Session-level effects of cognitive processing therapy and prolonged exposure on individual symptoms of posttraumatic stress disorder among U.S. veterans.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2024-07-01 Epub Date: 2024-03-28 DOI:10.1037/ccp0000880

Samantha J Moshier, Colin T Mahoney, Michelle J Bovin, Brian P Marx, Paula P Schnurr

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引用次数: 0

Abstract

Objective: To compare the course of change in individual posttraumatic stress disorder (PTSD) symptoms during prolonged exposure therapy (PE) and cognitive processing therapy (CPT).

Method: We analyzed data from a previously published randomized clinical trial comparing PE and CPT among male and female U.S. military veterans with PTSD (Schnurr et al., 2022). Using data from a self-rated PTSD symptom measure administered before each therapy session, we evaluated individual symptom change from pretreatment to final therapy session (N = 802). Then, using network intervention analysis, we modeled session-by-session PTSD symptom networks that included treatment allocation (CPT vs. PE) as a node in the networks, allowing us to compare individual symptom change following each session in each treatment.

Results: Relative to CPT, PE was associated with greater reduction in 10 PTSD symptoms from first to final session of therapy. Numerous treatment-specific effects on individual symptoms emerged during the treatment period; these session-level effects occurred only in symptoms relatively specific to the diagnosis of PTSD (e.g., avoidance, hypervigilance). PE was associated with greater reduction in avoidance following the introduction and early weeks of imaginal exposure. The treatments yielded comparable effects on trauma-related blame and negative beliefs from pretreatment to final therapy session. However, there were differences in session-level change in these symptoms that may reflect differential timing of interventions that reduce distorted cognitions within each treatment.

Conclusions: Findings may facilitate the shared decision-making process for patients choosing between CPT and PE. Session-level results provide direction for future research on the specific intervention components of CPT and PE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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认知加工疗法和长期暴露疗法对美国退伍军人创伤后应激障碍个体症状的疗程级影响。

摘要比较在长期暴露疗法（PE）和认知处理疗法（CPT）中个人创伤后应激障碍（PTSD）症状的变化过程：我们分析了之前发表的一项随机临床试验的数据，该试验对患有创伤后应激障碍的美国男女退伍军人进行了暴露疗法和认知处理疗法的比较（Schnurr 等人，2022 年）。利用每次治疗前进行的创伤后应激障碍症状自评量表中的数据，我们评估了从治疗前到最终治疗期间（N = 802）个人症状的变化。然后，通过网络干预分析，我们建立了逐个疗程的创伤后应激障碍症状网络模型，并将治疗分配（CPT vs. PE）作为网络中的一个节点，这样我们就可以比较每个疗程中每个疗程后的个体症状变化：结果：与 CPT 相比，PE 在治疗的第一个疗程到最后一个疗程期间，10 种创伤后应激障碍症状的减少幅度更大。在治疗期间，个别症状出现了许多治疗特异性效应；这些疗程层面的效应仅出现在创伤后应激障碍诊断相对特异的症状上（如回避、过度警觉）。在引入意象暴露和意象暴露的最初几周，PE 与回避症状的进一步减轻有关。从治疗前到最后一个疗程，这些治疗方法对创伤相关的自责和消极信念产生了相似的效果。然而，这些症状在疗程水平上的变化存在差异，这可能反映了每种治疗方法中减少扭曲认知的干预时机不同：结论：研究结果可能有助于患者在 CPT 和 PE 之间做出共同决策。疗程层面的结果为今后研究CPT和PE的具体干预内容提供了方向。(PsycInfo Database Record (c) 2024 APA，保留所有权利）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.