Temporary PTSD Symptom Increases Among Individuals Receiving CPT in a Hybrid Effectiveness-Implementation Trial: Potential Predictors and Association With Overall Symptom Change Trajectory

Sadie E. Larsen, Margaret Anne Mackintosh, Heidi L. La Bash, Wyatt R. Evans, Michael K. Suvak, Norman Shields, Jeanine E.M. Lane, Iris Sijercic, Candice M. Monson, Shannon Wiltsey Stirman

Research output: Contribution to journalArticlepeer-review

6 Scopus 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.

Original languageEnglish (US)
JournalPsychological Trauma: Theory, Research, Practice, and Policy
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Cognitive processing therapy
  • Posttraumatic stress disorder
  • Symptom exacerbations
  • Trauma-focused treatment
  • Treatment dropout

ASJC Scopus subject areas

  • Social Psychology
  • Clinical Psychology

Fingerprint

Dive into the research topics of 'Temporary PTSD Symptom Increases Among Individuals Receiving CPT in a Hybrid Effectiveness-Implementation Trial: Potential Predictors and Association With Overall Symptom Change Trajectory'. Together they form a unique fingerprint.

Cite this