive functioning moderates treatment‐related changes in quality of life in veterans with posttraumatic stress disorder and comorbid traumatic brain injury

“…Previous researchers have suggested that changes in psychiatric symptoms precede and contribute to changes in QOL over time (Sheehan & Sheehan, 2008), which is consistent with studies showing less symptom reduction was associated with less QOL improvement following PTSD treatment (Glassman et al., 2020; Sofko et al., 2016). Thus, executive dysfunction may affect treatment‐related changes in QOL indirectly via its impact on PTSD symptom reduction.…”

“…Specific factors may moderate changes in QOL and contribute to mixed findings in the literature and different recovery trajectories for individuals. The few studies conducted thus far have focused on the role of psychiatric symptoms in QOL changes after PTSD treatment (Glassman et al., 2020; Schnurr et al., 2006; Sofko et al., 2016); however, these investigations have not considered whether baseline cognitive functioning moderates posttreatment improvements in QOL despite research demonstrating associations between cognitive functioning and QOL (Cambridge et al., 2018; Diamond, 2013). For instance, executive functioning (EF), an umbrella term used to describe several higher‐order cognitive processes including planning, shifting or cognitive flexibility, inhibition, and working memory (Diamond, 2013; Miyake et al., 2000), is predictive of performance across areas of social, occupational, and health‐related functioning (Diamond, 2013).…”

Post‐traumatic stress disorder and depressive symptoms following a Herdsmen attack: The role of life meaning in mediating trait mindfulness

“…On the other hand, meaning in life, being a cognitive process, may be derived from interventions that are related to cognitive processing, such as cognitive processing therapy (Resick, Monson, & Chard, 2017) and exposure‐based therapies (Foa, Hembree, & Rothbaum, 2007; Markowitz et al., 2015). Thus, investigations have shown that exposure‐based therapies can be very useful in promoting certain constructs that are intrinsically related to meaning in life; these include facilitation of positive emotional processes in depression treatment (Hayes, 2015), reduction in the use of maladaptive cognitive emotion regulation strategies such as rumination by promoting positive reappraisal strategies (Wisco, Sloan, & Marx, 2013), and improved quality of life in people with PTSD (Glassman et al., 2020).…”