title: Changes in posttraumatic cognitions predict changes in posttraumatic stress disorder symptoms during cognitive processing therapy.
abstract: OBJECTIVE
  Although cognitive processing therapy (CPT) has strong empirical support as a treatment for posttraumatic stress disorder (PTSD), studies have not directly examined the proposed change mechanisms that underlie CPT-that change in trauma-related cognitions produces change in PTSD and depression symptoms. To improve the understanding of underlying mechanisms of psychotherapeutic change, this study investigated longitudinal association between trauma-related cognitions, PTSD, and depression among veterans receiving CPT during a 7-week residential PTSD treatment program.
  
  
  METHODS
  All 195 veterans met DSM-IV-TR diagnosis for PTSD. The sample was 53% male with a mean age of 48 years. Self-reported race was 50% White and 45% African American. The Posttraumatic Cognitions Inventory was used to assess trauma-related cognitions. The PTSD Checklist and Beck Depression Inventory-II were used to assess PTSD and depression, respectively. Cross-lagged panel models were used to test the longitudinal associations between trauma-related cognitions, PTSD, and depression. Measures were administered at three time points: pre-, mid-, and posttreatment.
  
  
  RESULTS
  Change in posttraumatic cognitions (self-blame; negative beliefs about the self) preceded change in PTSD. In addition, (a) change in negative beliefs about the self preceded change in depression, (b) change in depression preceded change in self-blame cognitions, and (c) change in depression preceded change in PTSD.
  
  
  CONCLUSIONS
  Findings support the hypothesized underlying mechanisms of CPT in showing that change in trauma-related cognitions precedes change in PTSD symptoms. Results suggest that reduction of depression may be important in influencing reduction of PTSD among veterans in residential PTSD treatment.
authors.affiliation: Cincinnati VA Medical Center.
authors.forename: Jeremiah A
authors.initials: JA
authors.lastname: Schumm
authors.affiliation: Cincinnati VA Medical Center.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Dickstein
authors.affiliation: Health and Behavioral Sciences, Naval Health Research Center, San Diego.
authors.forename: Kristen H
authors.initials: KH
authors.lastname: Walter
authors.affiliation: Department of Psychology, University of Tennessee-Knoxville.
authors.forename: Gina P
authors.initials: GP
authors.lastname: Owens
authors.affiliation: Cincinnati VA Medical Center.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Chard
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067073:Psychological Trauma / Q000523:psychology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*