Reflective Function as a Mediator of Interpersonal Psychotherapy (IPT)
Condition: PTSD
Study type: Observational

Summary: 
      Our recent randomized controlled trial of psychotherapies for posttraumatic stress disorder
      (PTSD) showed that Interpersonal Psychotherapy (IPT) benefitted patients. The mechanism of
      action for IPT is unclear; unlike most PTSD therapies, it does not work through exposure to
      trauma reminders. This assessment study will assess Symptom-Specific Reflective Function, a
      measure of emotional awareness of one's PTSD symptoms, as a potential mediator of IPT,
      capitalizing on naturalistic treatment of military veterans with PTSD at Columbia
      University/New York State Psychiatric Institute.
    

Detailed description: 
      In a randomized controlled study, the investigators recently showed that fourteen weeks of
      treatment with Interpersonal Psychotherapy (IPT) worked at least as well as the best studied
      exposure therapy in relieving symptoms of posttraumatic stress disorder (PTSD) (American
      Journal of Psychiatry, 2015). The investigators do not know the mechanism by which IPT works,
      however, except that it does not work through exposing patients to reminders of their trauma,
      as most exposure therapies for PTSD do. Rather, IPT seems to work in part by helping numbed
      patients to reconnect with and to understand their feelings, then use those feelings to
      handle interpersonal encounters with other people. One promising measure of this possible
      mechanism of IPT is Reflective Function, which has two components.

      Reflective Functioning (RF) measures how well an individual understands his or her emotions
      as well as the emotions of significant other people in his or her life. A separate aspect is
      Symptom-Specific Reflective Function (SSRF), which gauges the individual's emotional
      understanding of his or her PTSD symptoms. Both RF and SSRF can be measured in a tape
      recorded interview that takes about 20 minutes, in which the interviewer asks the patient to
      describe relationships with important people in the patient's life, as well as questions
      about the patient's understanding of his or her symptoms. The tape is then transcribed for
      scoring.

      A Veterans Clinic at New York State Psychiatric Institute to treat armed service veterans and
      their families who have PTSD and other psychiatric disorders has opened. This clinic is
      covered under a separate IRB protocol. As some of the patients in that clinic will receive
      treatment with IPT, the investigators propose to assess RF, SSRF, and a related measure, the
      Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), at three points in
      treatment (before treatment starts; at week 4; and after treatment ends, at week 14) to see
      whether change in SSRF in particular accounts for improvement in PTSD as measured by the
      Clinician-Administered PTSD Scale (CAPS), which will be assessed pre-treatment (week 0),
      mid-treatment (week 7), and post-treatment (week 14). Both veterans and their family members
      will be eligible for this protocol so long as they meet study eligibility criteria. Because
      there is no reason to expect that psychotropic medication alters RF, patients who are taking
      stable doses of medication will be allowed to continue them during IPT treatment.
    

Intervention name(s): Interpersonal Psychotherapy (IPT)
Intervention type(s): Behavioral
Intervention description(s): IPT is a 14 week psychotherapy for PTSD. SSRF is a brief interview to assess emotional understanding of one's symptoms.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        25 US veterans or their family members suffering from DSM-5 PTSD