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Temporary PTSD symptom increases among individuals receiving CPT in a hybrid effectiveness-implementation trial: Potential predictors and association with overall symptom change trajectory. Psychol Trauma 2022 Jul;14(5):853-861

Date

01/24/2020

Pubmed ID

31971424

DOI

10.1037/tra0000545

Scopus ID

2-s2.0-85078842301 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVE: Concern about symptom worsening with trauma-focused treatment may be one factor hindering the implementation of evidence-based treatments for PTSD, like cognitive processing therapy (CPT), despite evidence for their efficacy. Previous studies have examined the frequency and effect of symptom exacerbation, or temporary symptom increases, on outcomes, but primarily in randomized clinical trials.

METHOD: We examined this issue in a community sample of participants receiving CPT from front-line clinicians learning to deliver CPT in a randomized controlled implementation trial of training strategies. Patient participants (n = 183) completed self-report measures of PTSD symptoms at each session.

RESULTS: Most participants (67.3%) experienced at least one temporary symptom increase during CPT (only 1.6% continued to have higher symptoms by the end of treatment). Demographic variables, comorbid conditions (i.e., depression, anxiety, substance use), and baseline PTSD symptom levels did not predict symptom increases. Importantly, symptom increases did not predict treatment noncompletion, posttreatment PTSD symptom levels, or loss of probable PTSD diagnosis. Moreover, growth curve modeling revealed that temporary symptom increases did not predict the trajectory of PTSD symptoms over the course of treatment.

CONCLUSIONS: The rates of symptom increases, which were higher than in previous studies, may be attributed to a routine care sample or to the differences in session timing and measurement. These results add to a nascent literature documenting that symptom increases may be a normal, transient part of treatment that do not impact a patient's ability to have symptom improvement during a course of CPT. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Author List

Larsen SE, Mackintosh MA, La Bash H, Evans WR, Suvak MK, Shields N, Lane JEM, Sijercic I, Monson CM, Wiltsey Stirman S

Author

Sadie E. Larsen PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anxiety
Humans
Stress Disorders, Post-Traumatic
Symptom Flare Up
Treatment Outcome
Veterans