Changes in guilt cognitions in intensive PTSD treatment among veterans who experienced military sexual trauma or combat trauma.

Unresolved trauma-related guilt has been identified as a factor that can intensify posttraumatic stress disorder PTSD symptomology and is associated with many negative mental health outcomes. Evidence-based treatments, such as Cognitive Processing Therapy (CPT), have been shown to successfully reduce trauma-related guilt. However, less is known about how trauma-related guilt cognitions change over the course of PTSD treatment and, more specifically, intensive PTSD treatments. The current study examined whether guilt cognitions (i.e., hindsight bias/responsibility, insufficient justification, wrongdoing) changed over the course of a 3-week CPT-based intensive treatment program (ITP), whether guilt cognition changes predicted PTSD and depression symptom reductions over time, and whether guilt cognition changes and their association with PTSD and depression symptom changes differed based on whether they worked on combat trauma or military sexual trauma. Data were collected from 360 veterans enrolled in a 3-week ITP. Results from linear mixed effects models suggested that trauma-related guilt cognitions reduced significantly over the course of treatment (ps < .001), changes in wrongdoing (p = .032) and hindsight bias/responsibility (p = .003) were significant predictors of PTSD symptom reductions and hindsight bias/responsibility (p = .032) was the only significant predictor of depression symptom reduction. Overall differences in guilt cognitions over time based on cohort type were only significant for insufficient justification (p = .001). These findings suggest that changes in hindsight bias/responsibility demonstrated the largest effect size (d = 0.1.14), implying that hindsight bias/responsibility may be one of the most important guilt cognitions to target. This study also highlights the importance of the relationship between trauma-related guilt and PTSD and depression symptoms. Future research should examine whether changes in guilt cognitions precede changes in PTSD and depression symptoms, and if addressing certain types of guilt cognitions is more important to achieving PTSD and depression symptom reductions.

Building strong therapeutic relationships quickly: The effect of the perceived working alliance on veterans' intensive PTSD treatment outcomes.

Intensive treatment programs (ITPs) are successful at reducing posttraumatic stress disorder (PTSD) and depression symptoms in veterans. However, the role of the working alliance in the context of ITPs is largely unexplored. The purpose of this study was to examine veteran-rated working alliance with their individual cognitive processing therapy (CPT) provider as a predictor of changes in PTSD and depression symptoms as well as negative posttrauma cognitions in two unique ITP formats. Data were collected from 128 veterans who completed a 2-week ITP, involving 2 × individual CPT/day, as well as 73 veterans who completed a 3-week ITP, involving 1 × group CPT/day and 1 × individual CPT/day. Both ITPs included adjunctive wellness, skills, and psychoeducation services in addition to CPT. Linear mixed-effects models were used to determine whether changes in working alliance predicted changes in PTSD and depression symptoms. Stronger veteran-reported working alliance with their individual CPT therapist, most notably agreement on tasks, predicted significant reductions in both the 2-week and 3-week programs in PTSD (ps = .012 and .002, respectively) and depression symptoms (ps = .009 and .007, respectively) and negative posttrauma cognitions (ps = .009 and .016, respectively). These results highlight the importance of veterans' perceived working alliance with their individual treatment therapists in ITPs. Results suggest that a strong working alliance that is meaningful for treatment outcomes can be developed quickly despite the brevity of this intensive treatment format. Future research should examine ways to facilitate the development of a strong working alliance prior to or as early as possible in ITPs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Treating posttraumatic stress disorder at home in a single week using 1-week virtual massed cognitive processing therapy.

Posttraumatic stress disorder (PTSD) treatments are increasingly delivered in massed formats and have shown comparable results to standard, weekly treatment. To date, massed cognitive processing therapy (CPT), delivered daily, has been delivered primarily in combination with adjunctive services and among veteran populations, but it has not been rigorously evaluated as a standalone intervention. The present study evaluated 1-week massed CPT delivered virtually (i.e., via telehealth) to a community sample of trauma-exposed individuals (N = 24). Using a single-arm open-label design, participants received CPT twice per day for 5 days. The results indicated that most participants completed treatment (n = 23, 95.8%), and no adverse events were reported. Participants exhibited large reductions in clinician-rated, d = 2.01, and self-reported PTSD symptoms, d = 2.55, as well as self-reported depressive symptoms, d = 1.46. On average, participants reported a 5-point PTSD symptom reduction and 1-point reduction in depressive symptoms for each treatment day. Reductions in PTSD and depressive symptoms were maintained at 3-month follow-up. Overall, 1-week massed CPT delivered virtually was shown to be feasible and to result in rapid symptom reductions that were sustained over time. Virtual massed CPT has the potential to increase access to effective treatments and help trauma survivors restore aspects of their lives in short amounts of time.