title: Biological and symptom changes in posttraumatic stress disorder treatment: a randomized clinical trial.
abstract: BACKGROUND
  Understanding cognitive and biological mechanisms of PTSD treatment can help refine treatments and increase rates of response.
  
  
  METHODS
  Thirty-six veterans with PTSD were randomly assigned to receive Prolonged exposure therapy (PE) or Present-Centered therapy (PCT). We examined symptoms, trauma-related cognitions, and two indices of HPA axis function (cortisol awakening response and cortisol response to a script-driven imagery task).
  
  
  RESULTS
  Thirty veterans started treatment and 26 completed. PE resulted in significantly more symptom reduction than PCT (P = .008). High treatment responders collapsed across treatments showed nominally higher cortisol levels measured at pretreatment 30 min after trauma script exposure compared to low responders (P = .08). At midtreatment, high treatment responders showed higher cortisol levels throughout the imagery task (Ps = .03-.04). There were no differences between high and low treatment responders at posttreatment. Thoughts of incompetence (F (1.6, 35.8) = 16.8, P = .000) and a dangerous world (F (1.3, 29.9) = 8.2, P = .004) significantly improved over time in high treatment responders but showed no change in low responders. Script-associated cortisol response prior to treatment and reductions in thoughts of incompetence accounted for 83% of the variance in reductions in PTSD severity with PE.
  
  
  CONCLUSIONS
  Both increased cortisol response to personal trauma script prior to PTSD therapy and reductions in cognitive symptoms of PTSD were significantly and uniquely related to reductions in the core symptoms of PTSD in PE. However, contrary to our hypotheses, cortisol measures were not related to cognitive changes.
authors: PTSD Clinical Team, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
authors: Sheila A M
authors: SA
authors: Rauch
authors: Anthony P
authors: AP
authors: King
authors: James
authors: J
authors: Abelson
authors: Peter W
authors: PW
authors: Tuerk
authors: Erin
authors: E
authors: Smith
authors: Barbara O
authors: BO
authors: Rothbaum
authors: Erin
authors: E
authors: Clifton
authors: Andrew
authors: A
authors: Defever
authors: Israel
authors: I
authors: Liberzon
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D007171:Implosive Therapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000378:metabolism; D013313:Stress Disorders, Post-Traumatic / Q000378:metabolism* / Q000523:psychology* / Q000628:therapy; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*
chemical_list: D015415:Biomarkers; D006854:Hydrocortisone
keywords: PTSD; cognitive behavioral therapy; cortisol; exposure therapy; treatment; veteran