Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Summer;32(3):286-293.
doi: 10.1176/appi.neuropsych.19020032. Epub 2020 Jan 17.

Baseline Cognitive Performance and Treatment Outcomes From Cognitive-Behavioral Therapies for Posttraumatic Stress Disorder: A Naturalistic Study

Kaloyan S Tanev  1 , Lydia E Federico  1 , Mark S Greenberg  1 , Scott P Orr  1 , Elizabeth M Goetter  1 , Patricia A Resick  1 , Roger K Pitman  1
Affiliations
Observational Study

Baseline Cognitive Performance and Treatment Outcomes From Cognitive-Behavioral Therapies for Posttraumatic Stress Disorder: A Naturalistic Study

Kaloyan S Tanev et al. J Neuropsychiatry Clin Neurosci. 2020 Summer.

Abstract

Objective: Approximately 5%-20% of U.S. troops returning from Iraq and Afghanistan have posttraumatic stress disorder (PTSD), and another 11%-23% have traumatic brain injury (TBI). Cognitive-behavioral therapies (CBTs) are empirically validated treatment strategies for PTSD. However, cognitive limitations may interfere with an individual's ability to adhere to as well as benefit from such therapies. Comorbid TBI has not been systematically taken into consideration in PTSD outcome research or in treatment planning guidance. The authors hypothesized that poorer pretreatment cognitive abilities would be associated with poorer treatment outcomes from CBTs for PTSD.

Methods: This study was designed as a naturalistic examination of treatment as usual in an outpatient clinic that provides manualized CBTs for PTSD to military service members and veterans. Participants were 23 veterans, aged 18-50 years, with combat-related PTSD and a symptom duration of more than 1 year. Of these, 16 participants had mild TBI (mTBI). Predictor variables were well-normed objective tests of cognitive ability measured at baseline. Outcome variables were individual slopes of change of the PTSD Checklist for DSM-5 (PCL-5) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) over weeks of treatment, and of pretreatment-to-posttreatment change in PCL-5 and CAPS-5 (ΔPCL-5 and ΔCAPS-5, respectively).

Results: Contrary to prediction, neither pretreatment cognitive performance nor the presence of comorbid mTBI predicted poorer response to CBTs for PTSD.

Conclusions: These results discourage any notion of excluding patients with PTSD and poorer cognitive ability from CBTs.

Keywords: Cognition; Cognitive Behavioral Therapy; Evidence-Based Intervention; Posttraumatic Stress Disorder; Veteran.

PubMed Disclaimer

Conflict of interest statement

Disclosures: None of the authors have any disclosures of conflicts of interest.

Figures

Figure 1.
Figure 1.
Recruitment Flow Chart
See this image and copyright information in PMC

References

    1. Tanielian T, Jaycox LH, Schell TL, et al.: Invisible Wounds of War. Summary and Recommendations for Addressing Psychological and Cognitive Injuries, Santa Monica, CA, RAND Corporation, 2008. Available from: http://www.dtic.mil/dtic/tr/fulltext/u2/a480992.pdf
    1. Ramchand R, Schell TL, Karney BR, et al.: Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: Possible explanations. J. Trauma. Stress 2010; 23:59–68 - PubMed
    1. U.S. Department of Veterans Affairs: Report on VA Facility Specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans Diagnosed with Potential or Provisional PTSD, 2017. Available from: https://www.publichealth.va.gov/docs/epidemiology/ptsd-report-fy2015-qrt...
    1. Lindquist LK, Love HC, Elbogen EB: Traumatic Brain Injury in Iraq and Afghanistan Veterans: New Results from a National Random Sample Study. J. Neuropsychiatry Clin. Neurosci 2017; 29:254–259 - PMC - PubMed
    1. Whiteneck GG, Cuthbert JP, Mellick DC: VA Traumatic Brain Injury Veterans Health Registry Report, Department of Veterans Affairs/Department of Defense, 2015. Available from: https://www.publichealth.va.gov/docs/epidemiology/TBI-report-fy2013-qtr4...

Publication types