Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.

Author: Zalta AK1,2, Held P3, Smith DL4, Klassen BJ3, Lofgreen AM3, Normand PS3, Brennan MB3, Rydberg TS3, Boley RA3, Pollack MH3, Karnik NS3
1Rush University Medical Center, Chicago, IL, 60612, USA. azalta@uci.edu.
2University of California, Irvine, Irvine, CA, 92697, USA. azalta@uci.edu.
3Rush University Medical Center, Chicago, IL, 60612, USA.
4Olivet Nazarene University, Bourbonnais, IL, 60914, USA.
Conference/Journal: BMC Psychiatry.
Date published: 2018 Jul 27
Other: Volume ID: 18 , Issue ID: 1 , Pages: 242 , Special Notes: doi: 10.1186/s12888-018-1816-6. , Word Count: 304

BACKGROUND: Intensive delivery of evidence-based treatment for posttraumatic stress disorder (PTSD) is becoming increasingly popular for overcoming barriers to treatment for veterans. Understanding how and for whom these intensive treatments work is critical for optimizing their dissemination. The goals of the current study were to evaluate patterns of PTSD and depression symptom change over the course of a 3-week cohort-based intensive outpatient program (IOP) for veterans with PTSD, examine changes in posttraumatic cognitions as a predictor of treatment response, and determine whether patterns of treatment outcome or predictors of treatment outcome differed by sex and cohort type (combat versus military sexual trauma [MST]).

METHOD: One-hundred ninety-one veterans (19 cohorts: 12 combat-PTSD cohorts, 7 MST-PTSD cohorts) completed a 3-week intensive outpatient program for PTSD comprised of daily group and individual Cognitive Processing Therapy (CPT), mindfulness, yoga, and psychoeducation. Measures of PTSD symptoms, depression symptoms, and posttraumatic cognitions were collected before the intervention, after the intervention, and approximately every other day during the intervention.

RESULTS: Pre-post analyses for completers (N = 176; 92.1% of sample) revealed large reductions in PTSD (d = 1.12 for past month symptoms and d = 1.40 for past week symptoms) and depression symptoms (d = 1.04 for past 2 weeks). Combat cohorts saw a greater reduction in PTSD symptoms over time relative to MST cohorts. Reduction in posttraumatic cognitions over time significantly predicted decreases in PTSD and depression symptom scores, which remained robust to adjustment for autocorrelation.

CONCLUSION: Intensive treatment programs are a promising approach for delivering evidence-based interventions to produce rapid treatment response and high rates of retention. Reductions in posttraumatic cognitions appear to be an important predictor of response to intensive treatment. Further research is needed to explore differences in intensive treatment response for veterans with combat exposure versus MST.

KEYWORDS: Cognitive processing therapy; Combat; Intensive treatment; Military; Military sexual trauma; Mindfulness; Posttraumatic stress disorder; Veteran

PMID: 30053860 DOI: 10.1186/s12888-018-1816-6