Article

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.

Download full-text

Full-text

Available from: Candice M Monson, Oct 27, 2014
6 Followers
 · 
293 Views
  • Source
    [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Interpersonal trust is fundamental for the recovery of trauma survivors and the effectiveness of group psychotherapy. Yet there is limited research on the relationship between interpersonal trust and group psychotherapy. Twenty-one male Vietnam combat veterans with posttraumatic stress disorder (PTSD) (6 in a long-term process group [LTP], 10 in a short-term cognitive processing therapy group [CPT], and 5 treatment-as-usual controls) were evaluated before and after group psychotherapy using the Posttraumatic Stress Disorder Checklist-Military Version (PCL-M) and an in-vivo measure of interpersonal trust, the Iterated Trust Game. Three (14.3%) of the veterans were African American, 9 were Caucasian (42.9%), and 9 were Hispanic (42.9%); they averaged 61.9 years of age (SD = 1.8 years). Change in PCL-M scores differed by group (controls: -1.0 ± 3.7; CPT: -15.5 ± 6.8; LTP: -1.3 ± 12.2; p = .003). CPT group subjects improved more than controls (p < .001) and trended toward more improvement than the LTP group (p = .081). Members of the LTP group, compared to nonprocess group participants, showed greater initial (p = .042), and posttherapy trust (p = .003). Posttreatment, interpersonal trust was significantly higher in the LTP than the CPT group (p < .001). These results suggest that CPT treatment may be better than LTP treatment for improving PTSD symptoms, but LTP therapy may be better than CPT therapy for improving interpersonal trust in veterans with PTSD. They suggest important roles for both group treatments and point to the value of interpersonal trust in successful recovery from PTSD.
    Bulletin of the Menninger Clinic 09/2014; 78(4):335-48. DOI:10.1521/bumc.2014.78.4.335 · 0.72 Impact Factor