Skip to main content

Treatment-related reductions in PTSD and changes in physical health symptoms in women

Journal of Behavioral Medicine volume 37, pages 423–433 (2014)Cite this article

Abstract

This study examined the relationship between change in posttraumatic stress disorder (PTSD) symptoms over the course of PTSD treatment and the association with changes in general physical health symptoms. Both positive health habits (e.g., exercise) and negative (e.g., smoking), were examined to determine if they accounted for the association between changes in PTSD severity over time and changes in physical health. Participants were 150 women seeking treatment for PTSD. Latent growth curve modeling indicated a substantial relationship (R 2 = 34 %) between changes in PTSD and changes in physical health that occurred during and shortly following treatment for PTSD. However, there was no evidence to suggest that changes in health behaviors accounted for this relationship. Thus, PTSD treatment can have beneficial effects on self-reported physical health symptoms, even without direct treatment focus on health per se, and is not accounted for by shifts in health behavior.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2

Notes

  1. The orthogonal linear contrasts when using seven data points are −3, −2, −1, 0, 1, 2, 3 and 5, 0, −3, −4, −3, 0, 5 for the linear and quadratic parameters, respectively. One potential problem associated with using orthogonal linear contrasts is that sums of squares, and hence variance, are larger for quadratic contrasts than for linear contrasts (see Biesanz et al., 2004). To address this problem, we divided the linear and quadratic contrasts by the square root of the sums of square associated with the set of linear and quadratic contrasts, respectively, which produced the values of −.57, −.38, −.19, .00, 0.19, .38, .57 and .55, .00,−.33, −.44, −.33, .00, .55 for the linear and quadratic change components, respectively. The latter set of values still represent linear and quadratic change and they are still orthogonal (i.e., r = 0). However, the advantage of using the latter set of numbers is the variance of linear and quadratic parameters are equal.

  2. We conducted analyses using both approaches (i.e., power polynomial and orthogonal linear contrasts). The results were the identical. However, parameter estimates of the orthogonal linear approach were easy to interpret. Therefore, we chose to report the results of the models using OPCs to model change over time.

  3. One of the disadvantages of using the power polynomial approach is that the intercept does not correspond to initial status. The estimate of the intercept from the power polynomial model indicated that the average initial status was 29.93 (SD = 7.86).

  4. The indirect path from a predictor variable (i.e., change in PTSD) to an outcome (i.e., changes in physical health symptoms) through an intervening variable (i.e., change NHH) is a function of the product of the path from the predictor to the mediator and the path from the mediator to the outcome (when controlling for the predictor variable). While one might surmise that this follow-up analysis was unnecessary because change in NHH was unrelated to change in physical health symptoms, it is not impossible for the significance of the product term representing the indirect effect to be statistically significant even when one of the paths contributing to the indirect effect is not statistically significant (e.g., Lebreton et al., 2009). Therefore we conducted the follow-up analyses to thoroughly explore the possibility that the relationship between changes in PTSD and changes in physical health symptoms may be accounted for by changes in NHH.

  5. Many of the items from the PILL could be measuring physical manifestation of PTSD or anxiety more generally. We had two separate anxiety researchers review the PILL and denote items that could represent physical manifestations of PTSD or anxiety. We removed 22 (of 54) items (e.g., racing heart, out of breath, headaches, upset stomach) from the PILL that either of the researchers indicated could represent the physical manifestation of PTSD or anxiety. The revised/shortened version of the PILL was highly correlated with the full version (rs = .96, .97, .97, at the pre-treatment, post-treatment, and follow-up assessments, respectively). In addition, we conducted all of the analyses reported in the manuscript with the revised version of the PILL and the outcomes were similar.

References

  • Altemus, M., Dhabhar, F. S., & Yang, R. (2006). Immune function in PTSD. Annals of the New York Academy of Sciences, 1071, 167–183.

    CAS  PubMed  Article  Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

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

    Google Scholar 

  • Asmundson, G. J. G., Stein, M. B., & McCreary, D. R. (2002). Posttraumatic stress disorder symptoms influence health status of deployed peacekeepers and nondeployed military personnel. Journal of Nervous and Mental Disease, 190, 807–815.

    PubMed  Article  Google Scholar 

  • Beckham, J. C., Crawford, A. L., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Davidson, J. R. T., et al. (1997). Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. Journal of Psychosomatic Research, 43, 379–389.

    CAS  PubMed  Article  Google Scholar 

  • Biesanz, J. C., Deeb-Sossa, N., Papadakis, A. A., Bollen, K. A., & Curran, P. J. (2004). The role of coding time in estimating and interpreting growth curve models. Psychological Methods, 9, 30–52.

    PubMed  Article  Google Scholar 

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

    CAS  PubMed  Article  Google Scholar 

  • Breslau, N., Kessler, R., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives of General Psychiatry, 55, 626–632.

    CAS  PubMed  Article  Google Scholar 

  • Campbell, J. (2002). Health consequences of intimate partner violence. The Lancet, 359, 1331–1336.

    Article  Google Scholar 

  • Campbell, R., Greeson, M. R., Bybee, D., & Raja, S. (2008). The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: A mediational model of posttraumatic stress disorder and physical health outcomes. Journal of Consulting and Clinical Psychology, 76, 194–207.

    PubMed  Article  Google Scholar 

  • Clum, G. A., Calhoun, K. S., & Kimerling, R. (2000). Associations among symptoms of depression and posttraumatic stress disorder and self-reported health in sexually assaulted women. Journal of Nervous and Mental Disease, 188, 671–678.

    CAS  PubMed  Article  Google Scholar 

  • Creamer, M., Elliott, P., Forbes, D., Biddle, D., & Hawthorne, G. (2006). Treatment for combat-related posttraumatic stress disorder: Two-year follow-up. Journal of Traumatic Stress, 19, 675–685.

    PubMed  Article  Google Scholar 

  • Dong, M., Dube, S. R., Felitti, V. J., Giles, W. H., & Anda, R. F. (2003). Adverse childhood experiences and self-reported liver disease: New insights into the causal pathway. Archives of Internal Medicine, 163, 1949–1956.

    PubMed  Article  Google Scholar 

  • Dutton, M. A., Green, B. L., Kaltman, S. I., Roesch, D. M., Zeffiro, T. A., & Krause, E. D. (2006). Intimate partner violence, PTSD, and adverse health outcomes. Journal of Interpersonal Violence, 21, 955–968.

    PubMed  Article  Google Scholar 

  • Foa, E. B. (1995). Posttraumatic Stress Diagnostic Scale (manual). Minneapolis, MN: National Computer Systems.

    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.

    Article  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.

    PubMed Central  PubMed  Article  Google Scholar 

  • Glover, D. A., Stuber, M., & Poland, R. E. (2006). Allostatic load in women with and without PTSD symptoms. Psychiatry: Interpersonal and Biological Processes, 69, 191–203.

    Google Scholar 

  • Hickling, E. J., Blanchard, E. B., Schwarz, S. P., & Silverman, D. J. (1992). Headaches and motor vehicle accidents: Results of the psychological treatment of post-traumatic headache. Headache Quarterly, 3, 285–289.

    Google Scholar 

  • Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of PTSD with somatic symptoms, health care visits, and absenteeism among Iraq War veterans. The American Journal of Psychiatry, 164, 150–153.

    PubMed  Article  Google Scholar 

  • Jakupcak, M., Luterek, J., Hunt, S., Conybeare, D., & McFall, M. (2008). Posttraumatic stress and its relationship to physical health functioning in a sample of Iraq and Afghanistan war veterans seeking postdeployment VA health care. Journal of Nervous and Mental Disease, 196, 425–428.

    PubMed  Article  Google Scholar 

  • Karoly, P., Ruehlman, L. S., & Lanyon, R. I. (2005). The assessment of adult health care orientations: development and preliminary validation of the multidimensional health profile-health functioning index (MHP-H) in a national sample. Journal of Clinical Psychology in Medical Settings, 12, 79–91.

    PubMed Central  PubMed  Article  Google Scholar 

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, R. O. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.

    CAS  PubMed  Article  Google Scholar 

  • Korte, S. M., Koolhaas, J. M., Wingfield, J. C., & McEwen, B. S. (2005). The Darwinian concept of stress: Benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neuroscience and Biobehavioral Reviews, 29, 3–38.

    PubMed  Article  Google Scholar 

  • Lanyon, R. I., Maxwell, B. M., Karoly, P., & Ruehlman, L. S. (2007). Concurrent validity of the multidimensional health profile-health functioning scales (MHP-H) in the pre-operative assessment of applicants for gastric bypass surgery. Journal of Clinical Psychology in Medical Settings, 14, 41–49.

    Article  Google Scholar 

  • Lauterbach, D., Vora, R., & Rakow, M. (2005). The relationship between posttraumatic stress disorder and self-reported health problems. Psychosomatic Medicine, 67, 939–947.

    PubMed  Article  Google Scholar 

  • Lebreton, J. M., Wu, J., & Bing, M. N. (2009). The truth on testing for mediation in the social and organizational sciences. In C. E. Lance & R. J. Vandenberg (Eds.), Statistical and methodological myths and urban legends: Doctrine, verity and fable in the organizational and social sciences (pp. 107–137). New York, NY USA: Taylor & Francis Group, LLC.

    Google Scholar 

  • Leeies, M., Pagura, J., Sareen, J., & Bolton, J. M. (2010). The use of alcohol and drugs to self-medicate symptoms of posttraumatic stress disorder. Depression and Anxiety, 27, 731–736.

    PubMed  Google Scholar 

  • Linehan, M. M., & Heard, H. L. (1992). Dialectical behavior therapy for borderline personality disorder. In J. F. Clarkin, E. Marziali, & H. Munroe-Blum (Eds.), Borderline personality disorder: Clinical and empirical perspectives (pp. 248–267). New York, NY USA: Guilford Press.

    Google Scholar 

  • Malik, M. L., Connor, K. M., Sutherland, S. M., Smith, R. D., Davison, R. M., & Davidson, J. R. T. (1999). Quality of life and posttraumatic stress disorder: A pilot study assessing changes in SF-36 scores before and after treatment in a placebo-controlled trial of fluoxetine. Journal of Traumatic Stress, 12, 387–393.

    CAS  PubMed  Article  Google Scholar 

  • McArdle, J. J. (2009). Latent variable modeling of differences and changes with longitudinal data. Annual Review of Psychology, 60, 577–605.

    PubMed  Article  Google Scholar 

  • McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. In N. E. Adler, M. Marmot, B. S. McEwen, & J. Stewart (Eds.), Socioeconomic status and health in industrial nations: Social, psychological, and biological pathways (pp. 30–47). New York, NY USA: New York Academy of Sciences.

    Google Scholar 

  • McEwen, B. S., & Wingfield, J. C. (2003). The concept of allostasis in biology and biomedicine. Hormones and Behavior, 43, 2–15.

    PubMed  Article  Google Scholar 

  • Meredith, W., & Tisak, J. (1990). Latent curve analysis. Psychometrika, 55, 107–122, as cited in Muthen, L. K., & Muthen, B. O. (2007). Mplus user’s guide (5th ed.). Los Angeles, CA: Author.

  • Muse, M. (1986). Stress-related, posttraumatic chronic pain syndrome: Behavioral treatment approach. Pain, 25, 389–394.

    CAS  PubMed  Article  Google Scholar 

  • Muthen, L. K., & Muthen, B. O. (1998). Mplus User’s Guide (6th ed.). Los Angeles, CA: Muthen & Muthen.

    Google Scholar 

  • Norman, S. B., Means-Christensen, A. J., Craske, M. G., Sherbourne, C. D., Roy-Byrne, P. P., & Stein, M. B. (2006). Associations between psychological trauma and physical illness in primary care. Journal of Traumatic Stress, 19, 461–470.

    PubMed  Article  Google Scholar 

  • Norris, F. H. (1992). Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. Journal of Consulting and Clinical Psychology, 60, 409–418.

    CAS  PubMed  Article  Google Scholar 

  • Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer.

    Book  Google Scholar 

  • Ployhart, R. E., Holtz, B. C., & Bliese, P. D. (2002). Longitudinal data analysis: Applications of random coefficient modeling to leadership research. The Leadership Quarterly, 13, 455–486.

    Article  Google Scholar 

  • Rasmusson, A. M., Schnurr, P. P., Zukowska, Z., Scioli, E., & Forman, D. E. (2010). Adaptation to extreme stress: Post-traumatic stress disorder, neuropeptide Y and metabolic syndrome. Experimental Biology and Medicine (Maywood), 235, 1150–1162.

    CAS  Article  Google Scholar 

  • Rauch, S. A. M., Grunfeld, T. E. E., Yadin, E., Cahill, S. P., Hembree, E., & Foa, E. B. (2009). Changes in reported physical health symptoms and social function with prolonged exposure therapy for chronic posttraumatic stress disorder. Depression and Anxiety, 26, 732–738.

    PubMed  Article  Google Scholar 

  • Rauch, S. A. M., Morales, K. H., Zubritsky, C., Knott, K., & Oslin, D. (2006). Posttraumatic stress, depression, and health among older adults in primary care. The American Journal of Geriatric Psychiatry, 14, 316–324.

    PubMed  Article  Google Scholar 

  • Resick, P. A., Galovski, T. E., Uhlmansiek, M. O. B., Scher, C. D., Clum, G. A., & 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.

    PubMed Central  PubMed  Article  Google Scholar 

  • Resnick, H. S., Acierno, R., & Kilpatrick, D. G. (1997). Health impact of interpersonal violence 2: Medical and mental health outcomes. Behavioral Medicine, 23, 65–78.

    CAS  PubMed  Article  Google Scholar 

  • Rheingold, A. A., Acierno, R., & Resnick, H. S. (2004). Trauma, posttraumatic stress disorder, and health risk behaviors. In P. P. Schnurr & B. L. Green (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 217–243). Washington, DC USA: American Psychological Association.

    Chapter  Google Scholar 

  • Ruehlman, L. S., Lanyon, R. I., & Karoly, P. (1999). Development and validation of the multidimensional health profile. Part I: Psychosocial functioning. Psychological Assessment, 11, 166–176.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  • Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69, 242–248.

    PubMed  Article  Google Scholar 

  • Schnurr, P. P., & Green, B. L. (2004). Understanding relationships among trauma, PTSD, and health outcomes. Advances in Pain and Research Therapy, 20, 18–29.

    Google Scholar 

  • Schnurr, P. P., Hayes, A. F., Lunney, C. A., McFall, M., & Uddo, M. (2006). Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for PTSD. Journal of Consulting and Clinical Psychology, 74, 707–713.

    PubMed  Article  Google Scholar 

  • Schnurr, P. P., & Jankowski, M. K. (1999). Physical health and post-traumatic stress disorder: Review and synthesis. Seminars in Clinical Neuropsychiatry, 4, 295–304.

    CAS  PubMed  Google Scholar 

  • Schnurr, P. P., & Spiro, A. (1999). Combat disorder, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans. Journal of Nervous and Mental Disease, 187, 353–359.

    CAS  PubMed  Article  Google Scholar 

  • Schnurr, P. P., Spiro, A., & Paris, A. H. (2000). Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychology, 19, 91–97.

    CAS  PubMed  Article  Google Scholar 

  • Shiner, B., Watts, B. V., Pomerantz, A., Young-Xu, Y., & Schnurr, P. P. (2011). Sensitivity of the SF-36 to PTSD symptom change in veterans. Journal of Traumatic Stress, 24, 111–115.

    PubMed  Article  Google Scholar 

  • Shipherd, J. C., Beck, J. G., Hamblen, J. L., Lackner, J. M., & Freeman, J. B. (2003). A preliminary examination of treatment for posttraumatic stress disorder in chronic pain patients: A case study. Journal of Traumatic Stress, 16, 451–457.

    PubMed  Article  Google Scholar 

  • Shipherd, J. C., Keyes, M., Jovanovic, T., Ready, D. J., Baltzell, D., Worley, V., et al. (2007). Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain? Journal of Rehabilitation Research and Development, 44, 153–166.

    PubMed  Article  Google Scholar 

  • Shipherd, J. C., Pineles, S. L., Gradus, J. L., & Resick, P. A. (2009). Sexual harassment in the Marines, posttraumatic stress symptoms, and perceived health: Evidence for sex differences. Journal of Traumatic Stress, 22, 3–10.

    PubMed  Article  Google Scholar 

  • Smith, B. N., Shipherd, J. C., Schuster, J. L., Vogt, D. S., King, L. A., & King, D. W. (2011). Posttraumatic stress symptomatology as a mediator of the association between military sexual trauma and post-deployment physical health in women. Journal of Trauma & Dissociation, 12, 275–289.

    Article  Google Scholar 

  • Taft, C. T., Stern, A. S., King, L. A., & King, D. W. (1999). Modeling physical health and functional health status: The role of combat exposure, posttraumatic stress disorder, and personal resource attributes. Journal of Traumatic Stress, 12, 3–23.

    CAS  PubMed  Article  Google Scholar 

  • Wald, J., & Taylor, S. (2006). Trauma to the psyche and soma: A case study of posttraumatic stress disorder and comorbid problems arising from a road traffic collision. Cognitive and Behavioral Practice, 13, 1–7.

    Article  Google Scholar 

  • Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66, 579–592.

    PubMed  Article  Google Scholar 

  • Walsh, K., DiLillo, D., & Scalora, M. J. (2011). The cumulative impact of sexual revictimization on emotion regulation difficulties: An examination of female inmates. Violence Against Women, 17, 1103–1118.

    PubMed Central  PubMed  Article  Google Scholar 

  • Weaver, T. L., Nishith, P., & Resick, P. A. (1998). Prolonged exposure therapy and irritable bowel syndrome: A case study examining the impact of a trauma-focused treatment on a physical condition. Cognitive and Behavioral Practice, 5, 103–122.

    PubMed Central  PubMed  Article  Google Scholar 

  • Weisberg, R. B., Bruce, S. E., Machan, J. T., Kessler, R. C., Culpepper, L., & Keller, M. B. (2002). Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatric Services, 53, 848–854.

    PubMed  Article  Google Scholar 

  • Zoellner, L. A., Goodwin, M. L., & Foa, E. B. (2000). PTSD severity and health perceptions in female victims of sexual assault. Journal of Traumatic Stress, 13, 635–649.

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgments

This study was funded by the National Institute of Mental Health (2-R01-MH51509), in a grant awarded to Patricia A. Resick entitled “Cognitive Processes in PTSD: Treatment II”.

Author information

Authors and Affiliations

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

    Jillian C. Shipherd, Michael Suvak & Patricia A. Resick

  2. Department of Psychiatry, Boston University School of Medicine, 150 South Huntington Ave., Boston, MA, 02130, USA

    Jillian C. Shipherd & Patricia A. Resick

  3. Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA

    Gretchen Clum

  4. Department of Psychology, Suffolk University, 41 Temple Street (D609), Boston, MA, 02114, USA

    Michael Suvak

Authors
  1. Jillian C. Shipherd
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gretchen Clum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Suvak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patricia A. Resick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jillian C. Shipherd.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shipherd, J.C., Clum, G., Suvak, M. et al. Treatment-related reductions in PTSD and changes in physical health symptoms in women. J Behav Med 37, 423–433 (2014). https://doi.org/10.1007/s10865-013-9500-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-013-9500-2

Keywords

  • Health
  • Cognitive behavioral therapy
  • Health habits
  • Allostatic load
  • Posttraumatic stress disorder