The Role of Posttraumatic Cognitions in Integrated Treatments for Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder

Objective: Posttraumatic cognitions are a mechanism of posttraumatic stress disorder (PTSD) symptom reduction in trauma-focused interventions for PTSD. It is unclear how changes in posttraumatic cognitions are associated with important clinical correlates of PTSD, including drinking and psychosocial functioning. This study examined if changes in posttraumatic cognitions during integrated treatment for co-occurring PTSD/alcohol use disorder (AUD) were associated with concurrent improvements in PTSD severity, heavy drinking, and psychosocial functioning. Method: One hundred nineteen veterans (65.5% white and 89.9% men) with PTSD/AUD randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure or Seeking Safety completed assessments of posttraumatic cognitions (Posttraumatic Cognitions Inventory), PTSD severity (Clinician-Administered PTSD Scale for DSM5), drinking (Timeline Followback), and psychosocial functioning (Medical Outcomes Survey SF-36) at baseline, posttreatment, 3- and 6-month follow-up. Results: Structural equation models indicated that posttraumatic cognitions improved significantly during treatments for PTSD/AUD with no significant treatment differences. Reductions in posttraumatic cognitions during treatment were associated with concurrent improvements in PTSD severity and functioning, and differentially associated with drinking. Conclusions: Findings suggest that changes in posttraumatic cognitions in integrated treatments for PTSD/AUD are not solely important for symptom change but are implicated in improvements in functioning.