Re-Experiencing Symptom Self-Monitoring as an Early Step in the Treatment of Posttraumatic Stress Disorder Open Access

Brown, Amanda Joelle (2013)

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The efficacy of a brief self-monitoring intervention was evaluated as an initial step in the treatment of PTSD. Participants were 137 American combat veterans, diagnosed with PTSD and enrolled in a five-week psychoeducation group at a large Veterans Affairs medical center while waiting to begin individual treatment. Nine groups were designated as active and the other six served as controls. In addition to engaging in the standard group intervention, participants in the active condition were asked to record the number and content of daily nightmares, flashbacks, intrusive thoughts/memories, and physiological and emotional reactions to triggers. Records were collected each week to assess compliance. Symptoms of PTSD and related psychopathology were assessed at the beginning and end of treatment. Data were analyzed for the 88 participants who attended at least two group sessions and completed baseline and final assessments (54 active, 34 controls). The self-monitoring intervention did not significantly reduce symptoms overall, but age moderated response to treatment such that younger veterans in the active group reported a decrease in avoidance symptoms. Compliance with the self-monitoring was low, suggesting that it was experienced as difficult; however, dropout rates did not differ between the conditions. Results indicate that four weeks of intrusion monitoring is not sufficient to effect substantial change in individuals with chronic, severe PTSD. However, it may be an appropriate early step in treatment for individuals with short illness duration and/or exposure to few traumatic events. Follow-up studies are needed to examine the potential long-term impact of this early intervention on subsequent response to more intensive psychotherapies for PTSD.

Table of Contents

Table of Contents Introduction 1 Theoretical Models of PTSD 3 Early theories 4 Recent theories 14 Summary and contextualization of present study 21 Re-experiencing Symptom Self-monitoring 22 Self-monitoring as a therapeutic technique 25 Previous research 27 Proposed Intervention 30 Hypotheses 31 Methods 32 Participants 32 Research Design 32 Procedure 33 Measures 34

Data Analysis 37

Results 38

Participant Characteristics 38

Preliminary Analyses: Active Group vs. Control Group 38

Change in avoidance symptoms 38

Change in re-experiencing symptoms 39

Change in overall PTSD symptoms 39

Change in related pathology 39

Demographic Moderators 40

Monitoring Compliance 41

Discussion 43

Main Findings 43

Acceptability and feasibility 45

Interpretation and Theoretical Implications 45

Self-monitoring as an intervention technique 52

Clinical Implications 55

Strengths 57

Limitations 57

Future Directions 60

Conclusions 62

References 64

Tables and Figures 72

Table 1: DSM-IV criteria for PTSD 72

Table 2: Demographic information - Overall sample 73

Table 3: Clinical information - Overall sample 74

Table 4: Demographic information - Completers 76

Table 5: Clinical information - Completers 77

Table 6: Results of repeated measures ANOVAs 79

Figure 1: Change in distress related to avoidance 80

Table 7: Demographic moderator analyses 81

Table 8: Follow-up demographic moderator analyses 82

Table 9: Chi-square test crosstabulation 83

Table 10: Results of repeated measures ANOVAs 84

Figure 2: Interaction-PSS Avoidance 85

Figure 3: Interaction -PCL Intrusive 86

Figure 4: Interaction-PCL Distress 87

Table 11: Correlations-monitoring days and baseline data 88

Table 12: Correlations-monitoring days and change 89

Figure 5: Frequencies of cumulative monitoring days 90

Table 13: Results of RM ANOVAs, compliance as IV 91

Figure 6: Differences in outcome-PTCI Self 92

Table 14: Results of RM ANOVAs-PSS Avoid 93

Figure 7: Interaction between compliance and time 94

Appendix A: PTSD 101 handouts 95

Appendix B: Monitoring instructions and forms 132

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