# Cognitive and Psychotherapy in PTSD: Mechanisms and Functional Outcomes

> **NIH VA I01** · PHILADELPHIA VA MEDICAL CENTER · 2021 · —

## Abstract

Abstract
Posttraumatic stress disorder (PTSD) is prevalent among combat veterans and is a substantial public health
burden. Several psychotherapies, including cognitive processing therapy (CPT) and prolonged exposure (PE)
therapy, have been recommended as efficacious for the treatment of PTSD and are being disseminated
nationally in the VA Healthcare System. Yet many individuals show limited benefit from such treatments.
Accumulating evidence, including from our group, indicates that episodic memory deficits may be one factor
limiting psychotherapy treatment efficacy in PTSD. However, cognitive functioning is not often considered
during PTSD treatment, and Veterans with cognitive impairment may therefore be receiving treatments that are
suboptimal. Thus, systematic studies of how cognitive dysfunction impacts treatment response are greatly
needed to identify relevant, potentially modifiable factors affecting psychotherapy outcomes and inform the
development of effective rehabilitation interventions for individuals with PTSD. Critically, no studies to date
have examined the pathways by which cognitive functioning may affect treatment and functional outcomes. To
address this limitation, the proposed project aims to test specific models of pathways between memory
dysfunction and therapeutic and functional outcomes by integrating novel insights from both cognitive
neuropsychology and psychotherapy research. Approximately 140 Veterans with PTSD will be enrolled at the
Corporal Michael J. Crescenz Philadelphia VA Medical Center (CMC VAMC) and CMC VAMC Community-
Based Outpatient Clinics (CBOCs). All participants will undergo a standard, 12-session course of CPT by
certified and experienced study therapists. Participants will undergo assessments at baseline, mid-treatment,
and end of treatment. At baseline, participants will receive diagnostic interviews, behavioral questionnaires,
and a comprehensive cognitive assessment, including measures of executive control, emotion processing,
verbal functioning, emotionally-neutral episodic memory, and autobiographical memory. Assessments of PTSD
symptoms, treatment engagement, memory for treatment content, and functional outcomes will be collected
longitudinally. The proposed study will determine whether verbal memory is a specific predictor of CPT
outcomes in PTSD, including both symptom reductions and functional outcomes (Aim 1). The study will also
determine the pathways by which memory functioning affects treatment outcomes by examining relationships
between memory functioning, treatment engagement, recall of treatment content, and illness course. More
specifically, analyses will examine whether memory for treatment content mediates the relationship between
memory functioning and treatment outcomes (Aim 2). Finally, exploratory analyses will examine whether
alternative models of memory dysfunction in PTSD (e.g., autobiographical memory) provide increased
prediction of treatment and functional outcomes relati...

## Key facts

- **NIH application ID:** 10290876
- **Project number:** 5I01RX002699-04
- **Recipient organization:** PHILADELPHIA VA MEDICAL CENTER
- **Principal Investigator:** James Cobb Scott
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10290876

## Citation

> US National Institutes of Health, RePORTER application 10290876, Cognitive and Psychotherapy in PTSD: Mechanisms and Functional Outcomes (5I01RX002699-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10290876. Licensed CC0.

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