Cognition and Psychotherapy in PTSD
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 3/28/2019 |
| Start Date: | April 15, 2019 |
| End Date: | September 30, 2022 |
| Contact: | James C Scott, PhD |
| Email: | James.Scott2de50a@va.gov |
| Phone: | (215) 823-5800 |
Cognition and Psychotherapy in PTSD: Mechanisms and Functional Outcomes
Posttraumatic stress disorder (PTSD) is prevalent among combat Veterans and is a substantial
public health burden. Several psychotherapies, including cognitive processing therapy (CPT)
and prolonged exposure therapy, have been recommended as efficacious for the treatment of
PTSD and are being disseminated nationally in the VA Healthcare System. Yet many individuals
show limited benefit from such treatments. Accumulating evidence indicates that episodic
memory deficits may be one factor limiting psychotherapy treatment efficacy in PTSD. The
proposed study will determine whether verbal memory is a specific predictor of CPT outcomes
in PTSD, including both symptom reductions and functional outcomes. The study will also
determine the pathways by which memory functioning affects treatment outcomes by examining
relationships between memory functioning, treatment engagement, recall of treatment content,
and illness course. More specifically, analyses will examine whether memory for treatment
content affects the relationship between memory functioning and treatment outcomes.
public health burden. Several psychotherapies, including cognitive processing therapy (CPT)
and prolonged exposure therapy, have been recommended as efficacious for the treatment of
PTSD and are being disseminated nationally in the VA Healthcare System. Yet many individuals
show limited benefit from such treatments. Accumulating evidence indicates that episodic
memory deficits may be one factor limiting psychotherapy treatment efficacy in PTSD. The
proposed study will determine whether verbal memory is a specific predictor of CPT outcomes
in PTSD, including both symptom reductions and functional outcomes. The study will also
determine the pathways by which memory functioning affects treatment outcomes by examining
relationships between memory functioning, treatment engagement, recall of treatment content,
and illness course. More specifically, analyses will examine whether memory for treatment
content affects the relationship between memory functioning and treatment outcomes.
Accumulating evidence indicates that memory dysfunction: 1) is prominent in PTSD; and 2)
adversely affects psychotherapy outcomes. Identifying mechanisms underlying the relationship
between memory dysfunction and poor treatment outcomes is crucial to provide empirical
guidance regarding appropriate rehabilitation targets to reduce the impact of cognitive
dysfunction on therapy outcomes.
In this study, the investigators aim to examine the specific effects of verbal memory on both
PTSD symptoms and functional outcomes during CPT (Aim 1); identify the pathways by which
cognitive dysfunction affects psychotherapy treatment response, with a focus on memory for
treatment content and treatment adherence (Aim 2).
To achieve these aims, the investigators will enroll 105 Veterans with PTSD, who will
complete a standard course of cognitive processing therapy (CPT) and complete longitudinal
assessments of PTSD symptoms, functional status, treatment adherence, and memory for
treatment content. This study does not randomize participants to treatment since all
participants will be initiating CPT.
Recruitment. Participants will primarily be drawn from clinical referrals for PTSD therapy at
the Corporal Michael J. Crescenz VA Medical Center (CMC VAMC) or its Community Based
Outpatient Clinics (CBOCs).
Procedures. Participants will provide written informed consent and undergo intake screening.
Major assessments will be conducted with participants at study entry (baseline), after
session 6, and after session 12 (critical endpoint assessment) of CPT.
Baseline Visit (180-240 mins). Baseline procedures (before starting CPT) include diagnostic
interviews, questionnaires assessing mood and functioning, a neurocognitive assessment, and
additional memory measures. Participants will complete structured interview assessments for
psychiatric conditions including PTSD, stressful life events, sociodemographics and medical
history, and traumatic brain injury. Self-report assessments of mood, functional status
(e.g., social adjustment), combat exposure, and behavioral functioning will also be
administered. The neurocognitive assessment will include conventional neuropsychological
tests and tests drawn from the Penn Computerized Neurocognitive Battery to assess multiple
cognitive domains including memory, attention, speed of information processing, executive
functioning, social cognition, and an IQ estimate. Additional experimental measures of memory
processes from cognitive science will also be administered.
Psychotherapy. After the baseline visit, participants will begin a standard course of CPT (12
sessions) following standardized protocols (Resick et al, 2008) with the investigators' study
therapists, who will all have extensive, formalized training in CPT and be supervised by an
expert in CPT. Therapists will be blinded to scores on cognitive measures. After the initial
CPT session, participants will complete questionnaires of treatment expectancy and
self-efficacy (10 mins). At every following CPT visit, patients will complete brief
questionnaires of adherence and application of treatment, depression symptoms, and suicide
risk.
Mid-Treatment Assessments (20-30 mins). At CPT sessions 4, 6, 8, and 12 (end), participants
will complete measures of memory for treatment content, treatment expectancy, and brief
re-assessments of PTSD, mood, and functioning.
End of Treatment Assessment (120-180 mins). At the end of treatment, a final visit will
consist of questionnaires and interviews to assess symptoms of PTSD, mood, functioning,
cognitive functioning and memory for treatment content.
Although not a clinical trial, the investigators will examine individual change in symptoms
at treatment end. Participants who drop out and are not able to be re-engaged will be
contacted by study staff and asked to participate in a final assessment. After this visit is
complete (or if the participant refuses), Veterans will be offered additional treatment at
CMC VAMC as appropriate, with a warm handoff from study staff to the clinical team. Treatment
non-responders, defined as participants displaying less than a 10-point reduction in CAPS
Scores at follow-up, will also be referred for further treatment.
adversely affects psychotherapy outcomes. Identifying mechanisms underlying the relationship
between memory dysfunction and poor treatment outcomes is crucial to provide empirical
guidance regarding appropriate rehabilitation targets to reduce the impact of cognitive
dysfunction on therapy outcomes.
In this study, the investigators aim to examine the specific effects of verbal memory on both
PTSD symptoms and functional outcomes during CPT (Aim 1); identify the pathways by which
cognitive dysfunction affects psychotherapy treatment response, with a focus on memory for
treatment content and treatment adherence (Aim 2).
To achieve these aims, the investigators will enroll 105 Veterans with PTSD, who will
complete a standard course of cognitive processing therapy (CPT) and complete longitudinal
assessments of PTSD symptoms, functional status, treatment adherence, and memory for
treatment content. This study does not randomize participants to treatment since all
participants will be initiating CPT.
Recruitment. Participants will primarily be drawn from clinical referrals for PTSD therapy at
the Corporal Michael J. Crescenz VA Medical Center (CMC VAMC) or its Community Based
Outpatient Clinics (CBOCs).
Procedures. Participants will provide written informed consent and undergo intake screening.
Major assessments will be conducted with participants at study entry (baseline), after
session 6, and after session 12 (critical endpoint assessment) of CPT.
Baseline Visit (180-240 mins). Baseline procedures (before starting CPT) include diagnostic
interviews, questionnaires assessing mood and functioning, a neurocognitive assessment, and
additional memory measures. Participants will complete structured interview assessments for
psychiatric conditions including PTSD, stressful life events, sociodemographics and medical
history, and traumatic brain injury. Self-report assessments of mood, functional status
(e.g., social adjustment), combat exposure, and behavioral functioning will also be
administered. The neurocognitive assessment will include conventional neuropsychological
tests and tests drawn from the Penn Computerized Neurocognitive Battery to assess multiple
cognitive domains including memory, attention, speed of information processing, executive
functioning, social cognition, and an IQ estimate. Additional experimental measures of memory
processes from cognitive science will also be administered.
Psychotherapy. After the baseline visit, participants will begin a standard course of CPT (12
sessions) following standardized protocols (Resick et al, 2008) with the investigators' study
therapists, who will all have extensive, formalized training in CPT and be supervised by an
expert in CPT. Therapists will be blinded to scores on cognitive measures. After the initial
CPT session, participants will complete questionnaires of treatment expectancy and
self-efficacy (10 mins). At every following CPT visit, patients will complete brief
questionnaires of adherence and application of treatment, depression symptoms, and suicide
risk.
Mid-Treatment Assessments (20-30 mins). At CPT sessions 4, 6, 8, and 12 (end), participants
will complete measures of memory for treatment content, treatment expectancy, and brief
re-assessments of PTSD, mood, and functioning.
End of Treatment Assessment (120-180 mins). At the end of treatment, a final visit will
consist of questionnaires and interviews to assess symptoms of PTSD, mood, functioning,
cognitive functioning and memory for treatment content.
Although not a clinical trial, the investigators will examine individual change in symptoms
at treatment end. Participants who drop out and are not able to be re-engaged will be
contacted by study staff and asked to participate in a final assessment. After this visit is
complete (or if the participant refuses), Veterans will be offered additional treatment at
CMC VAMC as appropriate, with a warm handoff from study staff to the clinical team. Treatment
non-responders, defined as participants displaying less than a 10-point reduction in CAPS
Scores at follow-up, will also be referred for further treatment.
Inclusion Criteria:
- DSM-5 criteria for PTSD via the Clinician Administered PTSD Scale (CAPS-5)
- Willing to initiate CPT
Exclusion Criteria:
- Substance use disorder (moderate or above) not in remission for >1 mo
- Severe psychiatric illness (e.g., psychosis)
- Significant current suicidal or homicidal intent, including a specific plan Dementia,
neurological disorder, or severe TBI (i.e., loss of consciousness > 24h)
- Inability to speak or read English
We found this trial at
1
site
3900 Woodland Avenue
Philadelphia, Pennsylvania 19104
Philadelphia, Pennsylvania 19104
Principal Investigator: James C. Scott, PhD
Phone: 215-823-6024
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