Neurocognitive Correlates of Successful Treatment of PTSD in Female Veterans

Background: The influence of psychotherapy on neurocognition in post-traumatic stress disorder (PTSD) has not been examined methodically. This is despite evidence that pre-treatment learning and memory has been associated with treatment success and that executive function theories emphasize weak exe...

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Bibliographic Details
Published in:Journal of the International Neuropsychological Society 2016-07, Vol.22 (6), p.643-651
Main Authors: Haaland, Kathleen Y., Sadek, Joseph R., Keller, Jenna E., Castillo, Diane T.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Behavior modification
Cognition & reasoning
Executive function
Executive Function - physiology
Female
Humans
Learning - physiology
Memory
Middle Aged
Outcome Assessment (Health Care) - methods
Post traumatic stress disorder
Psychotherapy
Psychotherapy, Group - methods
Stress Disorders, Post-Traumatic - physiopathology
Stress Disorders, Post-Traumatic - therapy
Trauma
Veterans
Young Adult
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Summary:Background: The influence of psychotherapy on neurocognition in post-traumatic stress disorder (PTSD) has not been examined methodically. This is despite evidence that pre-treatment learning and memory has been associated with treatment success and that executive function theories emphasize weak executive functions (especially inhibition/switching) are associated with PTSD. Objectives: To determine (1) if higher pre-treatment learning/memory, inhibition/switching, or both predict treatment success; and (2) if treatment success is associated with specific improvement in inhibition/switching and not learning/memory or working memory, another aspect of executive function. Methods: Pre-treatment neurocognition and neurocognitive changes (inhibition/switching, learning/memory, working memory) were examined in female veterans with PTSD. They were evaluated before and after 16-weeks of group psychotherapy for PTSD that included three counterbalanced modules (cognitive restructuring therapy, exposure therapy, skills training) with fidelity checks for therapist adherence. Results: Only pre-treatment learning/memory predicted better treatment outcome. Treatment success was associated with improvement in inhibition/switching only, even after controlling for mild traumatic brain injury, and changes in depressive symptoms, working memory, and learning/memory. Conclusions: Our finding that learning/memory predicted treatment success is consistent with previous studies. We extended these studies by showing that the effect was restricted to learning/memory, which is contrary to the executive function theory of PTSD. In contrast, the fact that only inhibition/switching significantly improved with better treatment success is consistent with its potential importance in maintaining PTSD symptoms. Future research should determine whether inhibition/switching abilities are a risk for development and maintenance of PTSD or whether such abilities have a broader reciprocal relationship with PTSD symptom change. (JINS, 2016, 22, 643–651)
ISSN:1355-6177
1469-7661
DOI:10.1017/S1355617716000424