Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder.

Abstract

Objectives This study examined 1) relationships between trauma-related cognitions and Posttraumatic Stress Disorder (PTSD) symptoms from pre-treatment through a long-term period following cognitive behavioral therapy (CBT) for PTSD and 2) whether these relationships were impacted by treatment type. Method Participants were 171 women randomized into treatment for PTSD following rape. Measures of self-reported trauma-related cognitions and interviewer-assessed PTSD symptoms (i.e., Posttraumatic Maladaptive Beliefs Scale, Trauma-Related Guilt Inventory, and Clinician-Administered PTSD Scale) were obtained at pre-treatment, post-treatment, and 3-month, 9-month, and 5–10 year follow-ups. Multilevel regression analyses were used to examine relationships between trauma-related cognitions and PTSD symptoms throughout the study period and whether these relationships differed as a function of treatment type (i.e., Cognitive Processing Therapy or Prolonged Exposure). Results Initial multilevel regression analyses that examined mean within-participant associations suggested that beliefs regarding Reliability and Trustworthiness of Others, Self-Worth and Judgment, Threat of Harm, and Guilt were related to PTSD symptoms throughout follow-up. Growth curve modeling suggested that patterns of belief change throughout follow-up were similar to those previously observed in PTSD symptoms over the same time period. Finally, multilevel mediation analyses that incorporated time further suggested that change in beliefs was related to change in symptoms throughout follow-up. With one minor exception, relationships between beliefs and symptoms were not moderated by treatment type. Conclusions These data suggest that trauma-related cognitions are a potential mechanism for long-term maintenance of treatment gains following CBT for PTSD. Moreover, these cognitions may be a common, rather than specific, treatment maintenance mechanism.

Mechanisms of change in psychological interventions for posttraumatic stress symptoms: A systematic review with recommendations

“…Most studies examined PTCs or emotions as mechanisms of change during and immediately after treatment. In one significant exception, Scher, Suvak, and Resick (2017; medium quality) demonstrated that among female survivors of rape, changes in self-, world-and other-related PTCs as well as trauma-related guilt could partially explain the effects of time on PTSS up to ten years after treatment, with similar effects seen in both CPT and PE. Gallagher and Resick (2012; low quality) studied hope, a cognitive-emotional construct, as a mechanism of change, and found cognitive processing therapy (CPT) among female rape survivors to lead to greater decreases in hopelessness, compared with PE, and changes in hopelessness to associate with the effects of CPT on PTSS, as compared with PE.…”

Sustainability of Treatment Effects of Trauma-Focused Cognitive-Behavioral Therapy for Children and Adolescents: Findings from 6- and 12-Month Follow-Ups

“…These skills might result in greater self-confidence [9] and thus further recovery. Moreover, the reduction of trauma-related cognitions may contribute to the maintenance of treatment gains [10]. …”

The Association Between Negative Trauma‐Related Cognitions and Pain‐Related Functional Status Among Veterans With Posttraumatic Stress Disorder and Alcohol Use Disorder

“…Foa and Kozak () used the emotional processing theory to explain the development of PTSD through changes in preexisting cognitions of one's own competence and beliefs about one's safety and the danger in the world. Indeed, negative trauma‐related cognitions have been identified as important factors in the development, maintenance, and severity of PTSD (Foa, Ehlers, Clark, Tolin, & Orsillo, ; Scher, Suvak, & Resick, ), and negative beliefs have been linked to more alcohol cravings in individuals with comorbid PTSD and alcohol dependence (Jayawickreme, Yasinski, Williams, & Foa, ). Similarly, negative pain‐related cognitions, such as “catastrophizing” (i.e., unrealistic, negative self‐evaluations related to pain), have been linked to increased pain intensity as well as poorer mental health and functional status (Vowles, McCracken, & Eccleston, ).…”