Changes in positive and negative affect following prolonged exposure for PTSD comorbid with alcohol use disorder: Secondary analysis of a randomized clinical trial

Abstract

Many individuals with posttraumatic stress disorder (PTSD) report increased negative affect (NA) and decreased positive affect (PA). Little is known about whether treatments for PTSD improve PA. We conducted a secondary analysis of a randomized clinical trial comparing integrated exposure therapy (I-PE) to integrated coping skills therapy (I-CS) for comorbid PTSD and alcohol use disorder (AUD). Veterans (N = 119) were randomized to 12–16 weeks of I-PE (n = 63) or I-CS (n = 56) and completed PA and NA measures at baseline, post-treatment, and 3- and 6-month follow-up. The analysis sample included 80 (67%) participants with the required data. A significantly greater proportion of the full sample met “clinical” levels (i.e., ±0.5 SD away from a general population mean) for NA than PA at baseline, but not at post-treatment. At post-treatment, the I-PE group demonstrated significantly greater change in NA than PA. Change in NA compared to PA did not significantly differ in the I-CS group. In the full sample, NA reduction was significantly larger than PA elevation post-treatment; change in NA, but not PA, was independently associated with symptom changes. Results provide an initial evaluation of treatment efficacy in concurrently repairing PA and NA and suggest room to improve both in individuals with PTSD and AUD.