Prolonged Exposure and Sertraline Treatments for Posttraumatic Stress Disorder Also Improve Multiple Indicators of Social Functioning

Abstract

Trauma survivors with posttraumatic stress disorder (PTSD) frequently also suffer from difficulties in social functioning that range across emotional, cognitive, and environmental domains. A detailed evaluation of the differential impacts of effective PTSD treatments on social functioning is needed. Men and women (N = 200) with chronic PTSD received 10 weeks of prolonged exposure (PE) or sertraline in a randomized clinical trial and were followed for 24 months. A secondary data analysis examined changes in social functioning with regard to fear of intimacy; receipt of social support; and distress, avoidance, and negative cognitions in social situations. Effects were examined between treatments over time, controlling for baseline functioning. There were large, durable improvements across all indices. Compared to sertraline, PE was more efficient at reducing fear of intimacy and distress from negative social cognitions by posttreatment, ds = 0.94-1.14. Patients who received sertraline continued to improve over the course of follow-up, ds = 0.54-1.17. The differential speed of therapeutic effects may argue for more direct mechanisms in cognitive behavioral interventions versus cascade effects in serotonin reuptake inhibitors. Notably, both treatments produced substantial social benefits for trauma survivors with social functioning difficulties, and effect sizes were comparable to typical reductions in PTSD, depression, and anxiety.

Trial registration: ClinicalTrials.gov NCT00127673.

© 2020 The Authors. Journal of Traumatic Stress published by Wiley Periodicals, Inc. on behalf of International Society for Traumatic Stress Studies.

Figures

Figure 1. Trajectories of Individuals With Higher and Lower Scores of (A) Fear of Intimacy and (B) Distress From Negative Cognitions in Social Situations, from Pre- to Posttreatment and Through 24-Month Follow-Up

Note. Trajectories are presented for patients with higher (mean score + 1 standard deviation) and lower scores of pretreatment functioning (mean score − 1 standard deviation). Higher scores indicate more severe difficulties. FIS = Fear of Intimacy Scale; Mo = months after treatment; PE = prolonged exposure; Post = posttreatment; Pre = pretreatment; ISI-Cog = Inventory of Social Interactions–Negative Cognitions subscale.

Figure 2. Trajectories of Individuals With Higher and Lower Scores of (A) Avoidance of Social Situations, (B) Distress in Social Situations, and (C) Receipt of Social Support, from Pre- to Posttreatment and Through 24-Month Follow-Up

Note. Trajectories of individuals higher and lower in pretreatment social functioning with regard to avoidance of social situations (Inventory of Social Interactions [ISI] Avoidance subscale [ISI-A]; Panel A) and distress in social situations (ISI Distress [ISI-D] subscale; Panel B) are presented for patients with higher scores of pretreatment functioning (mean score + 1 standard deviation) and lower scores of pretreatment functioning (mean score − 1 standard deviation). Higher scores indicate more avoidance and distress. Frequency of receiving socially supportive behaviors (Inventory of Socially Supportive Behaviors [ISSB]; Panel C) is presented for patients who received more socially supportive behaviors (mean score + 1 standard deviation) and fewer supportive behaviors (mean score − 1 standard deviation). Higher scores indicate a higher frequency of receiving socially supportive behaviors. Mo = months after treatment; Post = posttreatment; Pre = pretreatment. Treatments are combined due to the lack of group differences.

Figure 2. Trajectories of Individuals With Higher and Lower Scores of (A) Avoidance of Social Situations, (B) Distress in Social Situations, and (C) Receipt of Social Support, from Pre- to Posttreatment and Through 24-Month Follow-Up

Note. Trajectories of individuals higher and lower in pretreatment social functioning with regard to avoidance of social situations (Inventory of Social Interactions [ISI] Avoidance subscale [ISI-A]; Panel A) and distress in social situations (ISI Distress [ISI-D] subscale; Panel B) are presented for patients with higher scores of pretreatment functioning (mean score + 1 standard deviation) and lower scores of pretreatment functioning (mean score − 1 standard deviation). Higher scores indicate more avoidance and distress. Frequency of receiving socially supportive behaviors (Inventory of Socially Supportive Behaviors [ISSB]; Panel C) is presented for patients who received more socially supportive behaviors (mean score + 1 standard deviation) and fewer supportive behaviors (mean score − 1 standard deviation). Higher scores indicate a higher frequency of receiving socially supportive behaviors. Mo = months after treatment; Post = posttreatment; Pre = pretreatment. Treatments are combined due to the lack of group differences.