Does Cognitive Bias Modification for Appraisals Change Symptom-Cognition Relations in PTSD? Evidence from Network Analysis in a Randomized Controlled Trial

Posttraumatic stress disorder (PTSD) is maintained by dysfunctional trauma-related appraisals. Cognitive Bias Modification for Appraisals (CBM-APP) aims to train patients to make more functional trauma-related appraisals and has been shown to reduce PTSD symptoms. However, little is known about how this training affects the functional interrelations among symptoms and cognitive appraisals. In this secondary analysis of a randomized controlled trial involving 77 adult patients diagnosed with PTSD (CBM-APP: n = 37; control training: n = 40), we applied cross-sectional network analysis to examine changes in the structure and centrality of associations among PTSD symptom clusters (re-experiencing, avoidance, negative cognition and mood, hyperarousal) and trauma-related cognitive measures. To capture multiple levels of cognitive processing, we included responses during a scenario task (reflective, idiosyncratic, spontaneous appraisals) and the Implicit Association Test (automatic self-associations). Four Gaussian Graphical Models were estimated (pre-/post-training × CBM-APP vs. control group). While overall network connectivity did not differ significantly across networks, descriptive patterns indicated that Alterations in Cognition and Mood emerged as the most central node in both groups at post-training assessment. Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential decoupling of automatic negative self-associations from symptom activation. Given the small sample and moderate network stability, findings are preliminary but suggest that CBM-APP may influence the relational structure of PTSD symptoms and cognitions, offering insight into putative mechanisms of cognitive therapeutic change.