Category: Schizophrenia / Psychotic Disorders


Differential Response to Brief Treatment Versus CBT for PTSD in Persons With Severe Mental Illness

Saturday, November 18
3:30 PM - 5:00 PM
Location: Sapphire Ballroom I & J, Level 4, Sapphire Level

Keywords: Severe Mental Illness | Stress | Clinical Trial
Presentation Type: Symposium

PTSD is a common but often under-treated comorbid disorder in persons with severe mental illnesses (SMI). Controlled research (N=108) has shown that a 12-16 week CBT program (including breathing retraining, psychoeducation, and cognitive restructuring) is more effective than treatment as usual (TAU) at reducing PTSD and related outcomes in people with SMI. Recently, a dismantling study (N=201) comparing CBT with a Brief (3 session) treatment including only breathing retraining and psychoeducation also reported superior effects for CBT on PTSD outcomes, but much weaker effects than in the first study compared to TAU, and clients in both groups improved similarly on most other outcomes (e.g., depression). The findings suggest that Brief treatment is clinically beneficial. Identifying who is most likely to benefit from Brief vs. CBT treatment could optimize clinical outcomes and conserve treatment resources.

We hypothesize that Brief treatment is effective by reducing anxiety through breathing retraining and normalizing PTSD symptoms, and thus speculate that clients with high anxiety (i.e., avoidance on the CAPS, BAI, Negative Cognitions About the World on the PTCI) and low levels of guilt will benefit most from it. We will explore baseline clinical predictors of response to Brief treatment using two complementary approaches. First, we will conduct mixed effects linear regression analyses on CAPS PTSD severity (and estimating equations analyses predicting PTSD diagnosis) at post-treatment and 6- and 12-month follow-ups, with treatment group (Brief vs. CBT), the predictor variable (e.g., baseline BAI), and the group X predictor interaction as independent variables. A main effect for the predictor will indicate it predicts PTSD outcomes in both treatments; an interaction effect will indicate it predicts better PTSD outcomes for one group than the other. Second, based on the rationale that improvement early in CBT following breathing retraining and psychoeducation (i.e., Brief treatment) will contribute to premature dropout, we will compare CBT completers with dropouts on the baseline symptom predictors using t-tests. High levels of baseline anxiety (and low levels of guilt) are expected to predict premature dropout from CBT.

Consistent findings for any predictors across the two approaches will provide strong evidence for tailoring treatment recommendations. The results of these analyses could inform clinical and shared decision-making in determining which clients with SMI are most likely to benefit from which treatment for their PTSD.

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