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Predictors of Treatment Outcome in Group or Individual Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Active Duty Military

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Abstract

Background

The purpose of this study was to examine demographic, psychological, military, and deployment variables that might predict posttraumatic stress disorder (PTSD) symptom improvement in a sample of active duty service members who received either group or individual cognitive processing therapy (CPT).

Methods

Data were analyzed from 165 active duty service members with pre- and posttreatment data participating in a randomized controlled trial comparing group with individual CPT. Pretreatment variables were examined as predictors of change in PTSD severity from baseline to posttreatment, assessed using the PTSD Symptom Scale-Interview Version (PSS-I). Predictors of PSS-I change were first evaluated using Pearson correlations, followed by partial and multiple correlations to clarify which associations remained when effects of other predictors were controlled. Multiple regression analyses were used to test for interactions between pretreatment variables and treatment format.

Results

Only age was a significant predictor of PTSD symptom change after controlling for other variables and statisitically correcting for testing multiple variables. There was also an interaction between age and treatment format.

Conclusions

Younger participants had greater symptom improvement, particularly if they received individual treatment. Other pretreatment variables did not predict outcome. CPT appears to be robust across most pretreatment variables, such that comorbid disorders, baseline symptom severity, and suicidal ideation do not interfere with application of CPT. However, individual CPT may be a better option particularly for younger service members.

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References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, text revised (4th ed.). Washington, DC: Author.

    Google Scholar 

  • Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology,56, 893–897. https://doi.org/10.1037/0022-006X.56.6.893.

    Article  CAS  PubMed  Google Scholar 

  • Beck, A. T., & Steer, R. A. (1991). Manual for the Beck Scale for suicide ideation. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the BDI-II. San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society B,57, 289–300. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x.

    Article  Google Scholar 

  • Castillo, D. T., Chee, C. L., Nason, E., Keller, J., C'de Baca, J., Qualls, C., …, Keane, T. M. (2016). Group-delivered cognitive/exposure therapy for PTSD in women veterans: A randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 404–412. https://doi.org/10.1037/tra0000111.

  • Department of Defense (2015). 2015 Demographics: Profile of the military community. Washington, DC: Department of Defense, Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy. Retrieved from https://download.militaryonesource.mil/12038/MOS/Reports/2015-Demographics-Report.pdf.

  • Dickstein, B. D., McLean, C. P., Mintz, J., Conoscenti, L. M., Steenkamp, M. M., Benson, T. A., …, Litz, B. T. (2010). Unit cohesion and PTSD symptom severity in Air Force medical personnel. Military Medicine,175, 482–486. https://doi.org/10.7205/milmed-d-09-00178.

  • Ehlers, A., Clark, D. M., Dunmore, E., Jaycox, L., Meadows, E., & Foa, E. B. (1998). Predicting response to exposure treatment in PTSD: The role of mental defeat and alienation. Journal of Traumatic Stress,11, 457–471. https://doi.org/10.1023/A:1024448511504.

    Article  CAS  PubMed  Google Scholar 

  • Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York: Oxford University Press.

    Book  Google Scholar 

  • Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress,6, 459–473. https://doi.org/10.1002/jts.2490060405.

    Article  Google Scholar 

  • Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy,26, 487–499. https://doi.org/10.1016/S0005-7894(05)80096-6.

    Article  Google Scholar 

  • Forbes, D., Bennett, N., Biddle, D., Crompton, D., McHugh, T., Elliott, P., et al. (2005). Clinical presentations and treatment outcomes of peacekeeper veterans with PTSD: Preliminary findings. American Journal of Psychiatry,162, 2188–2190. https://doi.org/10.1176/appi.ajp.162.11.2188.

    Article  PubMed  Google Scholar 

  • Forbes, D., Creamer, M., Hawthorne, G., Allen, N., & McHugh, T. (2003). Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder. Journal of Nervous and Mental Disease,191, 93–99. https://doi.org/10.1097/01.NMD.0000051903.60517.98.

    Article  PubMed  Google Scholar 

  • Galovski, T. E., Blain, L. M., Mott, J. M., Elwood, L., & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy. Journal of Consulting and Clinical Psychology,80, 968–981. https://doi.org/10.1037/a0030600.

    Article  PubMed  PubMed Central  Google Scholar 

  • Galovski, T. E., Monson, C., Bruce, S. E., & Resick, P. A. (2009). Does cognitive-behavioral therapy for PTSD improve perceived health and sleep impairment? Journal of Traumatic Stress,22, 197–204. https://doi.org/10.1002/jts.20418.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the life events checklist. Assessment,11, 330–341. https://doi.org/10.1177/1073191104269954.

    Article  PubMed  Google Scholar 

  • Hirano, K., Imbens, G. W., & Ridder, G. (2003). Efficient estimation of average treatment effects using the estimated propensity score. Econometrica,71(4), 1161–1189. https://doi.org/10.1111/1468-0262.00442.

    Article  Google Scholar 

  • Karatzias, A., Power, K., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., et al. (2007). Predicting treatment outcome on three measures for post-traumatic stress disorder. European Archives of Psychiatry and Clinical Neuroscience,257(1), 40–46. https://doi.org/10.1007/s00406-006-0682-2.

    Article  PubMed  Google Scholar 

  • Kubany, E. S., Haynes, S. N., Abueg, F. R., Manke, F. P., Brennan, J. M., & Stahura, C. (1996). Development and validation of the Trauma-Related Guilt Inventory (TRGI). Psychological Assessment,8, 428–444. https://doi.org/10.1037/1040-3590.8.4.428.

    Article  Google Scholar 

  • Lester, K., Artz, C., Resick, P. A., & Young-Xu, Y. (2010). Impact of race on early treatment termination and outcomes in posttraumatic stress disorder treatment. Journal of Consulting and Clinical Psychology,78, 480–489. https://doi.org/10.1037/a0019551.

    Article  PubMed  Google Scholar 

  • Lloyd, D., Nixon, R. D. V., Varker, T., Elliott, P., Perry, D., Bryant, R. A., …, Forbes, D. (2014). Comorbidity in the prediction of cognitive processing therapy treatment outcomes for combat-related posttraumatic stress disorder. Journal of Anxiety Disorders, 28, 237–240. https://doi.org/10.1016/j.janxdis.2013.12.002.

  • Morin, C. M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press.

    Google Scholar 

  • Owens, G. P., Chard, K. M., & Cox, T. A. (2008). The relationship between maladaptive cognitions, anger expression, and posttraumatic stress disorder among veterans in residential treatment. Journal of Aggression, Maltreatment, & Trauma,17, 439–452. https://doi.org/10.1080/10926770802473908.

    Article  Google Scholar 

  • Podsakoff, P. M., & MacKenzie, S. B. (1994). An examination of the psychometric properties and nomological validity of some revised and reduced substitutes for leadership scales. Journal of Applied Psychology,79, 702–713. https://doi.org/10.1037//0021-9010.79.5.702.

    Article  Google Scholar 

  • Pruiksma, K. E., Taylor, D. J., Wachen, J. S., Mintz, J., Young-McCaughan, S., Peterson, A. L., …, Resick, P. A., on behalf of the STRONG STAR Consortium. (2016). Residual sleep disturbances following PTSD treatment in active duty military personnel. Psychological Trauma: Theory, Research, Practice, and Policy, 8, 697–701. https://doi.org/10.1037/tra0000150.

  • Ramchand, R., Rudavsky, R., Grant, S., Tanielian, T., & Jaycox, L. (2015). Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Current Psychiatry Reports,17, 37. https://doi.org/10.1007/s11920-015-0575-z.

    Article  PubMed  Google Scholar 

  • Resick, P. A., Monson, C. M., & Chard, K. M. (2010). Cognitive processing therapy veteran/military version: Therapist’s manual. Washington, DC: Department of Veterans’ Affairs.

    Google Scholar 

  • Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C., & Feuer, C. A. (2002). A comparison of cognitive-processing therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Consulting and Clinical Psychology,70, 867–879. https://doi.org/10.1037//0022-006x.70.4.867.

    Article  PubMed  PubMed Central  Google Scholar 

  • Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., et al. (2017). Effect of group vs individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry,74, 28–36. https://doi.org/10.1001/jamapsychiatry.2016.2729.

    Article  PubMed  Google Scholar 

  • Resick, P. A., Wachen, J. S., Mintz, J., Young-McCaughan, S., Roache, J. D., Borah, A. M., …, Peterson, A. L., on behalf of the STRONG STAR Consortium. (2015). A randomized clinical trial of group cognitive processing therapy compared with group present-centered therapy for PTSD among active duty military personnel. Journal of Consulting and Clinical Psychology, 83, 1058–1068. https://doi.org/10.1037/ccp0000016.

  • Rizvi, S. L., Vogt, D. S., & Resick, P. A. (2009). Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder. Behaviour Research and Therapy,47, 737–743. https://doi.org/10.1016/j.brat.2009.06.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health,99, 1651–1658. https://doi.org/10.2105/AJPH.2008.150284.

    Article  PubMed  PubMed Central  Google Scholar 

  • Speckens, A. E. M., Ehlers, A., Hackmann, A., & Clark, D. M. (2006). Changes in intrusive memories associated with imaginal reliving in posttraumatic stress disorder. Anxiety Disorders,20, 328–341. https://doi.org/10.1016/j.janxdis.2005.02.004.

    Article  Google Scholar 

  • Spielberger, C. D. (1999). STAXI-2: State-trait anger expression inventory-2. Lutz, FL: Psychological Assessment Resources Inc.

    Google Scholar 

  • Tarrier, N., Sommerfield, C., Pilgrim, H., & Faragher, B. (2000). Factors associated with outcome of cognitive-behavioural treatment of chronic post-traumatic stress disorder. Behaviour Research and Therapy,38, 191–202. https://doi.org/10.1016/S0005-7967(99)00030-3.

    Article  CAS  PubMed  Google Scholar 

  • Taylor, S. (2003). Outcome predictors for three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Cognitive Psychotherapy,17, 149–162.

    Article  Google Scholar 

  • Taylor, S., Fedoroff, I. C., Koch, W. J., Thordarson, D. S., Fecteau, G., & Nicki, R. M. (2001). Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to cognitive–behavior therapy. Journal of Consulting and Clinical Psychology,69(3), 541–551. https://doi.org/10.1037//0022-006x.69.3.541.

    Article  CAS  PubMed  Google Scholar 

  • van Minnen, A., Arntz, A., & Keijsers, G. P. J. (2002). Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout. Behaviour Research and Therapy,40, 439–457. https://doi.org/10.1016/S0005-7967(01)00024-9.

    Article  PubMed  Google Scholar 

  • Vogt, D., Proctor, S. P., King, D. W., King, L. A., & Vasterling, J. J. (2008). Validation of scales from the Deployment Risk and Resilience Inventory (DRRI) in a sample of Iraq War veterans. Assessment,15, 391–403. https://doi.org/10.1177/1073191108316030.

    Article  PubMed  Google Scholar 

  • Zandberg, L. J., Rosenfield, D., McLean, C. P., Powers, M. B., Asnaani, A., & Foa, E. B. (2016). Concurrent treatment of posttraumatic stress disorder and alcohol dependence: Predictors and moderators of outcome. Journal of Consulting and Clinical Psychology,84, 43–56. https://doi.org/10.1037/ccp0000052.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Ray Aguilar, Abby Blankenship, Antoinette Brundige, Julie Collins, Paul Fowler, Vanessa Jacoby, Kristi E. Pruiskma and John Roache of the University of Texas Health Science Center at San Antonio and Brett Litz at VA Boston Healthcare System for their help on the project.

Funding

Funding for this work was made possible by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program awards W81XWH-08-02-116 (Patricia Resick), W81XWH-08-02-109 (Alan Peterson), and W81XWH-08-02-114 (Brett Litz). This work was supported in part by Career Development Award IK2RX002965 (Kirsten Dillon) from the United States Department of Veterans Affairs Rehabilitation R&D Service. The views expressed herein are solely those of the authors and do not reflect an endorsement by or the official policy or position of the U.S. Army, the Department of Defense, the Department of Veterans Affairs, or the U.S. Government.

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Author notes

  1. Kirsten H. Dillon

    Present address: Research and Development, Durham VA Medical Center, Durham, NC, USA

  2. Erica E. Nason

    Present address: School of Social Work, Texas State University, San Marcos, TX, USA

  3. Jeffrey S. Yarvis

    Present address: 21st Combat Support Hospital at Fort Hood, Killeen, TX, USA

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 1121 West Chapel Hill Street, Durham, NC, 27707, USA

    Patricia A. Resick, Stefanie T. LoSavio & Kirsten H. Dillon

  2. Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA

    Jennifer Schuster Wachen

  3. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Jennifer Schuster Wachen

  4. Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Erica E. Nason, Katherine A. Dondanville, Stacey Young-McCaughan, Alan L. Peterson & Jim Mintz

  5. Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA

    Alan L. Peterson

  6. Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA

    Alan L. Peterson

  7. Department of Behavioral Health, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA

    Jeffrey S. Yarvis

  8. Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

    Jim Mintz

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For the STRONG STAR Consortium

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Correspondence to Patricia A. Resick.

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Conflicts of interest

Patricia A. Resick, Stefanie T. LoSavio, Jennifer Schuster Wachen, Kirsten H. Dillon, Erica E. Nason, Katherine A. Dondanville, Stacey Young-McCaughan, Alan L. Peterson, and Jim Mintz all received funding on the grants listed in this study above. Patricia Resick also receives royalties from Guilford publishing for a CPT manual subsequent to the one used in this study. Jeffrey S. Yarvis has no known conflict of interests associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of Institutional Review Boards at Brooke Army Medical Center, the University of Texas Health Science Center at San Antonio, Duke University, and VA Boston Healthcare System and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Resick, P.A., LoSavio, S.T., Wachen, J.S. et al. Predictors of Treatment Outcome in Group or Individual Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Active Duty Military. Cogn Ther Res 44, 611–620 (2020). https://doi.org/10.1007/s10608-020-10085-5

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