Cognitive change predicts symptom reduction with cognitive therapy for posttraumatic stress disorder
Open accessAbstract
OBJECTIVE: There is a growing body of evidence for the effectiveness of trauma-focused cognitive behavior therapy (TF-CBT) for posttraumatic stress disorder (PTSD), but few studies to date have investigated the mechanisms by which TF-CBT leads to therapeutic change. Models of PTSD suggest that a core treatment mechanism is the change in dysfunctional appraisals of the trauma and its aftermath. If this is the case, then changes in appraisals should predict a change in symptoms. The present study investigated whether cognitive change precedes symptom change in Cognitive Therapy for PTSD, a version of TF-CBT. METHOD: The study analyzed weekly cognitive and symptom measures from 268 PTSD patients who received a course of Cognitive Therapy for PTSD, using bivariate latent growth modeling. RESULTS: Results showed that (a) dysfunctional trauma-related appraisals and PTSD symptoms both decreased significantly over the course of treatment, (b) changes in appraisals and symptoms were correlated, and (c) weekly change in appraisals significantly predicted subsequent reduction in symptom scores (both corrected for the general decrease over the course of therapy). Changes in PTSD symptom severity did not predict subsequent changes in appraisals. CONCLUSIONS: The study provided preliminary evidence for the temporal precedence of a reduction in negative trauma-related appraisals in symptom reduction during trauma-focused CBT for PTSD. This supports the role of change in appraisals as an active therapeutic mechanism.
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A study of trauma-focused CBT for PTSD found that weekly decreases in dysfunctional trauma-related appraisals predicted subsequent reduction in weekly PTSD symptoms.
“A recent study of trauma-focused CBT for posttraumatic stress disorder found a unidirectional relationship of weekly decreases in dysfunctional trauma related appraisals predicting subsequent reduction in weekly PTSD symptoms (Kleim et al., 2013).”
From Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder (2017) · cites this paper as Kleim et al., 2013
There is growing evidence that during CBT earlier changes in cognitive processes may impact subsequent decreases in social anxiety symptoms.
“Thus, there is growing evidence that during CBT earlier changes in cognitive processes may impact subsequent decreases in social anxiety symptoms.”
From Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder (2017) · cites this paper as Kleim et al., 2013
Catastrophic appraisals decline after successful therapy.
“as well as of their decline after successful therapy 106 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [106]
There is abundant evidence of the predictive role of catastrophic appraisals in the development and maintenance of PTSD.
“there is abundant evidence of the predictive role of catastrophic appraisals in the development and maintenance of PTSD”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [106]
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Self-citation
- Authors
- Kleim, B., Grey, N., Wild, J., Nussbeck, F. W., Stott, R., Hackmann, A., Clark, D. M., & Ehlers, A.
- Affiliations
- King's College London (GB)
- University of Zurich (CH)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2013-06
- Volume
- 81
- Issue
- 3
- Pages
- 383-393
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3665307
- OpenAlex
- W2122872879
- Cited by
- 235
- References
- 64
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 24 · 2023: 20 · 2022: 12 · 2021: 18 · 2020: 29 · 2019: 34 · 2018: 15 · 2017: 15 · 2016: 20 · 2015: 17 · 2014: 9 · 2013: 5
- FWCI
- 11.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- KOPS (University of Konstanz) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- PUB – Publications at Bielefeld University (Bielefeld University) (submittedVersion)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Wellcome Trust (069777)
- National Institute for Health Research Biomedical Research Centre for Mental Health
- King’s College London
- National Institute for Health Research Oxford Cognitive Health Clinical Research Facility
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, trauma-focused cognitive behavioral therapy, therapeutic mechanisms, cognitive change, symptom change, temporal precedence
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Models, Psychological, Predictive Value of Tests, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome
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