The Effect of Reducing Posttraumatic Stress Disorder Symptoms on Cardiovascular Risk
Condition: PTSD
MeSH terms: Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      Some individuals who are exposed to traumatic events experience both psychological and
      cardiovascular changes that affect their health and well-being. The purpose of this study is
      to learn more about how reducing the psychological symptoms (such as those that occur with
      posttraumatic stress disorder, or PTSD) affects cardiovascular systems that regulate heart
      and blood pressure.
    

Detailed description: 
      There is a fundamental gap in the understanding of how a diagnosis of post-traumatic stress
      disorder (PTSD) portends excess risk of coronary heart disease (CHD). This is primarily
      because of two reasons: (1) the core studies which provide support for an association between
      PTSD and CHD risk depended on lengthy follow-up periods with no repeat measurement of either
      PTSD or other related cardiovascular risk factors; (2) PTSD is highly comorbid with both
      adverse health behaviors and with psychiatric comorbidity that also vary across time and
      could largely explain the association between PTSD and increased risk of CHD. The long-term
      goal is to better understand whether there is a direct link between PTSD and CHD risk, as
      well as to ascertain the role of candidate pathophysiological mechanisms. The study proposed
      in this application is designed to examine how changes in PTSD symptoms following an
      established therapeutic intervention (Cognitive Processing Therapy) affect CHD disease
      pathways in individuals with PTSD. This design will permit an evaluation of the hypothesis
      that individuals who show significant improvement in PTSD symptoms will also show improvement
      in CHD risk biomarkers, and individuals who fail to show improvement or show worsening PTSD
      symptoms, will show no change or worsening in CHD biomarker activity. The study will also
      provide an evaluation of the role of key stress-related CHD biomarkers as mechanisms
      underlying the increased CHD risk burden associated with PTSD. Choice of CHD biomarkers
      focused on the established association of PTSD with chronic activation of stress response
      systems and includes autonomic nervous system dysregulation, chronic systemic inflammation,
      and vascular endothelial dysfunction. The proposed research is significant because it is
      expected to provide knowledge of the role of both the direct impact of PTSD symptoms on CHD
      risk pathways and the role of these systems as candidate mechanisms underlying the
      relationship between PTSD and CHD risk. By better defining how PTSD is a risk factor for CHD,
      as well as identifying the disease pathways involved, the proposed study will help inform
      strategies for CHD prevention, as well as guide optimal medical management for vulnerable men
      and women with PTSD, especially in those who refrain or who are refractory to psychiatric
      treatment.
    

Intervention name(s): Cognitive Processing Therapy - Cognitive
Intervention type(s): Behavioral
Intervention description(s): CPT-C is a brief cognitive behavioral treatment for PTSD. It consists of 2 hours of therapy each week for 6 weeks (i.e., two sessions).
Other intervention name(s): CPT-C
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Other