Sawaya, Jennifer Ann. An investigation of early response as a mediator in group psychotherapy for women with post-traumatic stress disorder and substance use disorders. Retrieved from https://doi.org/doi:10.7282/T3Z0365N
DescriptionThe depression, substance abuse, and bulimia psychotherapy literature has demonstrated that symptom improvement within the first 4-8 weeks of treatment bears a predictive relationship with long-term outcomes and that this information can be used for treatment planning purposes. However, little is known about the mechanisms through which early response is related to therapeutic change. Theoretical arguments maintain that early improvement reflects the effects of nonspecific factors and may mediate the oft-observed relationship between common factors, such as therapeutic alliance, and post-treatment outcomes. Early response to psychotherapy has not been studied among individuals with PTSD. Utilizing data from the Clinical Trials Network - Women and Trauma Study, the present study assessed the predictive validity of early treatment response among 353 women diagnosed with PTSD and substance use disorders. Participants were randomized to receive 12 sessions of Seeking Safety group psychotherapy or Women’s Health Education over 6 weeks. It was hypothesized that early response mediated the relationship between helping alliance and subsequent trauma and substance abuse outcomes, and that subjects in Seeking Safety improved more rapidly. ROC curves were used to assess the validity of early response and to generate clinical cutoff values predicting an individual’s likelihood of non-response during follow-up. Latent growth curve methodology was utilized to test the proposed mediation model. While subjects demonstrated early improvement in trauma symptoms, there was no early improvement in substance abuse symptoms. Trauma symptom severity and cumulative abstinence at the fourth week of treatment predicted response status up to one year following treatment with a fair to excellent degree of accuracy. The rates of early improvement in trauma symptoms showed near-significant differences between the two treatment groups (p = .06), suggesting that trauma symptoms improved more quickly among subjects in Seeking Safety. Early symptom improvement was not found to be a viable mediator of helping alliance and outcomes. Results diverged from previous findings regarding early response to substance abuse treatment, which may be attributable to study limitations. The current study is unique in that it supports the predictive validity of early improvement in PTSD symptoms among women with comorbid PTSD and addiction.