Individuals with posttraumatic stress disorder (PTSD) are at increased risk for suicidal thoughts and behaviors; however, clinicians often report apprehension about recommending trauma‐focused therapy to patients with an increased risk of suicide. The present study aimed to evaluate the safety, tolerability, and response to cognitive processing therapy (CPT) among a sample of military veterans with PTSD and increased suicide risk. A secondary aim was to provide a clinically useful definition of high suicide risk. Chart review was used to classify the suicide risk level of 290 veterans who participated in CPT at a Veterans Affairs clinic. Treatment outcomes in veterans with different suicide risk levels were also gathered and compared. Over 50% (n = 155) of the sample demonstrated increased suicide risk, and 1.0% (n = 3) engaged in suicidal behavior after initiating treatment. To date, hospital records show no suicide deaths since 2016 among clinic patients who received CPT. Suicide risk level was not associated with CPT tolerability, and PTSD symptom change was equivalent across groups, ps = .085–.976. Veterans across groups reported clinically significant reductions in PTSD symptoms. The tested suicide risk categorization schemes performed similarly in differentiating the odds of CPT completion and PTSD symptom reduction. These results suggest that veterans with PTSD and an increased risk of suicide, including those with previous suicide attempts and current ideation, can tolerate and benefit from CPT. Additional variables must be considered to truly determine the acute and imminent suicide risk that would deem CPT to be contraindicated.
Objective: Cognitive processing therapy (CPT) has reliably demonstrated efficacy for the treatment of posttraumatic stress disorder (PTSD) for most patients, however, not all patients derive the same benefit from CPT. The aim of the present study is to identify trauma-related variables that predict differential response to CPT in a sample of treatment-seeking veterans in order to improve individual responses to CPT. Method: The present study evaluated demographic, therapy, and trauma-related variables as possible predictors of variable response to CPT in a sample of 259 treatment-seeking veterans who received treatment in an outpatient clinic. Results: Nearly 43% of veterans completed group or individual CPT and of completers, 76.1% reported clinically significant improvement in PTSD symptoms. Although most variability in treatment response was attributable to person-level characteristics, no demographic, treatment, or trauma-related variables were associated with change in PTSD symptoms or explained variance in treatment response (all ps Ͼ 0.05). Conclusion: These results suggest that CPT can be effectively implemented in its various forms to a broad range of patients (i.e., male or female, of any age or race, trauma type, or time since traumatic event) when the treatment is completed and applied by a trained provider.
Clinical Impact StatementCognitive processing therapy (CPT) is a manualized trauma-focused psychotherapy that has been widely disseminated throughout large United States health care systems. Results of the present analyses indicate that CPT can be effectively applied to a wide variety of individuals with variable and complex trauma histories and/or comorbid depression, when the protocol is completed.
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