Changes in trauma-related cognitions predict subsequent symptom improvement during prolonged exposure in patients with childhood abuse-related PTSD

Change in negative posttraumatic cognitions is a proposed mechanism through which Prolonged Exposure (PE) leads to symptom reduction of posttraumatic stress disorder (PTSD). A strong case for posttraumatic cognitions as a change mechanism in PTSD treatment can be made by establishing temporal precedence of change in cognitions. The current study examines the temporal relationship between change in posttraumatic cognitions and PTSD symptoms during PE, using the Posttraumatic Cognitions Inventory. Patients with DSM-5 defined PTSD following childhood abuse (N = 83) received a maximum of 14–16 sessions of PE. Clinician-rated PTSD symptom severity and posttraumatic cognitions were assessed at baseline, week 4, 8, and 16 (post-treatment).


Using time-lagged mixed effect regression models, we found that posttraumatic cognitions predicted subsequent PTSD symptom improvement. Notably, when using the items of an abbreviated version of the PTCI (PTCI-9), we found a mutual relationship between posttraumatic cognitions and PTSD symptom improvement. Crucially, the effect of change in cognitions on PTSD symptom change was greater than the reverse effect. The current findings corroborate change in posttraumatic cognitions as a change process during PE, but cognitions and symptoms cannot be completely separated. The PTCI-9 is a short instrument that appears suitable to track cognitive change over time.





•  Change in cognitions predicted subsequent change in posttraumatic stress symptoms.

•  The temporal relationship between cognitions and symptoms was bi-directional.

•  A short instrument to measure posttraumatic cognitions over treatment is recommended.


Marike J. Kooistra, Chris M. Hoeboer, Danielle A.C. Oprel, Maartje Schoorl, Willem van der Does, Jackie June ter Heide, Agnes van Minnen, Rianne A. de Kleine | 2023
In: Behaviour Research and Therapy ; ISSN: 0005-7967 | 163 | april | 104284
Academic Achievement, Adults, Child Abuse, Children, Cognitive Disorders, Exposure, Exposure Therapy (en), Netherlands, Posttraumatic Stress Disorder, Predictors, Prolonged Exposure Therapy, PTSD (DSM-5), PTSD (en), Research