A randomized clinical trial investigating perceived burdensomeness as a mediator of brief intervention effects on posttraumatic stress symptoms

Abstract Objective Posttraumatic stress disorder (PTSD) is a prevalent and impairing condition that often involves difficulties with interpersonal functioning. Targeting interpersonal difficulties may be a promising alternative approach to reducing PTSD symptoms, particularly given the relatively low rates of treatment engagement and efficacy for first-line treatments for PTSD. Recent research has identified perceived burdensomeness (i.e., feelings of being a burden on others) and thwarted belongingness (i.e., feeling isolated and as if one does not belong) as two specific interpersonal factors related to increased PTSD symptoms. Thus, the current study tested whether a brief, computerized intervention would reduce PTSD symptoms via reductions in perceived burdensomeness and thwarted belongingness, vs. a repeated contact control condition. Method Hypotheses were tested among 250 trauma-exposed participants who were randomized to receive one of two active computerized interventions designed to target interpersonal factors (i.e., perceived burdensomeness or thwarted belongingness) or anxiety sensitivity, or participate in a repeated contact control condition, as part of a larger randomized clinical trial. Participants were then followed over six-months. Results Results indicated a direct effect of the active interventions on PTSD symptoms at month-one, that was not detected at months three or six. However, there was a significant indirect effect of condition at all-time points, such that reductions in perceived burdensomeness mediated condition effects on PTSD symptoms. Conclusions Findings identify perceived burdensomeness as a potential etiological factor in the maintenance of PTSD symptoms, and suggest that targeting perceived burdensomeness may be an effective approach to reducing PTSD symptoms.