Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.

BACKGROUND: Despite their general effectiveness, 14-50% of individuals do not fully respond to evidence-based treatments for posttraumatic stress disorder (PTSD). Although changes in negative posttrauma cognitions (NPCs) are considered a likely PTSD treatment mechanism, less is known about how NPCs change among individuals who continue to be symptomatic following treatment (non-optimal responders). OBJECTIVE: The objective of this study was to examine NPC change trajectories among individuals who were determined to be non-optimally responsive to intensive PTSD treatment. METHOD: Using a 3-week Cognitive Processing Therapy-based intensive PTSD treatment sample (ITP; N = 243), the present study examined the number of distinct NPC change trajectories among non-optimal responders via Group Based Trajectory Modeling and assessed predictors of non-optimal responders' NPC change trajectory membership. Analyses were replicated in a separate 2-week ITP sample (N = 215). RESULTS: In both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs. CONCLUSIONS: Findings suggest NPC change among non-optimal responders is nuanced and may inform subsequent intervention selection, resulting in testable hypotheses for future research.

Throughout intensive PTSD treatment, non-optimal responders exhibited two distinct negative posttrauma cognition change trajectories: (1) no change, and (2) slow change.Changes in PTSD symptom severity during treatment consistently predicted non-optimal responders' trajectory of change in negative posttrauma cognitions.Additional research is needed to explore how nuances of negative posttrauma cognition change may inform subsequent treatment intervention in initial non-optimal responders.

'Undoing a knot': a qualitative study of massed 1-week Cognitive Processing Therapy.

Introduction: Intensive or massed Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) has been found to result in significant PTSD symptom reductions. However, few studies to date have used qualitative approaches to systematically evaluate client reflections about massed treatment approaches for PTSD. To address this gap, the present study aimed to improve our understanding of trauma survivors' reflections following the completion of 1-week CPT.Method: We conducted semi-structured interviews with seven trauma survivors within 3-months of the completion of 1-week CPT. We used the scissor-and-sort technique to identify themes and subthemes in the qualitative data.Results: Using the scissor-and-sort technique, we generated five main themes and associated subthemes from the data. The main themes were: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Conclusion: Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.

Scant research has examined client reflections about massed treatment approaches for PTSD.Among participants who completed a semi-structured interview about their experiences with 1-week CPT for PTSD, we generated five themes: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.