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J Trauma Stress. 2019 Aug;32(4):625-632. doi: 10.1002/jts.22428. Epub 2019 Jul 29.

Patterns of Treatment Disengagement and Personality Traits Associated With Posttraumatic Stress Disorder in Recent-Era U.S. Veterans Receiving Cognitive Processing Therapy.

Lamkin J1,2,3, Hundt N1,2,3, Ahearn EP4,5, Stanley M1,2,3, Smith TL1,2,3.

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Veterans Affairs (VA), Health Services Research and Development Service, Houston Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.
VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA.
Department of Psychiatry, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USA.
William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.


in English, Spanish

Low treatment engagement is a barrier to implementation of empirically supported treatments for posttraumatic stress disorder (PTSD) among veterans. Understanding personality traits that predict dropout may help focus attempts to improve engagement. The current study included 90 veterans who served in recent conflicts in Iraq and/or Afghanistan and participated in a trial of cognitive processing therapy for PTSD. Goals were to characterize (a) personality correlates of PTSD, (b) patterns of engagement (i.e., attendance and homework completion), and (c) personality correlates of reduced engagement. Higher levels of PTSD symptoms were associated with a range of characteristics, including affective lability, r = .44 p < .001; anxiety, r = .38, p < .001; identity problems, r = .57, p < .001; intimacy problems, r = .34, p = .001; low affiliation, r = .33, p = .002; oppositionality, r = .36, p = .001; restricted expression, r = .35, p = .001; and suspiciousness, r = .50, p < .001. Notably, veterans with worse PTSD symptoms endorsed more cognitive dysregulation, r = .40, p < .001; and less insecure attachment, r = .14, p = .190, than expected. Only 52.2% of veterans completed the 12-session course of treatment and 31.0% of participants completed fewer than six sessions. Personality traits did not predict attendance or homework completion. Disengagement continues to be a significant issue in trauma-focused treatment for veterans with PTSD. Understanding veteran-level factors, such as personality traits, may be useful considerations for future research seeking to understand and improve engagement.


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