Investigating Relationships Between PTSD Symptom Clusters Within Virtual Reality Exposure Therapy for OEF/OIF Veterans

- The bulk of PTSD treatment research has relied on pre-post designs
- We investigated the therapeutic process over time within Virtual Reality Exposure
- Re-experiencing symptoms appear to impact the other three clusters across treatment
- Re-experiencing symptoms are a key factor in PTSD symptom change in exposure therapy

Several cognitive behavioral therapeutic approaches have been demonstrated to be effective in reducing post-traumatic stress disorder (PTSD) symptoms (Foa, Keane, Friedman, & Cohen, 2008). The bulk of PTSD treatment research has relied on pre-post designs, which are limited in their ability to investigate the therapeutic process over time. The present study investigated the relations between PTSD symptom clusters using symptom assessment at pretreatment, midtreatment, and posttreatment using cross-lagged panel design over the course of Virtual Reality Exposure (VRE) treatment. Participants were 156 Iraq and/or Afghanistan veterans who met DSM-IV criteria for PTSD due to military trauma. Using structural equation modeling, the final reexperiencing model demonstrated good fit, χ2(34) = 39.95, p = .22; RMSEA = .034, 90% CI: [0.00, 0.07], CFI = .993, and results suggested that reexperiencing at pretreatment demonstrated a significant effect on numbing, avoidance, hyperarousal at midtreatment, and reexperiencing symptoms at midtreatment demonstrate a significant effect on each of the three symptom clusters at posttreatment. These findings suggest that reexperiencing symptoms are indeed a key aspect of the therapeutic process within exposure therapy for PTSD. Additional research examining the impact of reexperiencing-focused intervention strategies on treatment outcomes is warranted.