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


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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Available from: Candice M Monson, Oct 27, 2014
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    • "Because PTSD could trigger lapse or relapse in smokers making a quit attempt, it is possible that traumafocused treatments reducing PTSD symptoms will have the additional benefit of increasing the efficacy of smoking cessation treatment. Reduced PTSD symptoms could be achieved by implementing Cognitive Processing Therapy (CPT), a trauma-focused PTSD treatment that has demonstrated efficacy in reducing PTSD symptoms and diagnosis across multiple trials (Monson et al., 2006; P. Resick, Williams, Suvak, Monson, & Gradus, 2012; Resick et al., 2008; Suris, Link-Malcolm, Chard, Ahn, & North, 2013). A variant of CPT removes the written trauma accounts so that more time can be devoted to challenging cognitions, referred to as CPT – Cognitive version (CPT-C) (Resick et al., 2008). "
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    • "For example, the presence of mental health comorbidity in those with PTSD and older patient age have been associated with increased likelihood of completing MAC for PTSD among OEF/OIF veterans (Seal et al., 2010). In keeping with prior studies as well as guidelines for evidence-based psychotherapies for PTSD, we defined MAC for PTSD as one or both of the following: completion of nine or more outpatient mental health visits (Foa et al., 2005; Monson et al., 2006; Lu et al., 2011) within any 15-week period (Seal et al., 2010); or at least twelve consecutive weeks of treatment with a medication endorsed by VA/DoD PTSD practice guidelines. These medications include selective serotonin reuptake inhibitors (SSRI; Wang et al., 2002; Seal et al., 2010; "
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    ABSTRACT: Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers. Copyright © 2015. Published by Elsevier Ireland Ltd.
    08/2015; 230(1). DOI:10.1016/j.psychres.2015.08.028
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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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