Change in posttraumatic stress disorder symptoms: do clinicians and patients agree?

This study assessed the longitudinal association between clinician and patient ratings of posttraumaticstressdisorder(PTSD)symptomsoverthecourseof2differentrandomizedclinicaltrialsofveteranswithchronic PTSD. One trial, the Department of Veterans Affairs Cooperative Study 420 (CSP 420; N 360)compared trauma-focused and present-centered group therapies, and the 2nd trial compared cognitiveprocessing theory and a waitlist control condition ( N 60). Linear mixed effects modeling revealedsignificant associations between clinician ratings (Clinician-Administered PTSD Scale; CAPS; D. D.Blake et al., 1990) and patient ratings (Posttraumatic Stress Disorder Checklist; PCL; F. W. Weathers,B. T. Litz, J. A. Herman, J. A. Huska, & T. M. Keane, 1993) in total and symptom clusters of PTSD.Contrary to hypothesis, the amount of change on the CAPS ranged from .75 to .82 standard deviationsfor every 1 standard deviation change on the PCL. The CAPS and PCL were more closely associated inthe trauma-focused vs. present-centered treatment condition in CSP 420, and especially regardinghyperarousal symptoms. When comparing categorization of clinically significant change on the CAPSand PCL, the authors found no differences in the percentages of agreement between clinicians andpatients in improvement and exacerbation. The value of multimodal assessment of PTSD treatmentoutcomes is discussed.Keywords: PTSD, assessment, treatment outcomes, concordance, psychometrics