BACKGROUND: Understanding cognitive and biological mechanisms of PTSD treatment can help refine treatments and increase rates of response. METHODS:Thirty-six veterans with PTSD were randomly assigned to receive Prolonged exposure therapy (PE) or Present-Centered therapy (PCT). We examined symptoms, trauma-related cognitions, and two indices of HPAaxis function (cortisol awakening response and cortisol response to a script-driven imagery task). RESULTS:Thirty veterans started treatment and 26 completed. PE resulted in significantly more symptom reduction than PCT (P = .008). High treatment responders collapsed across treatments showed nominally higher cortisol levels measured at pretreatment 30 min after trauma script exposure compared to low responders (P = .08). At midtreatment, high treatment responders showed higher cortisol levels throughout the imagery task (Ps = .03-.04). There were no differences between high and low treatment responders at posttreatment. Thoughts of incompetence (F (1.6, 35.8) = 16.8, P = .000) and a dangerous world (F (1.3, 29.9) = 8.2, P = .004) significantly improved over time in high treatment responders but showed no change in low responders. Script-associated cortisol response prior to treatment and reductions in thoughts of incompetence accounted for 83% of the variance in reductions in PTSD severity with PE. CONCLUSIONS: Both increased cortisol response to personal trauma script prior to PTSD therapy and reductions in cognitive symptoms of PTSD were significantly and uniquely related to reductions in the core symptoms of PTSD in PE. However, contrary to our hypotheses, cortisol measures were not related to cognitive changes.
RCT Entities:
BACKGROUND: Understanding cognitive and biological mechanisms of PTSD treatment can help refine treatments and increase rates of response. METHODS: Thirty-six veterans with PTSD were randomly assigned to receive Prolonged exposure therapy (PE) or Present-Centered therapy (PCT). We examined symptoms, trauma-related cognitions, and two indices of HPA axis function (cortisol awakening response and cortisol response to a script-driven imagery task). RESULTS: Thirty veterans started treatment and 26 completed. PE resulted in significantly more symptom reduction than PCT (P = .008). High treatment responders collapsed across treatments showed nominally higher cortisol levels measured at pretreatment 30 min after trauma script exposure compared to low responders (P = .08). At midtreatment, high treatment responders showed higher cortisol levels throughout the imagery task (Ps = .03-.04). There were no differences between high and low treatment responders at posttreatment. Thoughts of incompetence (F (1.6, 35.8) = 16.8, P = .000) and a dangerous world (F (1.3, 29.9) = 8.2, P = .004) significantly improved over time in high treatment responders but showed no change in low responders. Script-associated cortisol response prior to treatment and reductions in thoughts of incompetence accounted for 83% of the variance in reductions in PTSD severity with PE. CONCLUSIONS: Both increased cortisol response to personal trauma script prior to PTSD therapy and reductions in cognitive symptoms of PTSD were significantly and uniquely related to reductions in the core symptoms of PTSD in PE. However, contrary to our hypotheses, cortisol measures were not related to cognitive changes.
Authors: Adele M Hayes; Carly Yasinski; Damion Grasso; C Beth Ready; Elizabeth Alpert; Thomas McCauley; Charles Webb; Esther Deblinger Journal: Behav Ther Date: 2016-06-25
Authors: Sheila A M Rauch; Anthony King; H Myra Kim; Corey Powell; Nirmala Rajaram; Margaret Venners; Naomi M Simon; Mark Hamner; Israel Liberzon Journal: Psychoneuroendocrinology Date: 2020-05-15 Impact factor: 4.905
Authors: Lívia Maria Bolsoni; Thiago Dornela Apolinário da Silva; Silvana Maria Quintana; Margaret de Castro; José Alexandre Crippa; Antonio Waldo Zuardi Journal: Perm J Date: 2019-09-27
Authors: Matthew B Young; Seth D Norrholm; Lara M Khoury; Tanja Jovanovic; Sheila A M Rauch; Collin M Reiff; Boadie W Dunlop; Barbara O Rothbaum; Leonard L Howell Journal: Psychopharmacology (Berl) Date: 2017-07-24 Impact factor: 4.530
Authors: Seth Davin Norrholm; Tanja Jovanovic; Maryrose Gerardi; Kathryn G Breazeale; Matthew Price; Michael Davis; Erica Duncan; Kerry J Ressler; Bekh Bradley; Albert Rizzo; Peter W Tuerk; Barbara O Rothbaum Journal: Behav Res Ther Date: 2016-05-07
Authors: Joseph K Carpenter; Leigh A Andrews; Sara M Witcraft; Mark B Powers; Jasper A J Smits; Stefan G Hofmann Journal: Depress Anxiety Date: 2018-02-16 Impact factor: 6.505