Heart rate reactivity during trauma recall as a predictor of treatment outcome in cognitive processing therapy for PTSD.

Emotional engagement when recollecting a trauma memory is considered a key element of effective trauma-focused therapy. Research has shown that reduced physiological reactivity during trauma recall is associated with worse treatment outcomes for posttraumatic stress disorder (PTSD), but this has yet to be examined in a cognitively oriented treatment. This study examined whether pretreatment heart rate (HR) reactivity during trauma recall predicts PTSD symptom improvement and treatment dropout during Cognitive Processing Therapy (CPT) for PTSD. Participants were 142 women with PTSD secondary to interpersonal violence enrolled in one of two clinicals trials. HR reactivity reflected the mean increase in HR after listening to two 30-s scripts of the trauma memory prior to treatment. Linear mixed-effects models showed the effect of HR reactivity on change in total PTSD symptoms was not significant, but lower HR reactivity predicted less improvement in reexperiencing and avoidance and was associated with increased dropout. Findings suggest pretreatment physiological reactivity to the trauma memory may be a prognostic indicator of some elements of treatment response in CPT. Results tentatively support the importance of emotional activation during trauma recall in cognitive treatment of PTSD, though more research is needed to clarify how low HR reactivity impacts treatment.

Dissociation as a Distinct Peritraumatic Coping Response: A Preliminary Analysis.

Research examining physiological responses to trauma cues in PTSD has identified a subset of "nonresponders" showing suppressed physiological reactivity. The defense cascade model posits that individuals respond to stressors by progressing through a series of defensive reactions, with nonresponders having advanced to a shutdown response. It remains unclear whether dissociation is at the end of a continuum of passive behavior, indicating full shutdown, or if it comprises a distinct response. The present study aimed to address this uncertainty, using EFA to compare a two-factor (active, passive) and three-factor (active, passive, dissociative) model of defensive responding. Eighty-nine female physical and sexual assault survivors reported their peritraumatic reactions within 1 month of their assault, which were entered into the EFA. The three-factor model was superior, suggesting dissociation is a distinct category of peritraumatic coping. Peritraumatic use of both passive and dissociative coping strategies were each significantly associated with ongoing use of passive coping and increased PTSD symptoms 1-month posttrauma; surprisingly, the use of passive peritraumatic coping strategies was a better indicator than peritraumatic dissociation. The inclusion of depression as a covariate removed the association of passive (but not dissociative) coping with PTSD symptom severity. Active coping use was not significantly associated with any outcome, suggesting that the presence of shutdown responses is more informative than the presence or absence of any active coping. These findings highlight the importance of differentiating peritraumatic coping responses and the need for increased attention to the comparatively neglected topic of passive coping.