Does Cognitive Bias Modification for Appraisals Change Symptom-Cognition Relations in PTSD? Preliminary Evidence from Network Analysis in a Randomized Controlled Trial

AI Summary

CBM-APP reduced centrality of implicit trauma-related self associations from pre to post training, suggesting weaker automatic links with symptom activation.
Alterations in cognition and mood emerged as the most central node at post-training in both CBM-APP and control groups.
Overall network connectivity did not differ significantly, and conclusions are preliminary given small sample and moderate network stability.

AI Summary

Cognitive Bias Modification for Appraisals (CBM-APP) aims to train more functional trauma-related appraisals and has been shown to reduce PTSD symptoms.

Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential weaker associations of automatic negative self-associations with symptom activation.

Basic summary

Clin Psychol Psychother. 2026 Jul-Aug;33(4):e70308. doi: 10.1002/cpp.70308.

ABSTRACT

BACKGROUND: Post-traumatic stress disorder (PTSD) is maintained by dysfunctional trauma-related appraisals. Cognitive Bias Modification for Appraisals (CBM-APP) aims to train more functional trauma-related appraisals and has been shown to reduce PTSD symptoms. However, little is known about how this training affects the interrelations among symptoms and cognitive appraisals.

METHODS: In this secondary analysis of a randomized controlled trial involving 77 adult patients diagnosed with PTSD (CBM-APP: n = 37; control training: n = 40), we applied repeated cross-sectional network analysis to examine changes in the structure and centrality of associations among PTSD symptom clusters (re-experiencing, avoidance, negative cognition and mood, hyperarousal, assessed with the PTSD Checklist for DSM-5) and trauma-related cognitive measures, all assessed at both pre- and post-training. To capture multiple levels of cognitive processing, we included responses during a scenario task (reflective, idiosyncratic, spontaneous appraisals) and the Implicit Association Test (automatic self-associations). Four cross-sectional Gaussian Graphical Models were estimated for the training and control group and both timepoints (pre-/post-training × CBM-APP vs. control group).

RESULTS: While overall network connectivity did not differ significantly across networks, descriptive patterns indicated that Alterations in Cognition and Mood emerged as the most central node in both groups at post-training assessment. Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential weaker associations of automatic negative self-associations with symptom activation.

CONCLUSION: Given the small sample and moderate network stability, findings are preliminary but suggest that CBM-APP may influence the relational structure of PTSD symptoms and cognitions.

PMID:42470174 | DOI:10.1002/cpp.70308

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