Anger and Avoidant Coping as Predictors of Treatment Outcome in Military-Related Posttraumatic Stress Disorder

Abstract

The present study examined the impact of pre-treatment anger and avoidant coping on treatment outcome in military-related posttraumatic stress disorder (PTSD). Data from 83 Dutch veterans with PTSD attending treatment in a specialized institute were utilized. The effect of both prognostic factors was firstly investigated with repeated-measures analyses of variance using split-plot design, and subsequently with linear regression analyses. Regarding anger a greater decline in PTSD severity from pre-treatment to follow-up for high pre-treatment levels of anger compared to low levels of anger was found. Anger was also found to predict change in PTSD severity, but concerning the three separate PTSD symptom clusters anger only predicted change in the hyperarousal cluster. The interaction between pre-treatment PTSD severity and anger was furthermore found to predict change in PTSD severity, suggesting that higher pre-treatment anger was associated with better treatment responses as pre-treatment levels of PTSD severity decreased. With respect to avoidant coping no impact on treatment outcome was found. These results are inconsistent with the existing literature. This study stresses the importance of anger as a predictor of treatment outcome and is novel in suggesting its positive impact, raising questions about the previously assumed role of this prognostic factor. It is discussed how the findings of this research may help improve the screening and treatment process, however, replication is self-evidently required.