Understanding Veterans' Perceived Improvement in PTSD Treatment: Examining its Association with Clinical Predictors and Clinically Meaningful Improvement Thresholds.

Background: Patients' perceived improvement has utility in contextualizing markers of treatment success, often measured through PTSD severity, other clinical factors, and clinically meaningful improvement (CMI). This study investigated the relationship between perceived improvement, self-reported PTSD symptom changes, and changes in other clinical factors in veterans undergoing PTSD treatment.

Methods: Data were collected from 259 veterans who completed a two-week Cognitive Processing Therapy-based intensive PTSD treatment program. Self-report measures, including the Patient Global Impression of Improvement (PGI-I) and PTSD Checklist for DSM-5 (PCL-5), assessed symptom severity and perceived improvement. Ordinal logistic regression analyses examined associations between PTSD symptom changes, other clinical factors (e.g., depression, self-efficacy, emotion regulation), and perceived improvement.

Results: The average PCL-5 improvement was 20.93 points, with 87.65% of veterans reporting feeling at least a little better post-treatment. All CMI thresholds were related to perceived improvement. Reductions in PTSD severity significantly predicted higher perceived improvement while self-efficacy and emotion regulation also emerged as significant predictors. In contrast, changes in depression symptoms, negative posttraumatic cognitions, and resilience were not significant.

Conclusions: Perceived improvement in PTSD treatment aligns closely with reductions in PTSD severity and self-regulatory capacities, emphasizing their importance in subjective recovery. While the PGI-I may not fully replace other measures, its alignment with key outcomes and brevity make it a valuable patient-centered tool for assessing treatment effectiveness. Future research should assess the PGI-I's potential to complement or replace existing measures, and evaluate long-term outcomes across diverse treatment settings.