The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting

• Published in: Psychotherapy and psychosomatics 2021, Vol.90 (6), p.386-402
• Main Authors: Woud, Marcella L., Blackwell, Simon E., Shkreli, Lorika, Würtz, Felix, Cwik, Jan Christopher, Margraf, Jürgen, Holmes, Emily A., Steudte-Schmiedgen, Susann, Herpertz, Stephan, Kessler, Henrik
• Format: Article
• Language: English
• Subjects: Clinical trials; Cognition; Cognitive bias modification; Comparative analysis; Corticosteroids; Cortisol; Double-Blind Method; Dysfunctional appraisals; Humans; Hydrocortisone; Innovations; Inpatients; Intrusive memories; Mediation; Memory; Post-traumatic stress disorder; Posttraumatic stress disorder; Set (Psychology); Stress Disorders, Post-Traumatic - therapy
• ISSN: 0033-3190; 1423-0348; 1423-0348
• DOI: 10.1159/000514166

Abstract Introduction: Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. Objective: We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. Methods: We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. Results: In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82–1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.92, 95% CI 0.46–1.39) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.63, 95% CI 0.18–1.08), but not for long-term cortisol concentrations (d = 0.25, 95% CI –0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. Conclusions: Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.