Change in posttraumatic stress disorder-related thoughts during treatment: Do thoughts drive change when pills are involved?

• Type of Material: Article
• Authors: Sheila Rauch, Emory University; Myra H Kim, VA Ann Arbor Healthcare System; Margaret R Venners, VA Ann Arbor Healthcare System; Katherine E Porter, VA Ann Arbor Healthcare System; Sonya B Norman, National Center for PTSD, 215 N. Main Street, White River Junction, VT; Naomi M Simon, Massachusetts General Hospital; Barbara Rothbaum, Emory University; Peter W Tuerk, University of Virginia; Ron E Acierno, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC; Eric Bui, Massachusetts General Hospital; Corey Powell, University of Michigan; Erin R Smith, VA Ann Arbor Healthcare System; Elizabeth Goetter, Massachusetts General Hospital; Lauren B McSweeney, VA Boston Healthcare System
• Language: English
• Date: 2021-12-31
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 International Society for Traumatic Stress Studies.
• Final Published Version (URL): http://dx.doi.org/10.1002/jts.22762
• Title of Journal or Parent Work: JOURNAL OF TRAUMATIC STRESS
• Volume: 35
• Issue: 2
• Start Page: 496
• End Page: 507
• Grant/Funding Information: This work was supported by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command (MRMC; Randomized Controlled Trial of Sertraline, Prolonged Exposure Therapy, and Their Combination in OEF/OIF Combat Veterans with PTSD; (Award #W81XWH-11-1-0073; PI: Rauch); the National Center for Advancing Translational Sciences of the National Institutes of Health (Award #UL1TR000433).; This material is the result of work supported with resources and the use of facilities at Massachusetts General Hospital, the VA Ann Arbor Healthcare System, Ralph H. Johnson VA Medical Center, and VA San Diego Healthcare System. The views expressed in this article presentation are solely those of the author(s) and do not reflect an endorsement by or the official policy of the Department of Veterans Affairs, Department of Defense, or the U.S. Government, or the official views of the National Institutes of Health.
• Keywords: ATTRIBUTIONS; Life Sciences & Biomedicine; Psychology; SERTRALINE; Psychology, Clinical; IMPROVEMENT; THERAPY; PSYCHOTHERAPY; PROLONGED EXPOSURE; Social Sciences; Science & Technology; Psychiatry; EFFICACY; AUGMENTATION; MEDICATION; MECHANISMS

Abstract

Posttraumatic negative thoughts about one's self and the world are related to posttraumatic stress disorder (PTSD) symptom severity and change in cognitive behavioral treatment (CBT), but little is known about this association when CBT is delivered with medication. The current study presents a planned comparison of changes in negative posttraumatic thoughts during (a) prolonged exposure (PE) plus pill placebo (PE+PLB), (b) sertraline plus enhanced medication management (SERT+EMM), and (c) PE plus sertraline (PE+SERT) as part of a randomized clinical trial in a sample of 176 veterans. Lagged regression modeling revealed that change in posttraumatic negative thoughts was associated with PTSD symptom change in the conditions in which participants received sertraline, ds = 0.14–0.25, ps = 0.04–.001). However, contrary to previous research, the models that started with symptom change were also statistically significant, d = 0.23, p <.001, for the lagged effect of symptoms on negative thoughts about self in the SERT+EMM condition, indicating a bidirectional association between such thoughts and PTSD symptoms. In the PE+PLB condition, no significant association between posttraumatic thoughts and PTSD symptoms emerged in either direction. These results suggest that the previously demonstrated role of change in posttraumatic thoughts leading to PTSD symptom reduction in PE may be altered when combined with pill administration, either active or placebo.