Category: PTSD

Symposium

Negative Beliefs as a Predictor of Trajectory of Change in PTSD Treatment

Friday, November 17
1:45 PM - 3:15 PM
Location: Sapphire Ballroom E & F, Level 4, Sapphire Level

Keywords: PTSD Posttraumatic Stress Disorder | Cognitive Schemas / Beliefs | Therapy Process
Presentation Type: Symposium

Clinicians often wonder whether or not their patient is on a trajectory toward recovery.  That is, is what I am seeing across sessions indicative that this therapy going well or do I need to make adjustments? In psychotherapy for PTSD, emerging evidence points to the role of non-linear change being linked to more favorable outcome (e.g., Nishith et al., 2002; Jun et al., 2013).  In depression, having a distinct pattern of change is also related to better outcome (Vittengl et al., 2013).  In this study, we examined whether severity of pre-treatment negative beliefs and emotion regulation predicted linear or non-linear patterns of change.  One hundred and fifty-nine patients with chronic PTSD were treated for up to 10 weeks with prolonged exposure (PE) or sertraline as part of a randomized PTSD treatment trial. We evaluated patterns of change across all patients using growth modeling and also conducted individual regressions of three different change patterns for each patient’s symptom scores: a linear trajectory reflecting steady symptom reduction across treatment; a log­linear pattern reflecting greater improvements early in treatment; or a one­step trajectory indicating the occurrence of a large between­session symptom reduction at some point in treatment.  Across therapies, 23.3% fit a linear trajectory, 14.5% log­linear, 13.2% one­step drop pattern, and 49.1% did not fit into one of the three defined patterns.  More negative beliefs about the trauma (r = .23) and negative beliefs about anxiety (r = .22) predicted a linear pattern of change during PE; whereas, worse negative mood regulation (r = .26) and more reappraisal (r = .22) predicted a log-linear pattern of change during PE.  Notably, none of these factors predicted these trajectories during sertraline treatment.  Clinically, there are many different “pathways” that a patient may take to achieve good clinical outcomes, with pre-treatment predictors conferring modest prediction for clinicians in regard to which pattern.  

Lori A. Zoellner

Professor
University of Washington

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