Skip to main content

Advertisement

SpringerLink
Log in

Identifying Patterns and Predictors of PTSD and Depressive Symptom Change During Cognitive Processing Therapy

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

This study sought to identify specific trajectories of posttraumatic stress disorder (PTSD) and depression symptom change (and the relationship thereof) within a variable length course of cognitive processing therapy (CPT). Clinical characteristics, including initial severity of PTSD and depressive symptoms and characterological features consistent with personality disorder diagnoses, were examined as potential predictors of treatment response trajectory. Male and female interpersonal violence survivors (N = 69) with PTSD were treated with a modified form of CPT wherein treatment end was dictated by individual course of recovery (4–18 sessions). Latent class growth analysis and Bayesian information criteria revealed three distinct groups based on change patterns (partial responders, consistent responders, and initial responders). Baseline PTSD and depressive symptoms and characterological features were associated with patterns of change. Findings provide evidence for variability in efficiency of response to PTSD treatment and highlight the need for continued assessment of progress to inform the course of therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Aderka, I. M., Foa, E. B., Applebaum, E., Shafran, N., & Gilboa-Schechtman, E. (2011). Direction of influence between posttraumatic and depressive symptoms during prolonged exposure therapy among children and adolescents. Journal of Consulting and Clinical Psychology, 79, 421. doi:10.1037/a0023318.

    Article  PubMed  PubMed Central  Google Scholar 

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

  • Bauer, D. J., & Curran, P. J. (2003). Distributional assumptions of growth mixture models: Implications for overextraction of latent trajectory classes. Psychological Methods, 8, 338–363. doi:10.1037/1082-989X.8.3.338.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory (2nd ed.). San Antonio, TX: The Psychological Corporation.

    Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., et al. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90. doi:10.1007/bf02105408.

    Article  CAS  PubMed  Google Scholar 

  • Chard, K. M., Schumm, J. A., Owens, G. P., & Cottingham, S. M. (2010). A comparison of OEF and OIF veterans and Vietnam veterans receiving cognitive processing therapy. Journal of Traumatic Stress, 23, 25–32. doi:10.1002/jts.20500.

    PubMed  Google Scholar 

  • Clark, L. A. (1993). Schedule for nonadaptive and adaptive personality: Manual for administration, scoring, and interpretation. Minneapolis, MN: Univ. of Minnesota Press.

    Google Scholar 

  • Duncan, T. E., Duncan, S. C., Strycker, L. A., Li, F., & Alpert, A. (2006). An introduction to latent variable growth curve modeling: Concepts, issues, and applications (2nd ed.). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Elliott, P., Biddle, D., Hawthorne, G., Forbes, D., & Creamer, M. (2005). Patterns of treatment response in chronic posttraumatic stress disorder: An application of latent growth mixture modeling. Journal of Traumatic Stress, 18, 303–311. doi:10.1002/jts.20041.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Cashman, L., Jaycox, L., & Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: The Posttraumatic Diagnostic Scale. Psychological Assessment, 9, 445–451. doi:10.1037/1040-3590.9.4.445.

    Article  Google Scholar 

  • Forbes, D., Creamer, M., Bisson, J. I., Cohen, J. A., Crow, B. E., Foa, E. B., et al. (2010). A guide to guidelines for the treatment of PTSD and related conditions. Journal of Traumatic Stress, 23, 537–552. doi:10.1002/jts.20565.

    Article  PubMed  Google Scholar 

  • Friborg, O., Martinussen, M., Kaiser, S., Overgard, K. T., & Rosenvinge, J. H. (2013). Comorbidity of personality disorders and anxiety disorders: A meta-analysis of 30 years of research. Journal of Affective Disorders, 145, 143–155. doi:10.1016/j.jad.2012.07.004.

    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. doi:10.1037/a0030600.

    Article  PubMed  PubMed Central  Google Scholar 

  • Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose–effect relationship in psychotherapy. American Psychologist, 41, 159–164. doi:10.1037/0003-066X.41.2.159.

    Article  CAS  PubMed  Google Scholar 

  • Institute of Medicine. (2007). Treatment of PTSD: An assessment of the evidence. Washington, DC: National Academies Press.

    Google Scholar 

  • Jung, T., & Wickrama, A. S. (2008). An introduction to latent class growth analysis and growth mixture modeling. Social and Personality Psychology Compass, 2, 302–317. doi:10.1111/j.1751-9004.2007.00054.x.

    Article  Google Scholar 

  • Liverant, G. I., Suvak, M. K., Pineles, S. L., & Resick, P. A. (2012). Changes in posttraumatic stress disorder and depressive symptoms during cognitive processing therapy: Evidence for concurrent change. Journal of Consulting and Clinical Psychology, 80, 957–967. doi:10.1037/a0030485.

    Article  PubMed  Google Scholar 

  • Macdonald, A., Monson, C. M., Doron-Lamarca, S., Resick, P. A., & Palfai, T. P. (2011). Identifying patterns of symptom change during a randomized controlled trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Traumatic Stress, 24, 268–276. doi:10.1002/jts.20642.

    Article  PubMed  Google Scholar 

  • Nishith, P., Resick, P. A., & Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886. doi:10.1037/0022-006X.70.4.880.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pietrezak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011). Personality disorders associated with full and partial posttraumatic stress disorder in the U.S. population: Results from Wave 2 of the National Epidemiologic Survey on Alcohol related Conditions. Journal of Psychiatric Research, 24, 678–686.

    Article  Google Scholar 

  • Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Newbury Park, CA: Sage.

    Google Scholar 

  • Resick, P. A., Galovski, T. E., Uhlmansiek, M., Scher, C. D., Clum, G., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258. doi:10.1037/0022-006X.76.2.243.

    Article  PubMed  PubMed Central  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. doi:10.1037/0022-006X.70.4.867.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schumm, J. A., Dickstein, B. D., Walter, K. H., Owens, G. P., & Chard, K. M. (2015). Changes in posttraumatic stress disorder symptoms during cognitive processing therapy. Journal of Consulting and Clinical Psychology, 83, 1161–1166. doi:10.1037/ccp0000040.

    Article  PubMed  Google Scholar 

  • Schumm, J. A., Walter, K. H., & Chard, K. M. (2013). Latent class differences Explain variability in PTSD symptom changes during cognitive processing therapy for veterans. Psychology of Trauma: Theory, Research, Practice, & Policy, 5, 536–544.

    Article  Google Scholar 

  • Stecker, T., Shiner, B., Watts, B. V., Jones, M., & Conner, K. R. (2013). Treatment-seeking barriers for veterans of the Iraq and Afghanistan conflicts who screen positive for PTSD. Psychiatric Services, 64(3), 280–283. doi:10.1176/appi.ps.001372012.

    Article  PubMed  Google Scholar 

  • Stein, N. R., Dickstein, B. D., Schuster, J., Litz, B. T., & Resick, P. A. (2012). Trajectories of response to treatment for posttraumatic stress disorder. Behavior Therapy, 43, 790–800. doi:10.1016/j.beth.2012.04.003.

    Article  PubMed  PubMed Central  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, 541–551. doi:10.1037//0022-006X.69.3.541.

    Article  CAS  PubMed  Google Scholar 

  • Veterans Health Administration and Department of Defense. (2010). VA/DoD clinical practice guideline for the management of post-traumatic stress. Washington, DC: Veterans Health Administration, Department of Defense.

    Google Scholar 

  • Walter, K., Bolte, T., Owens, G., & Chard, K. (2012). The impact of personality disorders on treatment outcome for veterans in a postrauamtic stress disorder residential treatment program. Cognitive therapy & Research, 36, 576.

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Institute of Mental Health (NIMH) 1R34MH074937 Grant awarded to Tara E. Galovski at the University of Missouri-St. Louis and data was collected at the Center for Trauma Recovery. We thank the clinicians and research assistants whose work to make this research possible and the generous individuals who participated in these trials.

Funding

This study was funded by the National Institute of Mental Health/NIH (1R34-MH-074937).

Author information

Authors and Affiliations

  1. National Center for PTSD-Women’s Health Sciences Division, VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA, 02130, USA

    Tara E. Galovski

  2. National Center for PTSD-Executive Division, Veterans Affairs Medical Center, White River Junction, VT, USA

    Juliette M. Harik

  3. VA Maryland Healthcare System, Baltimore, MD, USA

    Leah M. Blain

  4. University of Missouri-St. Louis, St. Louis, MO, USA

    Courtney Farmer

  5. Wake Forest University, Winston-Salem, NC, USA

    Dana Turner & Tim Houle

Authors
  1. Tara E. Galovski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juliette M. Harik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leah M. Blain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Courtney Farmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dana Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tim Houle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tara E. Galovski.

Ethics declarations

Conflict of Interest

Galovski received grant support for this project from National Institute of Mental Health/NIH. She has also received research grants from SAMHSA that are not related to this project. Harik, Blain and Chappuis declare that they have no conflicts of interest. Turner holds a research grant from Merek, Inc. (Migraine MK-0974 Proposal #36554) which examines adherence to migraine medication. Houle holds a research grant from Merek, Inc. (Migraine MK-0974 Proposal #36554) which examines adherence to migraine medication. Houle is also a statistical consultant for DePOMED—designs an FDA application for an abortive migraine drug for children.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee 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.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation. Informed consent was obtained from all individual subjects participating in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galovski, T.E., Harik, J.M., Blain, L.M. et al. Identifying Patterns and Predictors of PTSD and Depressive Symptom Change During Cognitive Processing Therapy. Cogn Ther Res 40, 617–626 (2016). https://doi.org/10.1007/s10608-016-9770-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-016-9770-4

Keywords

Search

Navigation