Exploring the Efficacy of a Residential Treatment Program Incorporating Cognitive Processing Therapy-Cognitive for Veterans With PTSD and Traumatic Brain Injury

PTSD and Anxiety Disorders Division, Cincinnati VA Medical Center, Cincinnati, Ohio 45220, USA.
Journal of Traumatic Stress (Impact Factor: 2.72). 06/2011; 24(3):347-51. DOI: 10.1002/jts.20644
Source: PubMed


As the numbers of military personnel participating in the wars in Afghanistan and Iraq continue to grow, the percentage of individuals who return with both a traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) also increases. Although there appears to be significant overlap in the symptoms resulting from PTSD and TBI, the best course of treatment remains an area of controversy. The authors present initial findings from a Veterans Administration residential program for comorbid PTSD and TBI. Forty-two participants completed a program comprising psychoeducational groups and cognitive skill building that was augmented with a modification of standard cognitive processing therapy. The results suggest that residential programs that incorporate this form of cognitive therapy can anticipate meaningful participation from patients, and that it may be an effective approach to treat PTSD in individuals with a history of TBI.

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    • "This difference was most apparent between pre-and midtreatment assessments. Our findings were both comparable to, and divergent from, those of Resick et al.'s (2008) CPT dismantling study and Chard et al.'s (2011) prior investigation of this residential program. In particular, neither Resick et al. nor the current study found significant differences between CPT and CPT-C at posttreatment on self-reported PTSD symptoms. "
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    ABSTRACT: Cognitive processing therapy (CPT) is a leading cognitive-behavioral treatment for posttraumatic stress disorder (PTSD) and a front-line intervention according to the U.S. Department of Veterans Affairs treatment guidelines. The original CPT protocol entails the creation of a written trauma account and use of cognitive therapy. Cognitive processing therapy-cognitive therapy only (CPT-C) does not involve a written account and in a previous study resulted in faster symptom improvement and fewer dropouts than standard CPT. This study sought to replicate these findings by comparing the effectiveness of CPT to CPT-C in a sample of 86 U. S. male veterans receiving treatment in a PTSD residential program for individuals with a history of traumatic brain injury. CPT and CPT-C were delivered in a combined individual and group format as part of a comprehensive, interdisciplinary treatment program. Outcomes were self-and clinician-reported PTSD and self-reported depression symptoms. Multilevel analysis revealed no significant difference for PTSD symptoms, but did show a greater decrease in depression at posttreatment (d = 0.63) for those receiving CPT. When an experiment-wise a correction was applied, this effect did not remain significant.
    Journal of Traumatic Stress 08/2014; 27(4). DOI:10.1002/jts.21934 · 2.72 Impact Factor
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    • "PTSD is screened for in the current study, but the presence of PTSD symptoms is not exclusionary. While PTSD can influence performance in neuropsychological and experimental measures, we determined it would not be possible to study TBI effectively and exclude individuals with PTSD based on recent estimated comorbidity, particularly in military service-related TBI cases [14]. In addition to the severity level indicated by the GOS-E, in all cases we seek additional confirmatory evidence based on the Glasgow Coma Scale (GCS) and documentation of prior medical evaluations. "
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    ABSTRACT: Background Individuals who sustain traumatic brain injuries (TBIs) often continue to experience significant impairment of cognitive functions mediated by the prefrontal cortex well into chronic stages of recovery. Traditional brain training programs that focus on improving specific skills fall short of addressing integrative functions that draw upon multiple higher-order processes critical for social and vocational integration. In the current study, we compare the effects of two short-term, intensive, group-based cognitive rehabilitation programs for individuals with chronic TBI. One program emphasizes learning about brain functions and influences on cognition, while the other program adopts a top-down approach to improve abstract reasoning abilities that are largely reliant on the prefrontal cortex. These treatment programs are evaluated in civilian and military veteran TBI populations. Methods/design One hundred individuals are being enrolled in this double-blinded clinical trial (all measures and data analyses will be conducted by blinded raters and analysts). Each individual is randomly assigned to one of two treatment conditions, with each condition run in groups of five to seven individuals. The primary anticipated outcomes are improvement in abstract reasoning and everyday life functioning, measured through behavioral tasks and questionnaires, and attention modulation, as measured by functional neuroimaging. Secondary expected outcomes include improvements in the cognitive processes of working memory, attention, and inhibitory control. Discussion Results of this trial will determine whether cognitive rehabilitation aimed at teaching TBI-relevant information about the brain and cognition versus training in TBI-affected thinking abilities (e.g., memory, attention, and executive functioning) can improve outcomes in chronic military and civilian TBI patient populations. It should shed light on the nature of improvements and the characteristics of patients most likely to benefit. This trial will also provide information about the sustainability of treatment-related improvements 3 months post-training. Trial registration ClinicalTrials.gov Identifier: NCT01552473
    Trials 01/2013; 14(1):29. DOI:10.1186/1745-6215-14-29 · 1.73 Impact Factor
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    • "The impact of a pre-treatment diagnosis of MDD may influence treatment outcome in this population, but this has not been examined in the literature to date. The current study aimed to extend the findings of Chard et al. (2011) by comparing treatment outcome between veterans with PTSD and a history of TBI, with and without a pre treatment diagnosis of MDD. We predicted that overall, among veterans with PTSD and a history of TBI, those who also had a comorbid diagnosis of MDD at pretreatment would experience less symptom reduction than veterans without a diagnosis of MDD. "
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    ABSTRACT: Among military personnel, posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and a history of traumatic brain injury (TBI) are frequently reported, highlighting the need for treatment outcome research with this population. This study examined the influence of the presence or absence of comorbid MDD on the outcome of a residential treatment program at the midpoint and end of the program for 47 male veterans with PTSD and a history of TBI. Results demonstrated significant decreases of self-reported symptoms on the PTSD Checklist-Stressor Specific Version (PCL-S; MDD, d = 1.19; No MDD, d = 1.17) and the Beck Depression Inventory-II (BDI-II; MDD, d = 0.98; No MDD, d = 1.09) following treatment for both groups. There were no differences in the rate of symptom reduction between groups. Individuals who also met criteria for MDD at pretreatment, however, evidenced higher scores on symptom measures at all assessment time points (ds = 0.60-1.25).
    Journal of Traumatic Stress 08/2012; 25(4):426-32. DOI:10.1002/jts.21722 · 2.72 Impact Factor
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