Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic

Jeffreys, M. D. W.; Reinfeld, Courtney; Nair, Prakash V; Garcia, Hector A.; Mata-Galan, Emma; Rentz, Timothy O

doi:10.1016/j.janxdis.2013.04.010

Cited by 103 publications

(137 citation statements)

References 26 publications

Supporting

Mentioning

117

Contrasting

Order By: Relevance

“…However, such studies have largely been conducted in highly controlled settings. A smaller body of work (e.g., Chard et al, 2012;Jeffreys et al, 2014) has attempted to show the effectiveness of PTSD in settings that are more reflective of actual clinical practice.…”

Section: The Wars In Iraq Andmentioning

confidence: 99%

“…For example, there is evidence that veterans from the Vietnam War are less responsive to trauma-focused therapy than OEF-OIF veterans (Chard, Schumm, Owens, & Cottingham, 2010). Other studies have suggested that veterans with more severe PTSD symptoms may experience a significantly larger reduction in PTSD symptoms (e.g., Jeffreys et al, 2014). The study included additional patient variables such as age and initial PTSD symptom severity to add to this body of literature.…”

Section: The Wars In Iraq Andmentioning

confidence: 99%

“…Recent research has shown that the severity of PTSD symptoms can also influence how much patients benefit from treatment. Jeffreys et al (2014) suggested that patients who begin treatment with more severe symptoms experience greater gains in therapy than patients who begin treatment with lower symptoms. Schumm, Walter, and Chard (2013) Helms (1984) hypothesized that in counselor-client dyads with mixed races some interactions (e.g., parallel and progressive) would be more likely to result in long-lasting therapeutic relationships with more beneficial outcomes.…”

Section: Psychotherapies For Ptsdmentioning

confidence: 99%

“…Dropout has been defined as failure to complete a full psychotherapy protocol (e.g., Monson et al, 2006), attending less than two-thirds of the required number of sessions (Jeffreys et al, 2014), and failure to return to a previously scheduled appointment (Chard et al, 2010). Acomparison of dropout rates between treatments should also take into account the 8-session requirement for PE and 12-session requirement for CPT.…”

Section: Dropoutmentioning

confidence: 99%

See 3 more Smart Citations

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

et al. 2017

View full text Add to dashboard Cite

Multiple randomized clinical trials have shown that cognitive processing therapy (CPT) and prolonged exposure (PE) are evidence-based treatments for posttraumatic stress disorder (PTSD). However, additional research should verify the effectiveness of CPT and PE in conditions more reflective of clinical practice. The present study evaluated the effectiveness of CPT and PE at reducing veterans' self-reported PTSD symptoms as measured by total scores on the PTSD Checklist (PCL). This study involved a retrospective review of 2,030 charts. 750 veterans from 10 U.S. states who received CPT or PE in individual psychotherapy from the Veterans Health Administration were included in the study (N participants in CPT = 376; N participants in PE = 374). The study used multilevel modeling to evaluate the absolute and relative effectiveness of both treatments and to determine the relationship between patient-level factors and total PCL scores during treatment. Results showed that both CPT and PE were equally effective at reducing total PCL scores, but that the effectiveness of both therapies was reduced when compared to results obtained in randomized clinical trials. Patients who completed therapy reported significantly larger reductions on the PCL than patients who did not complete therapy. On average, patients who did not complete a full course of therapy reported little to no improvement on the PCL. Encouragingly, as a group these patients did not report an increase in the severity of their total PCL scores prior to dropping out from therapy. Patients who reported more severe total PCL scores at baseline experienced significantly larger reductions in PCL scores during therapy, but veterans at all levels of initial PTSD symptom severity benefited from treatment. Older veterans and Hispanic veterans had higher total PCL scores at baseline.However, veterans across all ages and three racial/ethnic groups (Caucasian, African American, Hispanic) experienced equivalent rates of symptom reduction. Therapist effects were small, but -ivstatistically significant. The study discusses the significance of these findings in light of prior research on trauma-focused therapy, future directions for research, and implications for practice.-v- Acknowledgements

show abstract

Section: The Wars In Iraq Andmentioning

confidence: 99%

Section: The Wars In Iraq Andmentioning

confidence: 99%

Section: Psychotherapies For Ptsdmentioning

confidence: 99%

Section: Dropoutmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Another recent study using a PCT sample (Jeffreys et al, 2014) found that Veterans who received Prolonged Exposure were more likely to benefit (i.e. effect size of 2.01) than those Veterans who received Cognitive Processing Therapy (i.e.…”

Section: Written Exposure Therapy As Step One In Reducing the Burden mentioning

confidence: 99%

Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

Austern¹

2017

PCSP

View full text Add to dashboard Cite

The purpose of this study is to explore the effects of a stepped-care model of treatment on Posttraumatic Stress Disorder (PTSD) symptomatology and sequelae in United States' Veterans. The study provides a literature review of the burden of PTSD, describes current best treatment practices, and illustrates key processes in the service-delivery of these treatments. Treatment considerations are demonstrated via three hybrid case examples, which serve as vivid portrayals of Veteran clients who struggle with research-consistent PTSD symptomatology and difficulties engaging in psychotherapy. In addition to being informed by clinical examples in relevant psychological literature, these composite cases, "Alex," "Bruno," and "Charles," contain disguised aspects drawn from psychotherapy clients who have been in my caseload in a PTSD clinic. Demonstrating these clients' courses of treatment provides an avenue for describing key clinical issues related to Veteran engagement in evidence-based PTSD therapy. By adopting a qualitative, disciplined inquiry approach, treatment is tailored to the client's unique psychological struggles within the context of historical, contextual, and cultural factors. Using a pragmatic case study research format (Fishman, 2013), case material is analyzed both qualitatively and quantitatively. The cases illustrate how a stepped-care model of treatment, beginning with Written Exposure Therapy (WET; Sloan, Lee, Litwack, Sawyer, & Marx, 2013) and culminating in Prolonged Exposure Therapy (PE; Foa, Hembree, & Rothbaum, 2007), has the potential to be distinctively helpful in the treatment of Veterans suffering from PTSD. These case studies are designed to be a resource for therapists who seek to gain additional understanding of how to provide efficient and effective treatment to Veterans.

show abstract

Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans

Polusny

Erbes

Thuras

et al. 2015

JAMA

260

230

View full text Add to dashboard Cite

IMPORTANCE Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD). OBJECTIVE To compare mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of 116 veterans with PTSD recruited at the Minneapolis Veterans Affairs Medical Center from March 2012 to December 2013. Outcomes were assessed before, during, and after treatment and at 2-month follow-up. Data collection was completed on April 22, 2014.INTERVENTIONS Participants were randomly assigned to receive mindfulness-based stress reduction therapy (n = 58), consisting of 9 sessions (8 weekly 2.5-hour group sessions and a daylong retreat) focused on teaching patients to attend to the present moment in a nonjudgmental, accepting manner; or present-centered group therapy (n = 58), an active-control condition consisting of 9 weekly 1.5-hour group sessions focused on current life problems. MAIN OUTCOMES AND MEASURESThe primary outcome, change in PTSD symptom severity over time, was assessed using the PTSD Checklist (range, 17-85; higher scores indicate greater severity; reduction of 10 or more considered a minimal clinically important difference) at baseline and weeks 3, 6, 9, and 17. Secondary outcomes included PTSD diagnosis and symptom severity assessed by independent evaluators using the Clinician-Administered PTSD Scale along with improvements in depressive symptoms, quality of life, and mindfulness.RESULTS Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment (change in mean PTSD Checklist scores from 63.6 to 55.7 vs 58.8 to 55.8 with present-centered group therapy; between-group difference, 4.95; 95% CI, 1.92-7.99; P=.002) and at 2-month follow-up (change in mean scores from 63.6 to 54.4 vs 58.8 to 56.0, respectively; difference, 6.44; 95% CI, 3.34-9.53, P < .001). Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (48.9% vs 28.1% with present-centered group therapy; difference, 20.9%; 95% CI, 2.2%-39.5%; P = .03) at 2-month follow-up, they were no more likely to have loss of PTSD diagnosis (53.3% vs 47.3%, respectively; difference, 6.0%; 95% CI, −14.1% to 26.2%; P = .55).CONCLUSIONS AND RELEVANCE Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect.

show abstract

Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic

Cited by 103 publications

References 26 publications

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

Effectiveness of Cognitive Processing Therapy and Prolonged Exposure in the Department of Veterans Affairs

Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans

Contact Info

Product

Resources

About