(PS11-A13) Institutional Betrayal in Military Sexual Trauma Survivors: Impact on Posttraumatic Stress Disorder Symptoms and Negative Posttrauma Cognitions

The military fosters an environment of camaraderie and trust, in which individuals are encouraged to rely on their fellow servicemembers for safety, and sometimes survival. Transgressions between individuals within military settings, as in the case of military sexual trauma (MST), can consequently lead to feelings of institutional betrayal (IB). IB can manifest due to beliefs that the institution failed to prevent and/or respond adequately to an experience of MST. MST can also lead to perceptions of IB due to the environmental and interpersonal contexts in which the event occurs (e.g., perpetration by a trusted authority figure).

 IB in MST survivors has previously been associated with more severe posttraumatic stress disorder (PTSD). IB may make trusting mental health providers difficult and thus limit treatment response, especially in treatment settings that closely resemble the institution in which the betrayal occurred, such as those with military-affiliation (e.g., Veteran Affairs (VA) settings). In non-MST populations, IB has also been associated with disrupted worldviews, a type of negative posttrauma cognition (NPC) characteristic of PTSD. Despite this, the impact of IB on changes in NPCs and PTSD symptoms throughout treatment has been minimally researched in treatment-seeking MST populations. Identifying whether IB severity limits the effectiveness of veteran-focused treatment settings can inform whether alternative treatment settings should be considered for veterans with high IB. The purpose of the present study was to assess whether changes in PTSD symptom severity and NPCs were impacted by IB severity in an intensive PTSD treatment program for veterans.

The present study investigated this relationship in a sample (N=112) of MST survivors engaged in a non-VA intensive (2-week) Cognitive Processing Therapy (CPT)-based PTSD treatment program for veterans.  Two separate linear regressions were conducted, and results indicated IB severity (IBQ-2 sum score) was not significantly associated with PTSD symptom change scores (PCL-5) or PTCI change scores (pre-post; ps>0.29). Two additional linear regressions were conducted to assess whether IB severity predicted baseline PTSD symptom and NPC severity, and results indicated no relationship (ps >0.18).
Study findings indicated MST survivors who endorse high IB experience similar reductions in PTSD symptoms and NPCs compared to those with low levels of IB. This means that regardless of IB severity, MST survivors respond similarly to CPT-based intensive treatment programs for veterans. Future research should replicate these findings in alternative settings, such as VA clinics, that may be more closely related to settings in which the patient’s MST occurred. Further, as this study was conducted in a group treatment setting with cohorts of MST survivors, future research could also consider whether connectedness to other MST survivors throughout a CPT-based PTSD treatment program mitigates the hypothesized deleterious effects of IB on treatment response. In doing so, research may identify whether treatment setting impacts treatment effectiveness in individuals with IB following MST, to better identify avenues of improving treatment outcomes in this population.