Physical, Emotional, and Cognitive Mediators of Therapeutic Expectations for Treating PTSD Related to Military Sexual Trauma

PTSD due to military sexual trauma affects both male and female Veterans, and Veterans with MST-related PTSD contend with a host of physical, emotional, and cognitive sequelae. Evidence-based treatments for MST-related PTSD broadly focus on reducing symptoms by increased exposure and/or emotional processing of physical, emotional, and cognitive triggers. However, given the high treatment dropout rates for Veterans with PTSD and given that avoidance symptoms are most predictive of a PTSD diagnosis for Veterans with MST, research suggests that it may be important to understand the role of pretreatment symptoms and therapeutic expectations for Veterans seeking treatment for PTSD related to MST. This study investigated whether physical, emotional, and cognitive variables mediated the relationship between pre-treatment PTSD severity and therapeutic expectations for Veterans seeking Cognitive Processing Therapy or Present-Centered Therapy for PTSD due to MST. Additionally, this study examined whether the relationship between pre-treatment therapeutic expectations and change in PTSD severity (pre-post treatment) was moderated by treatment type. Results indicated that the relationship between pre-treatment PTSD severity and therapeutic expectations was significantly mediated, within separate models, by posttraumatic cognitions and suicide-related cognitions. Results did not indicate significant moderation by treatment type of the relationship between pre-treatment therapeutic expectations and change in PTSD severity. Clinical implications for significant findings include recommendations for assessing posttraumatic cognitions before, during, and after treatment, bolstering hopefulness and strengthening the therapeutic alliance prior to commencing treatment, and directly addressing interpersonal factors for Veterans with greater PTSD severity and/or lower therapeutic expectations prior to treatment.