Implicit Trauma Identity Associations in Treatment-Seeking US Military Personnel Do Not Predict or Change in Response to Cognitive Processing Therapy for PTSD

Objective: This study evaluated implicit associations (i.e., associations in memory that are automatically activated and difficult to control consciously) related to trauma and one's self in the context of a clinical trial for active duty service members seeking treatment for posttraumatic stress disorder (PTSD). Previous studies with nontreatment-seeking community samples found that implicit trauma identity associations were associated with PTSD symptoms even after controlling for amount of trauma exposure and self-reported negative cognitions about the self. This study extended prior work by evaluating whether trauma-related implicit associations were associated with PTSD and depressive symptoms in a clinical sample seeking treatment for PTSD, predicted PTSD treatment response, or changed over the course of treatment. Method: This secondary analysis examined implicit trauma identity associations using data from a clinical trial evaluating a variable-length adaptation of cognitive processing therapy for military personnel. Participants were 127 active duty U.S. military personnel (13.4% women) seeking PTSD treatment. Implicit trauma identity associations were evaluated at baseline and posttreatment. Study hypotheses and data analysis plan were preregistered. Results: Contrary to predictions, baseline implicit trauma identity associations were not significantly associated with baseline PTSD or depressive symptoms and did not predict treatment response. Implicit trauma identity associations did not change significantly in response to treatment. Conclusions: More tailoring of implicit trauma measures for military personnel and/or treatment-seeking patients may be needed. The measure may lack sensitivity to change in response to treatment and have reduced utility in treatment-seeking samples with high symptom burden and less variability in symptoms. Clinical Impact Statement We examined whether implicit associations about trauma and identity (associations in memory that are automatically activated and difficult to control consciously) were associated with posttraumatic stress disorder (PTSD) and depression symptoms in military personnel seeking PTSD treatment. Implicit trauma associations were not significantly associated with baseline PTSD or depression, did not predict response to cognitive processing therapy (CPT), and did not change significantly in response to treatment. The measure of implicit trauma associations may need to be tailored to specific patients (e.g., military personnel); it may not have utility for treatment-seeking individuals with a higher burden of PTSD symptoms.