Magnetoencephalographic Correlates of Clinical Change After Cognitive Processing Therapy in Adults With PTSD (REC-HEALING-TR)

Participants receive 12 weekly individual sessions of CPT and undergo MEG and clinical assessment before and after treatment.

12 weekly 60-minute sessions; Spanish-adapted protocol based on Resick, Monson & Chard (2017); psychoeducation, cognitive restructuring, Socratic dialogue, weekly assignments; five themes: safety, trust, power/control, esteem and intimacy.

Recording at C3N-UCM before and after the intervention

Proportion of enrolled participants who complete the 12 sessions and both MEG recordings

Magnetoencephalography (MEG) will be recorded while participants perform a trauma memory cue task, adapted for MEG from the script-driven procedure used in the STAR mechanism study (Lanius et al., 2003; Whalley et al., 2013). Participants view personalised cues related to their trauma memory, contrasted with comparison cues. Functional connectivity (phase synchronisation between source-reconstructed regions of the cognitive-control and autobiographical-memory networks) will be estimated across canonical frequency bands. As this is the first MEG adaptation of the paradigm, the connectivity metric and bands are exploratory, with correction for multiple comparisons. The outcome is the change from baseline to week 12 in connectivity for the trauma versus comparison contrast.

MEG will be recorded during eyes-open and eyes-closed resting-state conditions. Functional connectivity (phase synchronisation between source-reconstructed regions of the cognitive-control and autobiographical-memory networks) will be estimated across canonical frequency bands, separately for each condition. The connectivity metric and bands are exploratory, with correction for multiple comparisons. The outcome is the change from baseline to week 12.

PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013).

• 20 items rated from 0 (not at all) to 4 (extremely). Total score ranges from 0 to 80.
• Higher scores indicate a worse outcome (more severe symptoms).

International Trauma Questionnaire (ITQ; Cloitre et al., 2018).

• 12 symptom items (6 PTSD, 6 Disturbances in Self-Organization) rated from 0 (not at all) to 4 (extremely). Symptom total score ranges from 0 to 48 (each of the two sets of items from 0 to 24).
• Higher scores indicate a worse outcome (more severe symptoms).

Symptom Assessment-45 Questionnaire (SA-45; Davison et al., 1997), a brief version of the Symptom Checklist-90-Revised (SCL-90-R).

• 45 items rated from 0 (not at all) to 4 (a lot). It covers a total of 9 different symptomatic areas (e.g. depression, anxiety, interpersonal sensibility) and gives an overall severity score. Total score ranges from [0 to 180].
• Higher scores indicate a worse outcome (more severe symptoms).

Ryff's Scales of Psychological Well-Being (Ryff & Keyes, 1995).

• 29 items rated from 1 (strongly disagree) to 6 (strongly agree). The SPWB evaluates 6 dimensions of psychological well-being: Self-acceptance, Positive relationships, Autonomy, Environmental mastery, Life purpose, and Personal growth. Scores ranges differ from scale to scale:
• Self-acceptance [4-24]
• Positive relationships [5-30]
• Autonomy [6-36]
• Environmental mastery [5-30]
• Life purpose [4-24]
• Personal growth [5-30]
• Higher scores indicate a better outcome (more psychological wellbeing).

Satisfaction with Life Scale (SWLS; Diener et al., 1985).

• 5 items rated from 1 (strongly disagree) to 7 (strongly agree). Total score ranges from 5 to 35.
• Higher scores indicate a better outcome (more satisfaction with life).

Cognitive Emotion Regulation Questionnaire-short (CERQ-short; Garnefski & Kraaij, 2007).

• 18 items rated from 1 (almost never) to 5 (almost always). The CERQ-short evaluates 9 dimensions (composed by 2 items each): Self-blame, Acceptance, Rumination, Positive refocusing, Refocus on planning, Positive reappraisal, Putting into perspectiva, Catastrophizing, and Other-blame. Each dimension ranges from 5 to 10. Also, two big dimensions are calculated depending on the type of strategy:
• Sum of the adaptive subscales (acceptance, positive refocusing, refocus on planning, positive reappraisal, putting into perspective; 10 items) ranges from 10 to 50. Higher scores indicate a better outcome.
• Sum of the maladaptive subscales (self-blame, rumination, catastrophizing, other-blame; 8 items) ranges from 8 to 40. Higher scores indicate a worse outcome.

Self-Care Scale (Spanish instrument; "Escala de autocuidado", Gonzalez et al., 2017),

• 31 items rated from 1 (completely disagre) to 7 (completely agree). The scale evaluates dimensions: Self-destructive behaviors, Non-tolerance towards positive affect, Issues accepting help, Resentment due to non-reciprocity, No positive activities, and None attendace towards personal needs.
• Higher scores indicate worse self-care.

Acceptability will be assessed after the intervention using a participant satisfaction questionnaire (CSQ-8). The questionnaire will evaluate participants' perceived usefulness, relevance, comprehensibility, and overall satisfaction with the intervention. 8 items rated from 1 to 4. Total score ranges from 8 to 32. Higher scores indicate greater satisfaction and acceptability (better outcome).

Experimental task from the STAR trial, adapted to MEG. This task is designed to activate trauma-related autobiographical memories and contrast them with neutral memories. This paradigm probes how traumatic experiences are represented and contextualized in the brain. It has been adapted from previously validated script-driven trauma memory procedures used in neuroimaging studies of PTSD, which have consistently demonstrated sensitivity to trauma recall and associated neural responses (e.g., Lanius et al., 2003: Whalley et al., 2013).

Patient Health Questionnaire-9 (PHQ-9; Kroenke et al., 2001).

• 9 items rated from 0 (not at all) to 3 (nearly every day). Total score ranges from 0 to 27.
• Higher scores indicate a worse outcome (more severe symptoms).