Introduction: Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. Objective: We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. Methods: We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. Results: In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82–1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39–1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23–1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI –0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. Conclusions: Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
Psychother Psychosom

中文翻译：

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使用认知偏差修正形式修正创伤后应激障碍功能失调评估的效果：住院环境中随机对照试验的结果

简介：对创伤事件及其后遗症的功能失调评估是创伤后应激障碍（PTSD）的关键机制。实验研究表明，计算机化认知训练，评估认知偏差修正（CBM-APP），可以修正功能失调的评估并减少健康和亚临床志愿者的类似创伤症状。目的：我们的目的是测试 CBM-APP 是否可以减少 PTSD 患者与创伤反应相关的功能失调评估，以及这是否会导致 PTSD 症状的改善。方法：我们在一项平行组原则验证双盲随机对照试验中，对住院诊所收治的 80 名 PTSD 患者进行了 CBM-APP 与假训练的比较。两组均包含为期两周的 8 次训练计划，并作为标准治疗计划的辅助手段完成。结果：在意向治疗分析中，与接受假训练的参与者相比，接受 CBM-APP 的参与者在训练前和训练后（主要结果）评估中对情景任务的功能失调评估显着减少（d = 1.30，95 %） CI 0.82–1.80），在创伤后认知量表（PTCI； d = 0.85，95% CI 0.39–1.32）和 DSM-5 PTSD 检查表（PCL-5； d = 0.68，95）% CI 0.23–1.14），但不适用于长期皮质醇浓度（ d = 0.25，95% CI –0.28 至 0.78）。通过情景任务评估的功能失调评估的减少与训练前到训练后时间点的 PTCI、PCL-5 和头发皮质醇浓度的减少相关。结论：结果支持功能失调评估作为一种可修改的认知机制，并且它们的近端修改会转移到下游的 PTSD 症状。这些发现可能为改进现有治疗方法开辟新途径。
心理医生