(PS4-98) Trauma Related Cognitions and Emotion Regulation as Mediators of PTSD Change During Online Written Exposure Therapy

Abstract Text: Prior research suggests that trauma related cognitions and emotion regulation are associated with changes in PTSD symptoms. A systematic review found that reductions in negative trauma-related cognitions mediates change in PTSD symptoms across different evidence-based treatments. However, trauma related cognitions have not been tested as a mediator of PTSD change during written exposure therapy (WET), which is an evidence-based PTSD treatment that was recently found to be helpful when delivered in an online program. Moreover, very few studies have tested alternate mediators, such as emotion regulation. This study addresses these gaps by testing trauma-related cognitions and emotion regulation as potential mediators of PTSD change during WET. Data were drawn from a larger study of 223 veterans (M age=48.46, SD=9.95) who were offered WET through an online program facilitated by peer coaches. PTSD symptoms (Posttraumatic Stress Disorder Checklist for DSM-5; PCL-5) were assessed at baseline, mid-, post-treatment, and three-month follow-up while trauma-related cognitions (Posttraumatic Cognitions Inventory; PTCI-9), and emotion regulation (Difficulties in Emotion Regulation Scale; DERS-16) were only assessed at baseline, mid-, and post-treatment. Repeated measures ANOVAs revealed reductions over time for the PCL-5, F(3)=29.87, p= <.001, PTCI-9, F(2)=7.659, p=.001, and DERS-16, F(2)=15.91, p= <.001. Results of lagged mediation analyses testing PTCI-9 and DERS-16 in a combined model will be presented. Identifying mediators of symptom change during WET may provide clues about potential mechanisms of therapeutic recovery. Future work should test a variety of hypothesized mediators across different PTSD treatments and could also explore subscales of PTCI-9 (self-blame, negative cognitions about the self, and negative cognitions about the world) and DERS-16 (clarity, goals, impulse, strategies, and nonacceptance) as mediators.