Effect of PTSD treatment on cardiovascular reactivity during trauma memory recall and correspondence with symptom improvement

ABSTRACT

Background: Prior research has shown PTSD treatment leads to reductions in cardiovascular reactivity during trauma recall, but the extent to which such reductions are associated with changes in PTSD symptoms is less clear. Moreover, such relationships have not been investigated in a cognitively focused PTSD treatment.

Objective: To examine changes in cardiovascular reactivity to the trauma memory in patients receiving cognitive processing therapy (CPT), CPT with a written trauma account, and a written account only condition. We also examined the association of such changes with symptom improvement.

Method: 118 women with PTSD secondary to interpersonal violence completed pre- and post-treatment assessments of PTSD symptoms and cardiovascular reactivity during a script-driven imagery task.

Results: Results indicated a significant but modest reduction in cardiovascular reactivity in CPT conditions. Changes in cardiovascular reactivity and reexperiencing symptoms were significantly associated among the whole sample. Among individuals with the greatest reactivity to the trauma memory at pretreatment, associations were also seen with changes in total PTSD, numbing, and trauma-related guilt.

Conclusions: Results indicate that previous findings on the effect of PTSD treatment on cardiovascular reactivity during trauma recall extend to cognitively oriented treatment. Baseline cardiovascular reactivity may influence the extent to which reductions in PTSD symptoms and reactivity during trauma recall are related.

HIGHLIGHTS

• Cognitive Processing Therapy leads to reduced heart rate reactivity when recalling a trauma memory.

• Decreases in heart rate reactivity are associated with reduced reexperiencing symptoms.

• Changes in heart rate reactivity and PTSD symptoms are more closely related among patients with greater pretreatment reactivity.

Antecedentes: Investigaciones anteriores han demostrado que el tratamiento del TEPT conduce a reducciones en la reactividad cardiovascular durante el recuerdo del trauma, pero el grado en que dichas reducciones se asocian con cambios en los síntomas del trastorno de estrés postraumático es menos claro. Además, tales relaciones no se han investigado en un tratamiento de TEPT centrado cognitivamente.

Objetivo: Examinar los cambios en la reactividad cardiovascular ante el recuerdo de la memoria traumática en pacientes que reciben terapia de procesamiento cognitivo (CPT por sus siglas en inglés), CPT con un relato escrito del trauma y una condición de solo relato escrito. También examinamos la asociación de tales cambios con la mejoría de los síntomas.

Método: 118 mujeres con TEPT secundario a violencia interpersonal completaron evaluaciones de los síntomas de TEPT y la reactividad cardiovascular antes y después del tratamiento durante una tarea de imaginería guiada por guión.

Resultados: Los resultados indicaron una reducción significativa pero modesta en la reactividad cardiovascular en condiciones de CPT. Los cambios en la reactividad cardiovascular y la reexperimentación de síntomas se asociaron significativamente en toda la muestra. Entre los individuos con mayor reactividad al recuerdo traumático en el momento previo al tratamiento, también se observaron asociaciones con cambios en el trastorno de estrés postraumático total, adormecimiento y culpa relacionada con el trauma.

Conclusiones: Los resultados indican que los hallazgos previos sobre el efecto del tratamiento del TEPT sobre la reactividad cardiovascular durante el recuerdo del trauma se extienden al tratamiento de orientación cognitiva. La reactividad cardiovascular inicial puede influir en el grado en que se relacionan las reducciones en los síntomas de TEPT y la reactividad durante el recuerdo del trauma.

KEYWORDS:

• PTSD
• cognitive processing therapy
• physiological reactivity
• trauma memory
• heart rate
• treatment outcomes

PALABRAS CLAVE:

• TEPT
• terapia de procesamiento cognitivo
• reactividad fisiológica
• memoria del trauma
• frecuencia cardíaca
• resultados del tratamiento

Disclosure statement

Dr Resick receives royalties from Guildford Press for sales of the Cognitive Processing Therapy manual. The other authors have no competing interests to report.

Data availability statement

Data can be made available pending a Data Use Agreement with VA Boston Healthcare System.

Additional information

Funding

This research was supported by funding from the National Center for Complementary and Integrative Health (NCCIH) grant R34-MH-074-937 awarded to Tara E. Galovski, the National Institute of Mental Health (NIMH) grant 2-R01-MH51509 awarded to Patricia A. Resick, and NIMH grant K23-MH129878 awarded to Joseph K. Carpenter. The contents of this research are the sole responsibility of the authors and do not necessarily represent the views of the NCCIH or NIMH.