Cognitive Processing Therapy for Veterans with Military-Related Posttraumatic Stress Disorder

Boston University, Boston, Massachusetts, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 11/2006; 74(5):898-907. DOI: 10.1037/0022-006X.74.5.898
Source: PubMed

ABSTRACT Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population.

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    • "Despite evidence that dysfunctional cognitions decrease during the course of CPT (Monson et al., 2006; Owens, Pike, & Chard, 2001; Resick et al., 2008; Sobel, Resick, & Rabalais, 2009), studies to date have not tested the primary assumption that changes in dysfunctional cognitions result in subsequent changes in PTSD and depression symptoms during CPT. Randomized clinical trials show that CPT is associated with moderate to large effect size reductions on measures of dysfunctional posttraumatic cognitions and large effect size reductions in PTSD and depression symptoms (Monson et al., 2006; Resick et al., 2008; Resick, Nishith, Weaver, Astin, & Feuer, 2002). Because the aim of these randomized clinical trials was to test the efficacy of CPT, the studies did not test whether changes in dysfunctional cognitions preceded changes in PTSD and depression symptoms during CPT. "
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    ABSTRACT: Although cognitive processing therapy (CPT) has strong empirical support as a treatment for posttraumatic stress disorder (PTSD), studies have not directly examined the proposed change mechanisms that underlie CPT-that change in trauma-related cognitions produces change in PTSD and depression symptoms. To improve the understanding of underlying mechanisms of psychotherapeutic change, this study investigated longitudinal association between trauma-related cognitions, PTSD, and depression among veterans receiving CPT during a 7-week residential PTSD treatment program. All 195 veterans met DSM-IV-TR diagnosis for PTSD. The sample was 53% male with a mean age of 48 years. Self-reported race was 50% White and 45% African American. The Posttraumatic Cognitions Inventory was used to assess trauma-related cognitions. The PTSD Checklist and Beck Depression Inventory-II were used to assess PTSD and depression, respectively. Cross-lagged panel models were used to test the longitudinal associations between trauma-related cognitions, PTSD, and depression. Measures were administered at three time points: pre-, mid-, and posttreatment. Change in posttraumatic cognitions (self-blame; negative beliefs about the self) preceded change in PTSD. In addition, (a) change in negative beliefs about the self preceded change in depression, (b) change in depression preceded change in self-blame cognitions, and (c) change in depression preceded change in PTSD. Findings support the hypothesized underlying mechanisms of CPT in showing that change in trauma-related cognitions precedes change in PTSD symptoms. Results suggest that reduction of depression may be important in influencing reduction of PTSD among veterans in residential PTSD treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 07/2015; DOI:10.1037/ccp0000040 · 4.85 Impact Factor
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    • "Although the majority of providers indicated no contraindication to the use of PE and CPT, others identified three broad reasons veterans were perceived to be less suitable candidates for PE and CPT: psychiatric comorbidities (i.e., substance dependence, dissociation, paranoia , personality disorders), cognitive limitations (due to both traumatic brain injury and organic causes), and low patient willingness or motivation. These factors are inconsistent with research findings demonstrating that veterans with multiple comorbidities can successfully participate in trauma-focused treatments (e.g., Monson et al., 2006; Schnurr et al., 2007). "
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    ABSTRACT: Despite extensive data from randomized controlled trials supporting the efficacy of evidence-based treatments (EBTs), the adoption of these interventions in the Department of Veterans Affairs (VA) and the Department of Defense has been markedly slow. Qualitative interviews were conducted with a nationally representative sample of 38 directors of specialized posttraumatic stress disorder outpatient programs in VA medical centers about implementation of two EBTs. Every director confirmed that EBTs, specifically prolonged exposure and cognitive processing therapy, were provided in their program. It was nearly universal, however, for these treatments to be preceded by preparatory groups. The consensus among directors was that these groups improve readiness for trauma-focused EBTs, help veterans to make informed decisions about their treatment plans, improve coping skills and symptom management, and decrease the likelihood of no-shows for scheduled EBTs. The concept of readiness for trauma-focused EBTs guided program development
    Professional Psychology Research and Practice 01/2015; DOI:10.1037/a0038535 · 1.34 Impact Factor
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    • "Finally, future research would also benefit from the inclusion of a waitlist condition to test whether the improvements in psychosocial functioning that were observed in the current study are the result of changes in PTSD symptom clusters or treatment itself. The PTSD treatment literature has consistently documented the efficacy of trauma-focused, cognitive–behavioral therapies to reduce PTSD symptom severity and diagnostic status (e.g., Forbes et al., 2012; Monson et al., 2006; Resick, Galovski et al., 2008; Resick et al., 2002). Similarly, improvements in psychosocial functioning following these treatments have also been documented (e.g., Galovski et al., 2005; Monson et al., 2006, 2012; Taylor et al., 2006). "
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    ABSTRACT: This study conducted secondary analyses of a published trial and sought to determine if different domains of psychosocial functioning (e.g., daily living, work, nonfamily relationships) improved following trauma-focused treatment for posttraumatic stress disorder (PTSD). Cognitive processing therapy (CPT), an empirically supported treatment that involves evaluating trauma-related beliefs and written trauma accounts, was compared to its components: CPT without the written accounts or written accounts only in a sample of 78 women with PTSD secondary to interpersonal violence. Overall and individual domains of functioning significantly improved with treatment and results were similar across treatment groups, Fs (2, 150) ≥ 11.87, ps < .001. Additionally, we investigated whether changes in different PTSD symptom clusters were associated with outcomes in domains of psychosocial functioning, after collapsing across treatment condition. Multiple hierarchical linear regression analyses revealed that overall clinician-assessed PTSD symptom reduction was associated with outcomes in all domains of functioning, βs = .44 to .68, ps < .001. Additionally, improvements in the emotional numbing symptom cluster were associated with outcomes in the nonfamily relationships domain, β = .42, p < .001, and improvements in the hyperarousal symptom cluster were associated with outcomes in the overall, daily living, and household tasks domains, βs = .34 to .39, ps < .01. Results suggest that it may be important to monitor improvements in emotional numbing and hyperarousal symptoms throughout treatment to increase the likelihood of changes in psychosocial functioning.ResumenEste estudio condujo un análisis secundario de un ensayo publicado y buscó determinar si diferentes dominios de funcionamiento psicosocial (ej., vida diaria, trabajo, relaciones no familiares) mejoraron después de un tratamiento enfocado en el trauma para trastorno por estrés post-traumático (TEPT). La terapia de procesamiento cognitivo (TPC), un tratamiento respaldado empíricamente que involucra la evaluación de las creencias relacionadas al trauma y los relatos escritos del trauma, fue comparado con sus componentes: TPC sin los relatos escritos o solamente relatos escritos en una muestra de 78 mujeres con TEPT secundario a violencia interpersonal. Los dominios de funcionamiento generales e individuales aumentaron significativamente con el tratamiento y los resultados fueron similares a través de los grupos de tratamiento, Fs (2, 150) ≥ 11.87, ps < .001. Adicionalmente, investigamos si los cambios en los diferentes grupos de síntomas de TEPT se asociaron con resultados en dominios de funcionamiento psicosocial, después de colapsar a través de las condiciones de tratamiento. Un análisis de regresión linear múltiple jerárquica reveló que la reducción general de síntomas de TEPT evaluada por clínicos se asoció con los resultados en todos los dominios de funcionamiento βs = .44 to .68, ps < .001. Adicionalmente, mejorías en el grupo de síntomas de entumecimiento emocional se asociaron con los resultados del dominio de relaciones no familiares, β = .42,p < .001, y mejorías en el grupo de síntomas de hiperexcitabilidad se asociaron con los resultados generales en los dominios, de vida diaria y tareas domésticas βs = .34 to .39, ps < .01.Los resultados sugieren que puede ser importante monitorear las mejorías en los síntomas de entumecimiento emocional e hiperexcitabilidad a lo largo del tratamiento para aumentar la probabilidad de cambios en el funcionamiento psicosocial.Traditional and Simplified Chinese Abstracts by AsianSTSS標題:人際暴力女倖存者接受認知處理療法的拆解試驗中功能和PTSD症狀羣的關係撮要:本研究為一已刊登研究的二次分析,驗証治療創傷後壓力症(PTSD)的聚焦創傷法後心理社會功能中不同領域(如日常生活、工作、家庭以外關係)的改進。認知處理療法(CPT)是實証支持的治療,包括評估創傷相連信念和創傷筆記。CPT在研究中對照其中成份:即CPT除去創傷筆記,或只有創傷筆記,而樣本是78名因人際暴力而患上PTSD的婦女。綜合和個別功能領域在治療後明顯改進,而不同治療組別中結果相類,FS (2, 150) 11.87, ps < .001。我們亦檢測不同PTSD症狀羣變化在除去治療狀況因素後會否與心理社會功能領域結果相連。多重階層綫性分析顯示綜合臨床評估PTSD症狀減退與功能的所有領域結果相關,βS= .44至 .68, ps< .001。情感麻木症狀羣的改進和非家庭關係領域結果相連,β= .42, p< .001., 而過激症狀羣改進則與綜合、日常生活和家居事務領域有關係,βS= .34至.39, ps< .01。結論是在治療中監察情感麻木和過激症狀的改進增加心理社會功能改善的機會。标题:人际暴力女幸存者接受认知处理疗法的拆解试验中功能和PTSD症状羣的关系撮要:本研究为一已刊登研究的二次分析,验证治疗创伤后压力症(PTSD)的聚焦创伤法后心理社会功能中不同领域(如日常生活、工作、家庭以外关系)的改进。认知处理疗法(CPT)是实证支持的治疗,包括评估创伤相连信念和创伤笔记。CPT在研究中对照其中成份:即CPT除去创伤笔记,或只有创伤笔记,而样本是78名因人际暴力而患上PTSD的妇女。综合和个别功能领域在治疗后明显改进,而不同治疗组别中结果相类,FS (2, 150) 11.87, ps < .001。我们亦检测不同PTSD症状羣变化在除去治疗状况因素后会否与心理社会功能领域结果相连。多重阶层线性分析显示综合临床评估PTSD症状减退与功能的所有领域结果相关,βS= .44至 .68, ps< .001。情感麻木症状羣的改进和非家庭关系领域结果相连,β= .42, p< .001., 而过激症状羣改进则与综合、日常生活和家居事务领域有关系,βS= .34至.39, ps< .01。结论是在治疗中监察情感麻木和过激症状的改进增加心理社会功能改善的机会。
    Journal of Traumatic Stress 10/2014; 27(5). DOI:10.1002/jts.21954 · 2.72 Impact Factor
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