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BMC Psychiatry
Published in: BMC Psychiatry 1/2018

Open Access 01-12-2018 | Research article

Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD

Authors: Alyson K. Zalta, Philip Held, Dale L. Smith, Brian J. Klassen, Ashton M. Lofgreen, Patricia S. Normand, Michael B. Brennan, Thad S. Rydberg, Randy A. Boley, Mark H. Pollack, Niranjan S. Karnik

Published in: BMC Psychiatry | Issue 1/2018

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Abstract

Background

Intensive delivery of evidence-based treatment for posttraumatic stress disorder (PTSD) is becoming increasingly popular for overcoming barriers to treatment for veterans. Understanding how and for whom these intensive treatments work is critical for optimizing their dissemination. The goals of the current study were to evaluate patterns of PTSD and depression symptom change over the course of a 3-week cohort-based intensive outpatient program (IOP) for veterans with PTSD, examine changes in posttraumatic cognitions as a predictor of treatment response, and determine whether patterns of treatment outcome or predictors of treatment outcome differed by sex and cohort type (combat versus military sexual trauma [MST]).

Method

One-hundred ninety-one veterans (19 cohorts: 12 combat-PTSD cohorts, 7 MST-PTSD cohorts) completed a 3-week intensive outpatient program for PTSD comprised of daily group and individual Cognitive Processing Therapy (CPT), mindfulness, yoga, and psychoeducation. Measures of PTSD symptoms, depression symptoms, and posttraumatic cognitions were collected before the intervention, after the intervention, and approximately every other day during the intervention.

Results

Pre-post analyses for completers (N = 176; 92.1% of sample) revealed large reductions in PTSD (d = 1.12 for past month symptoms and d = 1.40 for past week symptoms) and depression symptoms (d = 1.04 for past 2 weeks). Combat cohorts saw a greater reduction in PTSD symptoms over time relative to MST cohorts. Reduction in posttraumatic cognitions over time significantly predicted decreases in PTSD and depression symptom scores, which remained robust to adjustment for autocorrelation.

Conclusion

Intensive treatment programs are a promising approach for delivering evidence-based interventions to produce rapid treatment response and high rates of retention. Reductions in posttraumatic cognitions appear to be an important predictor of response to intensive treatment. Further research is needed to explore differences in intensive treatment response for veterans with combat exposure versus MST.
Appendix
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Footnotes
1
Quadratic time effects were non-significant for both PCL and PHQ outcomes when including lagged time-varying PTCI as a covariate, and were thus excluded from model estimates.
 
2
To examine clustering by cohort, three-level mixed models were also examined. However, because trends and significance patterns for time and covariates of interest were nearly identical, and due to our interest in including cohort type (MST and combat), only two-level models were reported here.
 
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Metadata
Title
Evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD
Authors
Alyson K. Zalta
Philip Held
Dale L. Smith
Brian J. Klassen
Ashton M. Lofgreen
Patricia S. Normand
Michael B. Brennan
Thad S. Rydberg
Randy A. Boley
Mark H. Pollack
Niranjan S. Karnik
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-018-1816-6

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