The purpose of this experiment was to conduct a dismantling study of cognitive processing therapy in which the full protocol was compared with its constituent components--cognitive therapy only (CPT-C) and written accounts (WA)--for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. The intent-to-treat (ITT) sample included 150 adult women with PTSD who were randomized into 1 of the 3 conditions. Each condition consisted of 2 hr of therapy per week for 6 weeks; blind assessments were conducted before treatment, 2 weeks following the last session, and 6 months following treatment. Measures of PTSD and depression were collected weekly to examine the course of recovery during treatment as well as before and after treatment. Secondary measures assessed anxiety, anger, shame, guilt, and dysfunctional cognitions. Independent ratings of adherence and competence were also conducted. Analyses with the ITT sample and with study completers indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition.

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Objective This study tested a modified Cognitive Processing Therapy intervention (MCPT) designed as a more flexible administration of the protocol. Number of sessions was determined by client progress toward a priori defined end-state criteria, “stressor sessions” were inserted when necessary, and therapy was conducted by novice CPT clinicians. Method A randomized, controlled, repeated measures, semi-crossover design was utilized to 1) test the relative efficacy of the MCPT intervention compared to a Symptom-Monitoring Delayed Treatment (SMDT) condition and 2) to assess within-group variation in change with a sample of 100 male and female interpersonal trauma survivors with posttraumatic stress disorder (PTSD). Results Hierarchical linear modeling analyses revealed that MCPT evidenced greater improvement on all primary (PTSD and depression) and secondary (guilt, quality of life, general mental health, social functioning, and health perceptions) outcomes compared with SMDT. After the conclusion of SMDT, participants crossed over to MCPT, resulting in a Combined MCPT sample (n = 69). Of the 50 participants who completed MCPT, 58% reached end-state criteria prior to the 12th session, 8% at session 12, and 34% between sessions 12-18. Maintenance of treatment gains was found at the 3-month follow-up, with only two of the treated sample meeting criteria for PTSD. The use of stressor sessions did not result in poorer treatment outcomes. Conclusions Findings suggest that individuals respond at a variable rate to CPT, with significant benefit from additional therapy when indicated and excellent maintenance of gains. The insertion of stressor sessions did not alter the efficacy of the therapy.

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There is a paucity of empirical study about the effects of evidence-based psychotherapy for posttraumatic stress disorder (PTSD) on concurrent health concerns including sleep impairment. This study compares the differential effects of cognitive processing therapy (CPT) and prolonged exposure (PE) on health-related concerns and sleep impairment within a PTSD sample of female, adult rape survivors (N = 108). Results showed that participants in both treatments reported lower health-related concerns over treatment and follow-up, but there were relatively more improvements in the CPT condition. Examination of sleep quality indicated significant improvement in both CPT and PE across treatment and follow-up and no significant differences between treatments. These results are discussed with regard to the different mechanisms thought to underlie the treatments and future innovations in PTSD treatment.A growing literature implicates traumatic stress in adverse health outcomes when measured by biological and physiological indices, self-report, and mortality rates (Friedman & Schnurr, 1995;Green & Kimerling, 2004). Environmental and behavioral factors unique to traumatized individuals complicate the relationship between exposure to trauma and poor health status. A second factor contributing to negative health consequences within traumatized individuals is the significant sleep impairment observed in this population. A minimally studied area is whether treatment of trauma-related sequelae, specifically posttraumatic stress disorder (PTSD), also ameliorates concerns about physical health. This directly compares the effects of two evidence-based, trauma-focused psychotherapies, cognitive processing therapy (CPT; Resick & Schnicke, 1992, 1993 and prolonged exposure (PE;Foa, Hearst, Dancu, Hembree, & Jaycox, 1994), on both health-related concerns and sleep impairment, within female sexual assault survivors suffering from PTSD.Correspondence concerning this article should be addressed to: Tara E. Galovski, Center for Trauma Recovery, University of MissouriSt. Louis, One University Boulevard, St. Louis, MO 63121-4499. galovskit@msx.umsl.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptPosttraumatic stress disorder and poor health-related outcomes have been consistently linked in cross-sectional research. Several large-scale studies conducted with combat veterans have compared those with and without PTSD, and found that veterans with PTSD report significantly more chronic health conditions and generally poorer perception of physical health than their non-PTSD counterparts (Barrett et al., 2002, Kulka et al., 1990Schnurr & Jankowski, 1999;Schnurr et al., 2000), even when controlling for behaviors known to independently contribute to poor health outcomes such as smoking, alcohol use, deployment status, military status, and demographics (Barrett et al., 2002;Schnurr & Spiro, 1999). Although less research has been conducted in non-veteran populations, specific medical conditions s...

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Objective Despite the success of empirically supported treatments for posttraumatic stress disorder (PTSD), sleep impairment frequently remains refractory following treatment for PTSD. This single-site, randomized controlled trial examined the effectiveness of sleep-directed hypnosis as a complement to an empirically supported psychotherapy for PTSD (cognitive processing therapy; CPT). Method Participants completed either 3 weeks of hypnosis (n = 52) or a symptom monitoring control condition (n = 56) before beginning standard CPT. Multilevel modeling was used to investigate differential patterns of change to determine whether hypnosis resulted in improvements in sleep, PTSD, and depression. An intervening variable approach was then used to determine whether improvements in sleep achieved during hypnosis augmented change in PTSD and depression during CPT. Results After the initial phase of treatment (hypnosis or symptom monitoring), the hypnosis condition showed significantly greater improvement than the control condition in sleep and depression, but not PTSD. After CPT, both conditions demonstrated significant improvement in sleep and PTSD; however, the hypnosis condition demonstrated greater improvement in depressive symptoms. As sleep improved, there were corresponding improvements in PTSD and depression, with a stronger relationship between sleep and PTSD. Conclusion Hypnosis was effective in improving sleep impairment, but those improvements did not augment gains in PTSD recovery during the trauma-focused intervention. Public Health Significance: This study suggests that hypnosis may be a viable treatment option in a stepped-care approach for treating sleep impairment in individuals suffering from PTSD.

There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence-connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption-as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ(2) (d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (ηp (2) = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (ηp (2) = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events.