Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD : Changes in verbal memory and executive functioning

Objectives: Individuals with post-traumatic stress disorder (PTSD) have neurocognitive deficits in verbal memory and executive functioning. In this study, we examined whether memory and executive functioning changed over the course of treatment and which clinical variables were associated with change. Design: Neuropsychological assessments were administered at baseline and endpoint of a randomized controlled trial as secondary outcome. Methods: Trauma survivors (n = 88) diagnosed with PTSD received trauma-focused psychotherapy within a 17-week randomized controlled trial. Neuropsychological tests were the California Verbal Learning Test, Rivermead Behavioural Memory Test, Stroop Color Word Test, and Trail Making Test. Results: Significant, small- to medium-sized improvements in verbal memory, information processing speed, and executive functioning were found after trauma-focused psychotherapy (Cohen's d 0.16–0.68). Greater PTSD symptom decrease was significantly related to better post-treatment neurocognitive performance (all p <.005). Patients with comorbid depression improved more than patients with PTSD alone on interference tasks (p <.01). No differences emerged between treatment conditions and between patients on serotonergic antidepressants and those who were not. Conclusions: This study suggests that neurocognitive deficits in PTSD can improve over the course of trauma-focused psychotherapy and are therefore at least partly reversible. Improvements over treatment are in line with previous neuropsychological and neuroimaging studies and effect sizes exceed those of practice effects. Future research should determine whether these changes translate into improved functioning in the daily lives of the patients. Practitioner points: Patients with PTSD have difficulties performing verbal memory tasks (e.g., remembering a grocery list, recall of a story) and executive functioning tasks (e.g., shifting attention between two tasks, ignoring irrelevant information to complete a task). Verbal memory, information processing speed, and executive functioning significantly improved in patients with post-traumatic stress disorder over the course of trauma-focused psychotherapy. Improvements were equal in size for two different trauma-focused psychotherapies (Eye movement desensitization and reprocessing therapy and brief eclectic psychotherapy for PTSD). Medium-sized effects were found for recall of a story, whereas effects in other aspects of verbal memory, information processing speed, and executive functioning were small-sized. No causal attributions can be made because we could not include a control group without treatment for ethical reasons. Findings may be more reflective of patients who completed treatment than patients who prematurely dropped out as completers were overrepresented in our sample

Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD : Changes in verbal memory and executive functioning

Objectives: Individuals with post-traumatic stress disorder (PTSD) have neurocognitive deficits in verbal memory and executive functioning. In this study, we examined whether memory and executive functioning changed over the course of treatment and which clinical variables were associated with change. Design: Neuropsychological assessments were administered at baseline and endpoint of a randomized controlled trial as secondary outcome. Methods: Trauma survivors (n = 88) diagnosed with PTSD received trauma-focused psychotherapy within a 17-week randomized controlled trial. Neuropsychological tests were the California Verbal Learning Test, Rivermead Behavioural Memory Test, Stroop Color Word Test, and Trail Making Test. Results: Significant, small- to medium-sized improvements in verbal memory, information processing speed, and executive functioning were found after trauma-focused psychotherapy (Cohen's d 0.16–0.68). Greater PTSD symptom decrease was significantly related to better post-treatment neurocognitive performance (all p <.005). Patients with comorbid depression improved more than patients with PTSD alone on interference tasks (p <.01). No differences emerged between treatment conditions and between patients on serotonergic antidepressants and those who were not. Conclusions: This study suggests that neurocognitive deficits in PTSD can improve over the course of trauma-focused psychotherapy and are therefore at least partly reversible. Improvements over treatment are in line with previous neuropsychological and neuroimaging studies and effect sizes exceed those of practice effects. Future research should determine whether these changes translate into improved functioning in the daily lives of the patients. Practitioner points: Patients with PTSD have difficulties performing verbal memory tasks (e.g., remembering a grocery list, recall of a story) and executive functioning tasks (e.g., shifting attention between two tasks, ignoring irrelevant information to complete a task). Verbal memory, information processing speed, and executive functioning significantly improved in patients with post-traumatic stress disorder over the course of trauma-focused psychotherapy. Improvements were equal in size for two different trauma-focused psychotherapies (Eye movement desensitization and reprocessing therapy and brief eclectic psychotherapy for PTSD). Medium-sized effects were found for recall of a story, whereas effects in other aspects of verbal memory, information processing speed, and executive functioning were small-sized. No causal attributions can be made because we could not include a control group without treatment for ethical reasons. Findings may be more reflective of patients who completed treatment than patients who prematurely dropped out as completers were overrepresented in our sample

Brief Eclectic Psychotherapy for PTSD

Brief eclectic psychotherapy for PTSD (BEPP), developed since the 1980s, has proven to be an efficacious psychotherapy for patients with PTSD. Several randomized controlled trials have shown that its effects on PTSD and depressive symptoms are similar to those of other trauma-focused treatments. What makes BEPP special is that it integrated and adapted interventions from several therapeutic schools to not only diminish core symptoms of PTSD but also learn from the trauma and develop a new perspective on relationships with others and the future. In contrast to other trauma-focused treatments, BEPP focuses on the expression of strong emotions like grief and anger which stem from the traumatic event and on learning from the way the event has affected someone’s life. Some trauma-focused treatments disregard that the losses a trauma involves bring forth a lasting change and therefore seem to give the message that the patient will be the same as before the trauma, whereas the message in BEPP is that one becomes “sadder and wiser” and finds a new equilibrium with the surrounding world. BEPP is structured and delivered in 16 sessions

Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study

Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as ‘the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.’ These events can provoke emotions such as remorse, guilt and shame, and affects someone’s self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT