The predictive association between social support, communal mastery, and response to culturally adapted cognitive processing therapy among Native American women

Though social support (SS) and communal mastery (CM) are resilience factors among American Indian and Alaska Natives (AIAN), they have not been examined as trauma treatment predictors in this at-risk group. This study evaluated whether SS and CM were associated with improved treatment response in a sample of 73 AIAN women with posttraumatic stress disorder (PTSD) symptoms. Participants received culturally adapted CPT and were assessed for PTSD, CM, and SS. Data were analyzed using linear mixed-effects models. SS predicted improved PTSD, β = -.16, SE = .05, p = .003, and mental health, β = .16, SE = .05, p = .005, but not physical health. CM predicted improved PTSD, β = -.93, SE = .34, p = .008; mental health, β = .90, SE = .36, p = .013; and physical health, β = .95, SE = .31, p = .003. In a combined model, SS predicted improvements in PTSD, β = -.15, SE = .04, p < .001, and mental health, β = .12, SE = .06, p = .037, whereas CM did not. CM predicted improved physical health, β = 1.04, SE = .33, p = .003, whereas SS did not. Results highlight the benefits of SS and CM in trauma treatment outcomes for AIAN women, consistent with prior work, and further underscore the differential role of SS versus CM on mental versus physical health. Future work should explore how orientation to close and communal-level relationships may inform the protective benefits of social resources among AIAN.