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Despite numerous advances in the understanding of the development and maintenance of posttraumatic stress disorder (PTSD), current research is often narrowly focused on symptom reduction. Despite this, the impact of PTSD also extends into areas such as interpersonal relationships, pursuit of valued activities, and self-acceptance. These processes appear to be especially relevant in chronic/complex PTSD but are rarely represented in controlled trials. As a result, there is a need to expand the focus of PTSD research beyond symptom reduction to include processes of well-being.


Using a latent growth curve analytical approach, this study examined the impact of change in self-compassion, psychological inflexibility, and interpersonal courage on PTSD symptom reduction, trauma-related shame, quality of life, and valued living for participants in an exposure-based PTSD partial hospitalization program (n = 537; 75% White; 83% female; mean age = 36).


All key processes assessed except for interpersonal courage showed clinically meaningful change over the course of the program. For the PTSD and valued living three-piece spline model slopes, only the three self-compassion slopes were significant predictors (p < .001). The psychological inflexibility slope predicted the quality of life slope (p < .001), while the interpersonal courage slope predicted the trauma-related shame slope (p < .001).


Results supported the importance of broadening the focus of PTSD conceptualization, treatment, and outcome assessment to include processes such as psychological inflexibility, self-compassion, and interpersonal courage.


Accepted version. Mindfulness, Vol. 12, No. 12 (December 2021): 2983-2996. DOI. © 2021 Springer. Used with permission.

Mauricio Garnier-Villarreal was affiliated with Vrije Universiteit Amsterdam at the time of publication.

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