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

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.

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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.

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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”.

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Correspondence to Jillian C. Shipherd.

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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

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Keywords

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