Elsevier

Journal of Affective Disorders

Volume 262, 1 February 2020, Pages 344-349
Journal of Affective Disorders

Research paper
A randomized clinical trial investigating perceived burdensomeness as a mediator of brief intervention effects on posttraumatic stress symptoms

https://doi.org/10.1016/j.jad.2019.11.041Get rights and content

Highlights

  • Computerized mood- and anxiety-focused interventions were tested against a control.

  • Interventions reduced perceived burdensomeness post-intervention.

  • Treatments reduced PTSD symptoms at One-Month.

  • Perceived burdensomeness mediated reductions in PTSD at 1, 3, and 6 months.

Abstract

Objective

Posttraumatic stress disorder (PTSD) is a prevalent and impairing condition that often involves difficulties with interpersonal functioning. Targeting interpersonal difficulties may be a promising alternative approach to reducing PTSD symptoms, particularly given the relatively low rates of treatment engagement and efficacy for first-line treatments for PTSD. Recent research has identified perceived burdensomeness (i.e., feelings of being a burden on others) and thwarted belongingness (i.e., feeling isolated and as if one does not belong) as two specific interpersonal factors related to increased PTSD symptoms. Thus, the current study tested whether a brief, computerized intervention would reduce PTSD symptoms via reductions in perceived burdensomeness and thwarted belongingness, vs. a repeated contact control condition.

Method

Hypotheses were tested among 250 trauma-exposed participants who were randomized to receive one of two active computerized interventions designed to target interpersonal factors (i.e., perceived burdensomeness or thwarted belongingness) or anxiety sensitivity, or participate in a repeated contact control condition, as part of a larger randomized clinical trial. Participants were then followed over six-months.

Results

Results indicated a direct effect of the active interventions on PTSD symptoms at month-one, that was not detected at months three or six. However, there was a significant indirect effect of condition at all-time points, such that reductions in perceived burdensomeness mediated condition effects on PTSD symptoms.

Conclusions

Findings identify perceived burdensomeness as a potential etiological factor in the maintenance of PTSD symptoms, and suggest that targeting perceived burdensomeness may be an effective approach to reducing PTSD symptoms.

Section snippets

Participants

Participants (n = 250) were recruited for a larger clinical trial investigating a computerized intervention targeting risk for suicide (NCT01941862; Schmidt et al., review). Current results focusing on a trauma-exposed sample and effects of mood-focused interventions on PTSD symptoms have not been reported elsewhere. Participants were selected if they experienced a trauma according to the Posttraumatic Stress Diagnostic Scale (PDS; Foa et al., 1997). Eligible participants were English speakers,

Descriptive statistics

Average PTSD symptoms measured by the PCL-C were above the clinical cutoff of 44 (Blanchard et al., 1996; see Table 1). Mean PB and TB scores were higher than in prior research on inpatients (Bryan et al., 2013). All variables were significantly positively correlated. There were no differences between the active and control group on PTSD, PB, or TB according to t-tests (ps > 0.288), suggesting successful randomization of participants into conditions.

Direct effect analyses

Results indicated a direct effect on

Discussion

The current study found brief, computerized interventions targeting PB, TB, and AS led to reductions in PTSD symptoms compared to a repeated contact control in a trauma-exposed mixed clinical sample. These reductions were mediated by reductions in the hypothesized mechanisms (i.e., PB). Moreover, improvements in PTSD symptoms were durable as they were still evident at the six-month follow-up via reductions in PB.

Consistent with hypothesis, reductions in PTSD symptoms were mediated by PB,

Role of the funding source

This work was in part supported by the Military Suicide Research Consortium(MSRC), Department of Defense, and VISN 19Mental Illness Research, Education, and Clinical Center(MIRECC), but does not necessarily represent the views of the Department of Defense, Department of Veterans Affairs, or the United States Government. Support from the MSRC does not necessarily constitute or imply endorsement, sponsorship, or favoring of the study design, analysis, or recommendations. This research was also

Contributors

The first author conceptualized the study idea, ran the statistics, and wrote the majority of the manuscript. The second author wrote the methods. The third author assisted in writing. The fourth author provided critical feedback on all drafts. All authors have approved the final manuscript.

Declaration of Competing Interest

None.

Acknowledgments

None.

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      In fact, recent research suggests that brief web-based interventions are effective in reducing perceived burdensomeness and, in turn, suicidality (Hill et al., 2019; Short et al., 2019). Additionally, one recent study found that intervening on perceived burdensomeness may decrease posttraumatic stress symptoms (Short et al., 2020). However, this study must be considered in the context of several limitations.

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