Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors

Resick, Patricia A.; Wachen, Jennifer Schuster; Dondanville, Katherine A.; LoSavio, Stefanie T.; Young‐McCaughan, Stacey; Yarvis, Jeffrey S.; Pruiksma, Kristi E.; Blankenship, Abby E.; Jacoby, Vanessa M.; Peterson, Alan L.; Mintz, Jim

doi:10.1016/j.brat.2021.103846

Cited by 40 publications

(37 citation statements)

References 49 publications

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“…Novel treatment approaches, such as meditation-based interventions, have demonstrated moderate reductions in hyperarousal symptoms as compared to supported psychotherapy (Crawford et al, 2019). Finally, recent research supports the use of variable-treatment lengths for CPT (Resick et al, 2021;Taylor et al, 2021). Varying treatment length rather than adhering to the 12-session model allowed 12% more patients to reach a good end state (i.e., PTSD Checklist for DSM-5 , 19).…”

Section: Discussionmentioning

confidence: 99%

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Miles¹,

Hale²,

Mintz³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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Objective: Evidence-based psychotherapies are efficacious at reducing posttraumatic stress disorder (PTSD) symptoms, but military and veteran samples improve less than civilians. The objective of this secondary analysis of two clinical trials of cognitive processing therapy (CPT) was to determine if hyperarousal symptoms were more resistant to change compared with other PTSD symptom clusters in active duty service members. Method: Service members completed the PTSD Checklist for the DSM-5 (PCL-5) pre-and post-CPT. Symptoms were coded present if rated 2 (moderate) or higher on a 0-4 scale. Cutoffs for reliable and clinically significant change classified 21%, 18%, and 61% of participants as recovered, improved, and suboptimal responders, respectively. Data analyses focused on the posttreatment status of symptoms that were present at baseline to determine their persistence as a function of treatment outcome. Generalized linear mixed effects models with items treated as a repeated measure estimated the proportions who continued to endorse each symptom and compared hyperarousal Shannon R. Miles https://orcid.

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Section: Discussionmentioning

confidence: 99%

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Miles¹,

Hale²,

Mintz³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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“…In addition, among studies treating service members, CPT without written accounts has been investigated more frequently than the full protocol version. 4 , 5 , 15 Based on prior findings of WET, we expected WET would be noninferior to CPT at all assessment periods included in the study and associated with better treatment retention than CPT.…”

Section: Introductionmentioning

confidence: 99%

Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder

et al. 2022

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IMPORTANCE Posttraumatic stress disorder (PTSD) occurs more commonly among military service members than among civilians; however, despite the availability of several evidence-based treatments, there is a need for more efficient evidence-based PTSD treatments to better address the needs of service members. Written exposure therapy is a brief PTSD intervention that consists of 5 sessions with no between-session assignments, has demonstrated efficacy, and is associated with low treatment dropout rates, but prior randomized clinical trials of this intervention have focused on civilian populations. OBJECTIVE To investigate whether the brief intervention, written exposure therapy, is noninferior in the treatment of PTSD vs the more time-intensive cognitive processing therapy among service members diagnosed with PTSD. DESIGN, SETTING, AND PARTICIPANTSThe study used a randomized, noninferiority design with a 1:1 randomization allocation. Recruitment for the study took place from August 2016 through October 2020. Participants were active-duty military service members diagnosed with posttraumatic stress disorder. The study was conducted in an outpatient setting for service members seeking PTSD treatment at military bases in San Antonio or Killeen, Texas.INTERVENTIONS Participants received either written exposure therapy, which consisted of 5 weekly sessions, or cognitive processing therapy, which consisted of 12 twice-weekly sessions. MAIN OUTCOMES AND MEASURESParticipants were assessed at baseline and at 10, 20, and 30 weeks after the first treatment session. The primary outcome measure was PTSD symptom severity assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Noninferiority was defined as the difference between the 2 groups being less than the upper bound of the 1-sided 95% CI-specified margin of 10 points on the CAPS-5. RESULTSOverall, 169 participants were included in the study. Participants were predominantly male (136 [80.5%]), serving in the Army (167 [98.8%]), with a mean (SD) age of 34 (8) years. Eightyfive participants were randomly assigned to written exposure therapy, with 65 (76.5%) completing all treatment sessions, and 84 to cognitive processing therapy, with 47 (54.8%) completing all treatment sessions. Findings indicated that written exposure therapy was noninferior to cognitive processing therapy, with the largest difference in change in outcome between the treatment conditions of 3.96 points on the outcome measure. The 1-sided 95% CI upper limit was less than 10 (continued) Key Points Question Is a 5-session, traumafocused written exposure therapy treatment noninferior to a more timeintensive, trauma-focused cognitive processing therapy treatment for activeduty service members diagnosed with posttraumatic stress disorder (PTSD)? Findings In this randomized noninferiority clinical trial that included 169 men and women activity-duty service members, written exposure therapy was found to be noninferior to cognitive processing therapy. Dropout rates for written exposure therapy were s...

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“…As many as 33–55% of civilians who dropped out of a CPT clinical trial demonstrated clinically significant reductions in symptoms, or met good end-state functioning related to depression or PTSD [ 30 ]. A recent study of variable-length CPT found 28% of dropouts were found to have remitted from their PTSD and 23% made clinically significant improvements [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial

et al. 2022

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Background Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. Methods The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. Results Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = −.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. Conclusions CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. Trial registration ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).

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Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors

Cited by 40 publications

References 49 publications

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Hyperarousal symptoms linger after successful PTSD treatment in active duty military.

Effect of Written Exposure Therapy vs Cognitive Processing Therapy on Increasing Treatment Efficiency Among Military Service Members With Posttraumatic Stress Disorder

In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial

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