Does Cognitive Bias Modification for Appraisals Change Symptom-Cognition Relations in PTSD? Preliminary Evidence from Network Analysis in a Randomized Controlled Trial.

Abstract

Post-traumatic stress disorder (PTSD) is maintained by dysfunctional trauma-related appraisals. Cognitive Bias Modification for Appraisals (CBM-APP) aims to train more functional trauma-related appraisals and has been shown to reduce PTSD symptoms. However, little is known about how this training affects the interrelations among symptoms and cognitive appraisals. In this secondary analysis of a randomized controlled trial involving 77 adult patients diagnosed with PTSD (CBM-APP: n = 37; control training: n = 40), we applied repeated cross-sectional network analysis to examine changes in the structure and centrality of associations among PTSD symptom clusters (re-experiencing, avoidance, negative cognition and mood, hyperarousal, assessed with the PTSD Checklist for DSM-5) and trauma-related cognitive measures, all assessed at both pre- and post-training. To capture multiple levels of cognitive processing, we included responses during a scenario task (reflective, idiosyncratic, spontaneous appraisals) and the Implicit Association Test (automatic self-associations). Four cross-sectional Gaussian Graphical Models were estimated for the training and control group and both timepoints (pre-/post-training × CBM-APP vs. control group). While overall network connectivity did not differ significantly across networks, descriptive patterns indicated that Alterations in Cognition and Mood emerged as the most central node in both groups at post-training assessment. Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential weaker associations of automatic negative self-associations with symptom activation. Given the small sample and moderate network stability, findings are preliminary but suggest that CBM-APP may influence the relational structure of PTSD symptoms and cognitions.