Owen, Emily; (2025) Trajectories of Change in Social Functioning in Patients Treated for Post-Traumatic Stress Disorder. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Functional impairment is common in individuals with post-traumatic stress disorder (PTSD). Psychological interventions are often successful in alleviating PTSD symptoms, however, they tend to focus primarily on symptom reduction, rather than functional improvement, and there is considerable variation in how individuals respond to treatment over time. Previous studies have employed growth mixture modelling (GMM) to identify distinct trajectories of symptom change in PTSD treatment through routine outcome modelling (ROM), but have not considered change in functional impairment. Aims: This study aimed to examine trajectories of change in social functioning in individuals treated for PTSD, using data from NHS talking therapies for anxiety and depression (TTad) services, whether the trajectory classes identified differ in baseline characteristics, and whether they are associated with eventual treatment outcomes. Method: GMMs were applied to a sample of 6144 patients receiving treatment in NHS TTad services to identify distinct trajectories of change in self-reported impairment in social leisure activities and close relationships over the course of treatment. Multinomial regression analyses were then adopted to explore how membership in these trajectory classes related to treatment outcomes. Results: Four trajectory classes were identified for social leisure activity impairment, while two classes were identified for close relationship impairment. Participants in trajectory classes characterised by lower baseline WSAS scores and greater improvement, particularly in social leisure activities, had significantly higher probabilities of reliable recovery and improvement, and lower odds of deterioration and attrition. Those in classes with persistently high WSAS scores experienced poorer outcomes. While fewer trajectory patterns were observed for ‘close relationships’ scores, individuals in the more impaired class (higher WSAS-5 scores) had significantly lower odds of recovery and higher PTSD severity. These associations remained significant after adjusting for demographic, clinical, and treatment-related variables. Conclusions: These findings highlight the role of social functioning in PTSD treatment outcomes. Addressing functional impairment alongside symptom reduction may enhance recovery and inform more person-centred, effective models of care within psychological therapy services.

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