Transient symptom increases and clinician–patient dyad response in trauma-focused treatment.

OBJECTIVE: Research has demonstrated that short-term cognitive-behavioral psychotherapies, such as cognitive processing therapy (CPT), lead to substantial and sustained improvements in posttraumatic stress disorder. One barrier to CPT use is clinician perception that treatment can worsen patients' symptoms or distress. This study used session-level data to evaluate (a) if characteristics often hypothesized to be related to transient symptom increase (TSI) were associated with TSI and (b) how clinician-patient dyads work through TSI. METHOD: = 95) were drawn from an implementation trial of CPT. Presence or discussion of childhood interpersonal trauma, multiple/repeated traumas, self-harm, suicidal ideation or behavior, substance use, encoding difficulties, and life stress were examined as predictors of TSI. Hierarchical logistic regression was used. RESULTS: Patient and trauma characteristics were not associated with TSI. Presence of a current life stressor was the only predictor of TSI. When a life stressor was discussed in session, it increased the likelihood that a patient reported a TSI at the next session by approximately 76%. CONCLUSIONS: The findings suggest that current life stressors can heighten the experience of traumatic stress symptoms; however, patient or trauma characteristics should not deter clinicians from recommending CPT or offering evidence-based posttraumatic stress disorder treatments to the full spectrum of patients who may benefit from them out of concern that it would lead to symptom worsening. (PsycInfo Database Record (c) 2026 APA, all rights reserved).