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Marcella Woud, Simon E. Blackwell, Lorika Shkreli, Felix Würtz, Jan Christopher Cwik, Jürgen Margraf, Emily A. Holmes, Susann Steudte-Schmiedgen, Stephan Herpertz, Henrik Kessler

• \(\bf Introduction:\) Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers. \(\bf Objective:\) We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms. \(\bf Methods:\) We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme. \(\bf Results:\) In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (\(\it d \)= 1.30, 95% CI 0.82–1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; \(\it d \) = 0.85, 95% CI 0.39–1.32) and the PTSD Checklist for DSM-5 (PCL-5; \(\it d \) = 0.68, 95% CI 0.23–1.14), but not for long-term cortisol concentrations (\(\it d \) = 0.25, 95% CI –0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points. \(\bf Conclusions:\) Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.