Neurocognitive Predictors of Treatment Outcomes in Psychotherapy for Comorbid PTSD and Substance Use Disorders

J. Cobb Scott, Kevin G. Lynch, David P. Cenkner, Shannon M. Kehle-Forbes, Melissa A. Polusny, Ruben C. Gur, Shirley Chen, Edna B. Foa, David W. Oslin

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Comorbidity between posttraumatic stress disorder (PTSD) and substance use disorders (SUD) is common, and both are associated with cognitive dysfunction. However, few studies examine the impact ofcognitive deficits on treatment outcomes. Here, we leverage data from a randomized clinical trial ofintegrated versus phased psychotherapy for SUD and PTSD to examine the relation of cognitive functioningto treatment response. Method: One-hundred and thirteen veterans with co-occurring PTSD and SUDcompleted Penn Computerized Neurocognitive Battery tests assessing attention, executive control, memory,and spatial processing. Linear mixed-effects models examined interactions between cognitivefunctioning and time in predicting primary PTSD and SUD outcomes across both treatments. Results:Significant verbal immediate memory by time interactions were found for both PTSD symptoms (p =.01,f2 = 0.020) and percent heavy drinking or drug use days (p =.004, f2 = 0.020). There was a significantworking memory by time interaction for percent heavy drinking or drug use days (p =.007, f2 = 0.016).Participants with better verbal memory had greater reductions across time in PTSD symptoms and drinking/drug use, while those with better working memory had lesser reductions in their drinking/drug use acrosstime. Conclusions: Individuals with lower verbal memory functioning had less robust PTSD and SUDsymptom reductions in PTSD/SUD psychotherapy, with differences that were generally small in magnitude.Those with better working memory functioning had worse SUD outcomes.

Original languageEnglish (US)
Pages (from-to)937-946
Number of pages10
JournalJournal of consulting and clinical psychology
Issue number11
StatePublished - 2021

Bibliographical note

Funding Information:
This work was supported by a United States (U.S.) Department of Veterans Affairs Merit Review Awards to Dr. David W. Oslin (ZDA1-03-W10) andto Dr. J. Cobb Scott (I01RX002699). Dr. Shannon M. Kehle-Forbes was supported by a Health Services Research & Development Career DevelopmentAward (09-020). This work was supported with resources and the use offacilities at the Mental Illness Research, Education, and Clinical Center atthe Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) and theMinneapolis VA Healthcare System. The funder was not involved in the studydesign; collection, analysis, and interpretation of data; writing the report; or thedecision to submit this article for publication. The views expressed in this articleare those of the authors and do not necessarily reflect the position or policy of theDepartment of Veterans Affairs. The authors declare no conflicts of interest

Publisher Copyright:
© 2021. American Psychological Association


  • Episodic memory
  • Neuropsychology
  • Posttraumatic stress disorder
  • Psychotherapy
  • Substance use treatment


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