The Relationship between Posttraumatic and Depressive Symptoms during Prolonged Exposure with and without Cognitive Restructuring for the Treatment of Posttraumatic Stress Disorder

• Published in: Journal of consulting and clinical psychology 2013-06, Vol.81 (3), p.375-382
• Main Authors: Aderka, Idan M, Gillihan, Seth J, McLean, Carmen P, Foa, Edna B
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; Assault; Assaults; Behavior therapy. Cognitive therapy; Biological and medical sciences; Cognition & reasoning; Cognitive Restructuring; Cognitive Therapy - methods; Comorbidity; Correlation; Depression; Depression (Psychology); Depression - epidemiology; Depression - etiology; Depression - therapy; Exposure Therapy; Female; Females; Human; Humans; Implosive Therapy - methods; Major Depression; Mediation Theory; Medical sciences; Mental depression; Mental health care; Mood disorders; Outcomes of Treatment; Post traumatic stress disorder; Posttraumatic Stress Disorder; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Selfreport; Sex Offenses - psychology; Statistical Analysis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - etiology; Stress Disorders, Post-Traumatic - therapy; Survivors - psychology; Symptoms; Symptoms (Individual Disorders); Therapy; Treatment Outcome; Treatments; Victims of Crime; Violence - psychology; Womens health
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/a0031523

Objective: In the present study, we examined the relationship between posttraumatic and depressive symptoms during prolonged exposure (PE) treatment with and without cognitive restructuring (CR) for the treatment of posttraumatic stress disorder (PTSD). Method: Female assault survivors (N = 153) with PTSD were randomized to either PE alone or PE with added CR (PE/CR). During treatment, bi-weekly self-report measures of posttraumatic and depressive symptoms were administered. Results: Multilevel mediational analyses indicated that during PE, changes in posttraumatic symptoms accounted for 80.3% of changes in depressive symptoms, whereas changes in depressive symptoms accounted for 45.0% of changes in posttraumatic symptoms. During PE/CR, changes in posttraumatic symptoms accounted for 59.6% of changes in depressive symptoms, and changes in depressive symptoms accounted for 50.7% of changes in posttraumatic symptoms. Conclusions: This pattern of results suggests that PE primarily affects posttraumatic symptoms, which in turn affect depressive symptoms. In contrast, PE/CR results in a more reciprocal relationship between posttraumatic and depressive symptoms. (Contains 2 tables, 2 figures, and 4 footnotes.)