Abstract
BackgroundPost-traumatic stress disorder (PTSD) is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy (CPT), are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in CPT in some individuals with PTSD.Methods and AnalysisHere, we present a protocol describing the Cognition and PsychoTherapy in PTSD (CPTPTSD) study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD (NCT# 03641924). The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: (1) examining the specificity of memory effects on treatment response; (2) exploring how baseline cognitive functioning impacts functional outcomes; and (3) examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory.DiscussionIf successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD.
Highlights
Individuals who experience combat, sexual trauma, and other traumatic events are at higher risk for developing post-traumatic stress disorder (PTSD)
Using a 5% alpha-level, our attrition reduced sample of 105 yields 80% power for scenarios with medium or larger effects for the effect of verbal learning on a mediator, and the effect of the mediator on the outcome. This protocol paper describes an observational prospective study to examine the relationship between neurocognitive mechanisms and Cognitive Processing Therapy (CPT) outcomes in a sample of veterans with PTSD
Secondary analyses of PTSD psychotherapy trials have consistently shown that verbal memory impacts treatment outcomes across settings and samples
Summary
Individuals who experience combat, sexual trauma, and other traumatic events are at higher risk for developing post-traumatic stress disorder (PTSD). Within VA, roughly 20% of Veterans who endorse military sexual trauma (MST) have a diagnosis of PTSD (Gilmore et al, 2016). PTSD is frequently chronic (Kessler et al, 1995) and is often associated with impaired functioning (Byers et al, 2014). The above considerations illustrate the urgent need to develop effective treatments for PTSD. Post-traumatic stress disorder (PTSD) is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy (CPT), are effective in treating PTSD, a fair proportion of individuals show limited benefit from such treatments. Memory dysfunction may limit treatment gains in CPT in some individuals with PTSD
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