Within-patient association between emotion regulation and outcome in prolonged exposure for posttraumatic stress disorder.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2024-09-01 Epub Date: 2023-11-16 DOI:10.1037/ccp0000837

Alice E Coyne, Elsa Mattson, Jenna M Bagley, Alexandra B Klein, Kathy Shekhtman, Sinan Payat, Daniella S Levine, Norah C Feeny, Lori A Zoellner

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Abstract

Objective: Difficulties with emotion regulation (ER) are a risk factor for the development and maintenance of posttraumatic stress disorder (PTSD). Less is known about temporal relations between ER and PTSD symptom change during treatment, including whether ER may represent a more potent change ingredient for some patients relative to others. This study examined the association between within-patient changes in ER and next-session PTSD symptom change and whether this association was more pronounced for patients with poorer baseline ER, more severe depression, or higher borderline personality disorder symptoms.

Method: Data derived from a randomized controlled trial (NCT01600456) in which 149 adults with PTSD received up to 10 sessions of prolonged exposure (PE) or PE + sertraline. Patients rated difficulties with ER and PTSD symptoms repeatedly during treatment. Moderators were assessed at baseline.

Results: Cross-lagged, dynamic structural equation models revealed that ER improvements were associated with next-session reductions in PTSD (standardized effect = 0.13). PTSD symptom reduction was also associated with next-session ER improvement (standardized effect = 0.34). Moderator analyses revealed that the within-person ER-PTSD symptoms association was stronger for patients with higher baseline depression (standardized effect = 0.39).

Conclusions: Reductions in PTSD symptoms may facilitate ER improvements during PE and PE augmented with sertraline rather than improvements in ER producing changes in PTSD symptoms. For patients with higher severity co-occurring depression, ER may represent a more active change ingredient. PE therapists could therefore consider placing particular emphasis on improving ER capabilities when working with this subgroup of patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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创伤后应激障碍长期暴露患者情绪调节与预后的关系。

目的:情绪调节困难(ER)是创伤后应激障碍(PTSD)发展和维持的危险因素。在治疗期间，ER与PTSD症状改变之间的时间关系尚不清楚，包括ER是否对某些患者而言是一种更有效的改变因素。本研究考察了患者内部ER变化与下一阶段PTSD症状变化之间的关联，以及这种关联是否在基线ER较差、抑郁症较严重或边缘型人格障碍症状较高的患者中更为明显。方法:数据来源于一项随机对照试验(NCT01600456)，其中149名成年PTSD患者接受长达10次的延长暴露(PE)或PE +舍曲林治疗。在治疗过程中，患者反复评价出现急症和创伤后应激障碍症状。调节者在基线进行评估。结果:交叉滞后的动态结构方程模型显示，ER的改善与下一阶段PTSD的减少相关(标准化效应= 0.13)。PTSD症状减轻也与下一阶段ER改善相关(标准化效应= 0.34)。调节分析显示，在基线抑郁程度较高的患者中，人内ER-PTSD症状的相关性更强(标准化效应= 0.39)。结论:创伤后应激障碍症状的减少可能促进内质网改善和舍曲林增强内质网，而不是改善内质网产生PTSD症状的改变。对于严重程度较高的合并抑郁症患者，ER可能是一种更积极的改变成分。因此，体育治疗师在治疗这类患者时可以考虑特别强调提高急诊能力。(PsycInfo数据库记录(c) 2023 APA，版权所有)。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.