Cognitive and affective predictors of treatment outcome in cognitive processing therapy and prolonged exposure for posttraumatic stress disorder

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Abstract

This study examined cognitive and affective predictors of treatment dropout and treatment efficacy in Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) for PTSD. Study participants were women with PTSD from a sexual assault who received at least one session of either treatment (n = 145) as part of a randomized clinical trial. Results revealed that younger age, lower intelligence, and less education were associated with higher treatment dropout, whereas higher depression and guilt at pretreatment were associated with greater improvement in PTSD symptomatology. Results by treatment condition indicated that women with higher anger at pretreatment were more likely to dropout of PE and that older women in PE and younger women in CPT had the best overall outcomes. These findings have implications for efforts to enhance treatment efficacy and retention in CBT treatment protocols.

Section snippets

Participants

Procedures are described in detail in Resick et al. (2002). Briefly, female participants were included if they had experienced at least one discrete incident of completed rape (oral, anal, or vaginal) in childhood or adulthood, they met criteria for PTSD, and at least three months had passed since their most recent trauma. Exclusion criteria from the study included apparent current psychosis, suicidal intent, current self-injurious behavior, current substance dependence, illiteracy, or ongoing

Predictors of treatment dropout

In the CPT group, 16 women (22.2%) dropped out of treatment; 17 women (23.3%) dropped out of PE. The dropouts in the CPT condition completed a median of 4 sessions out of 12 (range 1–8; M = 3.81, SD = 1.98) and the dropouts in the PE condition completed a median of 3 sessions out of 9 (range 1–6; M = 2.88, SD = 1.45). These findings indicate that approximately half of the individuals who dropped out of treatment in both conditions completed less than one-third of the therapy sessions. All but

Discussion

This study examined potential predictors of treatment outcome in two evidence-based treatments for PTSD: CPT and PE. We hypothesized that several cognitive and affective variables would be related to both treatment dropout as well as treatment efficacy. Overall, results supported our hypothesis that cognitive variables would influence dropout; specifically, both lower intelligence and education were related to a greater likelihood of premature termination. However, in contrast with

Acknowledgments

This research was supported by Grant NIH-1 RO1-MH51509 from the National Institute of Mental Health awarded to Patricia A. Resick.

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