Biological and symptom changes in posttraumatic stress disorder treatment: A randomized clinical trial

Sheila A.M. Rauch, Anthony P. King, James Abelson, Peter W. Tuerk, Erin Smith, Barbara O. Rothbaum, Erin Clifton, Andrew Defever, Israel Liberzon

Research output: Contribution to journalArticlepeer-review

78 Scopus citations


Background Understanding cognitive and biological mechanisms of PTSD treatment can help refine treatments and increase rates of response. Methods Thirty-six veterans with PTSD were randomly assigned to receive Prolonged exposure therapy (PE) or Present-Centered therapy (PCT). We examined symptoms, trauma-related cognitions, and two indices of HPA axis function (cortisol awakening response and cortisol response to a script-driven imagery task). Results Thirty veterans started treatment and 26 completed. PE resulted in significantly more symptom reduction than PCT (P =.008). High treatment responders collapsed across treatments showed nominally higher cortisol levels measured at pretreatment 30 min after trauma script exposure compared to low responders (P =.08). At midtreatment, high treatment responders showed higher cortisol levels throughout the imagery task (Ps =.03-.04). There were no differences between high and low treatment responders at posttreatment. Thoughts of incompetence (F (1.6, 35.8) = 16.8, P =.000) and a dangerous world (F (1.3, 29.9) = 8.2, P =.004) significantly improved over time in high treatment responders but showed no change in low responders. Script-associated cortisol response prior to treatment and reductions in thoughts of incompetence accounted for 83% of the variance in reductions in PTSD severity with PE. Conclusions Both increased cortisol response to personal trauma script prior to PTSD therapy and reductions in cognitive symptoms of PTSD were significantly and uniquely related to reductions in the core symptoms of PTSD in PE. However, contrary to our hypotheses, cortisol measures were not related to cognitive changes.

Original languageEnglish (US)
Pages (from-to)204-212
Number of pages9
JournalDepression and Anxiety
Issue number3
StatePublished - Mar 1 2015


  • PTSD
  • cognitive behavioral therapy
  • cortisol
  • exposure therapy
  • treatment
  • veteran

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Biological and symptom changes in posttraumatic stress disorder treatment: A randomized clinical trial'. Together they form a unique fingerprint.

Cite this