Changes in trauma-related cognitions predict subsequent symptom improvement during prolonged exposure in patients with childhood abuse-related PTSD

Behaviour Research and Therapy, vol. 163, pp. 104284

Abstract

Change in negative posttraumatic cognitions is a proposed mechanism through which Prolonged Exposure (PE) leads to symptom reduction of posttraumatic stress disorder (PTSD). A strong case for posttraumatic cognitions as a change mechanism in PTSD treatment can be made by establishing temporal precedence of change in cognitions. The current study examines the temporal relationship between change in posttraumatic cognitions and PTSD symptoms during PE, using the Posttraumatic Cognitions Inventory. Patients with DSM-5 defined PTSD following childhood abuse (N = 83) received a maximum of 14-16 sessions of PE. Clinician-rated PTSD symptom severity and posttraumatic cognitions were assessed at baseline, week 4, 8, and 16 (post-treatment). Using time-lagged mixed effect regression models, we found that posttraumatic cognitions predicted subsequent PTSD symptom improvement. Notably, when using the items of an abbreviated version of the PTCI (PTCI-9), we found a mutual relationship between posttraumatic cognitions and PTSD symptom improvement. Crucially, the effect of change in cognitions on PTSD symptom change was greater than the reverse effect. The current findings corroborate change in posttraumatic cognitions as a change process during PE, but cognitions and symptoms cannot be completely separated. The PTCI-9 is a short instrument that appears suitable to track cognitive change over time.

Authors 8

1. Marike J. Kooistra corresponding Aachen Department of Clinical Psychology

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: m.j.kooistra@fsw.leidenuniv.nl

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

   Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands

2. Chris Maria Hoeboer Aachen Department of Clinical Psychology

   Leiden University

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands. Electronic address: c.m.hoeboer@fsw.leidenuniv.nl

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

3. Danielle A. C. Oprel Aachen Department of Clinical Psychology

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: d.oprel@psyq.nl

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

   Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands

4. Maartje Schoorl Aachen Department of Clinical Psychology

   Leiden University

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Leiden University Treatment Center (LUBEC), Leiden, the Netherlands. Electronic address: m.schoorl@fsw.leidenuniv.nl

   Leiden University Treatment Center (LUBEC), Leiden, the Netherlands

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

5. Willem A. J. van der Does Aachen Department of Clinical Psychology

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands; Leiden University Treatment Center (LUBEC), Leiden, the Netherlands. Electronic address: vanderdoes@fsw.leidenuniv.nl

   Leiden University Treatment Center (LUBEC), Leiden, the Netherlands

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

   Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands

6. Jackie June ter Heide
   Affiliation as printed

   ARQ Centrum'45, Nienoord 5, 1112 XE, Diemen, Oegstgeest, the Netherlands. Electronic address: J.ter.Heide@arq.org

   ARQ Centrum'45, Nienoord 5, 1112 XE, Diemen, Oegstgeest, the Netherlands

7. Agnes van Minnen

   Radboud University Nijmegen

   Affiliation as printed

   PSYTREC, Bronkhorststraat 2, 3723 MB, Bilthoven, the Netherlands; Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands. Electronic address: vanminnen@psytrec.com

   PSYTREC, Bronkhorststraat 2, 3723 MB, Bilthoven, the Netherlands

   Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands

8. Rianne A. de Kleine Aachen Department of Clinical Psychology

   Leiden University · Parnassia Groep · PsyQ

   Affiliation as printed

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands; Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands. Electronic address: r.a.de.kleine@fsw.leidenuniv.nl

   Leiden University, Department of Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands

   Parnassia Groep, PsyQ, Lijnbaan 4, 2512 VA, The Hague, the Netherlands