Augmenting trauma-focused cognitive behavior therapy for post-traumatic stress disorder with memory specificity training: a randomized controlled trial.

Abstract

Although trauma-focused cognitive behavior therapy (TF-CBT) is the recommended treatment for post-traumatic stress disorder (PTSD), up to one-half of patients do not respond to this intervention. There is an urgent need to develop new strategies to improve treatment response. Training people to recall specific positive memories may augment treatment gains in TF-CBT. We conducted a controlled trial in Australia with current or former first responders (including police, firefighters and paramedics) with PTSD, who were randomized on a 1:1 basis to 12 weekly 90-min individual sessions of either TF-CBT combined with memory specificity training (TF-CBT/MT) or TF-CBT alone. The primary outcome was change in PTSD severity independently assessed at baseline, post-treatment, and six months after treatment (primary outcome timepoint). Secondary outcomes included measures of depression, trauma-related cognitions, alcohol use, and quality of life. Between October 2021 and May 2023, fifty participants were randomized to TF-CBT/MT, and fifty to TF-CBT alone. Most participants were males (71.0%) and the mean age was 46.8±9.9 years. At the 6-month assessment, participants receiving TF-CBT/MT showed a greater reduction of PTSD severity than those randomized to TF-CBT alone (mean difference: 9.2, 95% CI: 3.2-15.1, p=0.003), indicating a large effect size (0.9, 95% CI: 0.1-1.6). Participants receiving TF-CBT/MT also had greater reductions in alcohol use (mean difference: 5.3, 95% CI: 1.5-9.2, p=0.007; effect size: 0.8, 95% CI: 0.2-1.4) and self-blame cognitions (mean difference: 0.8, 95% CI: 0.2-1.4, p=0.008; effect size: 0.5, 95% CI: 0.1-0.9). These data suggest that memory specificity training adds significantly to the effect of standard TF-CBT in reducing PTSD severity. This approach can offer a simple and easy to implement strategy to augment treatment for PTSD patients.