(PS11-A14) Temporal Association Between Self-blame and Emotion Regulation in PTSD Treatment

Trauma-related beliefs, particularly those about self-blame, as well as emotion regulation (ER), are important potential mediators of change in PTSD treatment. The important role of trauma-related beliefs in PTSD symptom change has been replicated across treatment modalities, including prolonged exposure (PE), cognitive processing therapy (CPT), and written exposure therapy (WET). What is not yet known is how these changes in specific beliefs, such as self-blame, occur, and how this may relate to other important changes that occur during treatment, such as changes in ER. There may also be changes in the sequence of change between ER and self-blame by treatment modality. Previous studies have demonstrated that PE and sertraline (an SSRI) are equally effective in reducing ER in treatment for PTSD. Others have found that CPT may be more effective than WET and PE in reducing self-blame and other beliefs. Knowledge about the sequence of change across treatments, and of the impact of treatment type on change processes, may inform treatment selection and optimization. The current study examined the temporal relationship between changes in self-blame and changes in ER over the course of PTSD treatment, and the possible moderation of this effect by treatment modality. It was hypothesized that changes in self-blame would facilitate emotion regulation, particularly for those receiving both an SSRI and psychotherapy. 96 participants were randomized to receive 10 weeks of PE or 10 weeks of PE plus sertraline. Measures of trauma-related self-blame (Posttraumatic Cognitions Inventory [PTCI]) and emotion regulation (Difficulties in Emotion Regulation [DERS]) were completed at baseline, each session, and post-treatment. Cross-lagged dynamic structural equation models (DSEMs) examined within-person, time-lagged associations among PTCI self-blame and DERS, while controlling for time trends. Treatment modality was added as a second step. Within-person improvements in PTCI blame predicted subsequent improvements in DERS, standardized β = 0.25, SE = 0.04, p < .001. Within-person improvements in DERs also predicted subsequent improvements in PTCI blame, standardized β = 0.10, SE = 0.03, p < .001. Treatment did not moderate these effects (all p’s > .05). Although a reciprocal relationship was observed, the reduction of trauma-related self-blame on subsequent reductions in ER was considerably larger than the other direction. Reductions in self-blame likely impact subsequent improvements in emotion regulation ability, an effect that is not impacted by the addition of sertraline. PE alone is sufficient for changes in distorted self-blame, and these changes in self-blame may lead to changes in ER. Furthermore, ER may be a consequence of other improvements over the course of PTSD treatment, rather than a central mechanisms of change. Important future directions include assessing the relationship between changes in trauma-related beliefs, such as self-blame, and changes in other possible mediators of change to see if these processes are consequences of other improvements, rather than true mechanisms of change, with treatment.