Philip Held, Daniel R Szoke, Sarah A Pridgen, Dale L Smith
{"title":"追踪认知加工治疗中的个体化瓶颈:改变的数量很重要。","authors":"Philip Held, Daniel R Szoke, Sarah A Pridgen, Dale L Smith","doi":"10.1002/jts.23155","DOIUrl":null,"url":null,"abstract":"<p><p>Cognitive processing therapy (CPT) targets maladaptive beliefs called \"stuck points,\" which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person-specific individualized stuck points (ISPs) were associated with reductions in self-reported and clinician-rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults (N = 57) with PTSD received 1-week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1- and 3-month follow-ups. Linear mixed-effects models examined associations between ISP changes and self-reported (PTSD Checklist for DSM-5 [PCL-5]) and clinician-rated PTSD (Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1-month follow-up, M<sub>PCL-5 reduction</sub> = 29.4, d = 2.02; M<sub>CAPS-5 reduction</sub> = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1-month follow-up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL-5 scores, p = .021, R<sup>2</sup> = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, ps = .352-.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI-assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.</p>","PeriodicalId":17519,"journal":{"name":"Journal of traumatic stress","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tracking individualized stuck points in cognitive processing therapy: The amount of change matters.\",\"authors\":\"Philip Held, Daniel R Szoke, Sarah A Pridgen, Dale L Smith\",\"doi\":\"10.1002/jts.23155\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Cognitive processing therapy (CPT) targets maladaptive beliefs called \\\"stuck points,\\\" which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person-specific individualized stuck points (ISPs) were associated with reductions in self-reported and clinician-rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults (N = 57) with PTSD received 1-week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1- and 3-month follow-ups. Linear mixed-effects models examined associations between ISP changes and self-reported (PTSD Checklist for DSM-5 [PCL-5]) and clinician-rated PTSD (Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1-month follow-up, M<sub>PCL-5 reduction</sub> = 29.4, d = 2.02; M<sub>CAPS-5 reduction</sub> = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1-month follow-up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL-5 scores, p = .021, R<sup>2</sup> = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, ps = .352-.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI-assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.</p>\",\"PeriodicalId\":17519,\"journal\":{\"name\":\"Journal of traumatic stress\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-05-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of traumatic stress\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/jts.23155\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of traumatic stress","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jts.23155","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PSYCHIATRY","Score":null,"Total":0}
Tracking individualized stuck points in cognitive processing therapy: The amount of change matters.
Cognitive processing therapy (CPT) targets maladaptive beliefs called "stuck points," which are typically assessed using standardized measures (e.g., the Posttraumatic Cognitions Inventory [PTCI]). This study examined whether changes in person-specific individualized stuck points (ISPs) were associated with reductions in self-reported and clinician-rated posttraumatic stress disorder (PTSD) symptoms and whether ISPs predicted PTSD severity beyond general stuck points (GSPs) measured using the PTCI. Adults (N = 57) with PTSD received 1-week massed virtual CPT via one of two randomized controlled trials. ISPs were tracked, and ISP belief strengths were rated after every other session and at 1- and 3-month follow-ups. Linear mixed-effects models examined associations between ISP changes and self-reported (PTSD Checklist for DSM-5 [PCL-5]) and clinician-rated PTSD (Clinician-Administered PTSD Scale for DSM-5 [CAPS-5]) symptom reductions, adjusting for baseline depression, gender, age, and treatment condition. Participants showed large reductions in PTSD symptoms from baseline to 1-month follow-up, MPCL-5 reduction = 29.4, d = 2.02; MCAPS-5 reduction = 10.49, d = 0.72. Average ISP belief strength decreased by 50.2% during treatment and up to 1-month follow-up, d = 2.75. Higher numbers of ISPs also predicted reduced PCL-5 scores, p = .021, R2 = .02. However, when controlling for PTCI score, ISPs no longer significantly predicted PTSD symptom change, ps = .352-.534, whereas PTCI scores remained significant predictors, p < .001. ISP reductions were associated with PTSD symptom improvements but did not predict outcomes beyond PTCI-assessed GSPs. Tracking ISPs may still be valuable for tailoring therapy and enhancing patient engagement.
期刊介绍:
Journal of Traumatic Stress (JTS) is published for the International Society for Traumatic Stress Studies. Journal of Traumatic Stress , the official publication for the International Society for Traumatic Stress Studies, is an interdisciplinary forum for the publication of peer-reviewed original papers on biopsychosocial aspects of trauma. Papers focus on theoretical formulations, research, treatment, prevention education/training, and legal and policy concerns. Journal of Traumatic Stress serves as a primary reference for professionals who study and treat people exposed to highly stressful and traumatic events (directly or through their occupational roles), such as war, disaster, accident, violence or abuse (criminal or familial), hostage-taking, or life-threatening illness. The journal publishes original articles, brief reports, review papers, commentaries, and, from time to time, special issues devoted to a single topic.