Improvement in mindful awareness during prolonged exposure treatment leads to reduction in posttraumatic stress...

Anger is a problematic symptom of posttraumatic stress disorder (PTSD) that causes significant distress, and it is often reported as a residual symptom following PTSD treatment. Although gold-standard treatments for PTSD can reduce anger, the mechanisms underlying this effect remain unknown. This study examines whether a gold-standard PTSD treatment, Prolonged Exposure, improves veterans' mindful awareness and if that change leads to a reduction in PTSD symptoms and anger expression.

This is a secondary data analysis of veterans randomly assigned to prolonged exposure delivered through home-based telehealth (n = 58), office-based telehealth (n = 59), or in-home, in-person treatment (n = 58). Veterans completed pre-, post-, and 6-month follow-up assessments of anger, as measured by the State and Trait Anger Expression Inventory-2, and PTSD symptoms PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5, as well as pre- and post-assessments of mindful awareness, as measured by the Mindful Attention Awareness Scale.

Pre- to posttreatment improvement in mindful awareness was related to a reduction in both anger up (β = -0.84, p < .001) and PTSD symptoms (β = -0.79, p < .001) from baseline to 6-month follow-up.

Specific components of prolonged exposure (e.g., in vivo and imaginal exposures) may improve mindful awareness, and findings suggest that improvement in mindful awareness reduces PTSD symptoms and anger expression. (PsycInfo Database Record (c) 2026 APA, all rights reserved).