The following is a summary of “Effect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: A randomized clinical trial,” published in the July 2023 issue of the Psychosomatic Research by Watkins et al.
Coronary heart disease (CHD) is associated with posttraumatic stress disorder (PTSD); however, the effects of PTSD treatment on CHD biomarkers are uncertain. This investigation investigated whether cognitive processing therapy (CPT) enhances 24-hour heart rate variability (HRV), a predictor of CHD mortality. Individuals between the ages of 40 and 65 with PTSD (n = 112) were randomly assigned to receive either 12 sessions of cognitive processing therapy (CPT) or a Waiting List (WL) intervention consisting of six weekly telephone assessments of emotional status.
The primary outcome was 24-hour HRV estimated from the standard deviation of all regular R-R intervals (SDNN); secondary outcomes included the root mean square of successive heartbeat differences (RMSSD), low-frequency HRV (LF-HRV), and high-frequency HRV (HF-HRV). In addition, 24-hour urinary catecholamine excretion, plasma C-reactive protein (CRP), and flow-mediated dilation (FMD) of the brachial artery were secondary outcomes. Mean differences (Mdiff) were estimated using linear mixed longitudinal product models.
Participants randomized to the CPT group did not show improved SDNN (Mdiff = 9.8; 95% CI, −2.7 to 22.3; P = 0.12), the primary outcome variable, but showed improved RMSSD (Mdiff = 3.8; 95% CI, 0.5 to 7.1; P = 0.02), LF- HRV (Mdiff =0.3; 95% CI, 0.1 to 0.5; P= 0.01), and HF-HRV (Mdiff = 0.3; 95% CI, 0.0 to 0.6; P = 0.03) compared to WL. There were no differences in catecholamine excretion, FMD, or inflammatory markers between groups. Treating PTSD may enhance the quality of life and mitigate the elevated CHD risk factors associated with PTSD.