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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    • "The third RCT was an Internet-based selfmanagement intervention compared with supportive treatment with a small sample (N 45) as a proof-of-concept design (Litz, Engel, Bryant, & Papa, 2007). Cognitive processing therapy (CPT) is an evidenced-based, trauma-focused cognitive therapy for PTSD that has been found to be efficacious in both civilian and veteran RCT studies (Bass et al., 2013; Forbes et al., 2012; Monson et al., 2006; Resick, Nishith, Weaver, Astin, & Feuer, 2002), with long-lasting results over 5 to 10 years (Resick, Williams, Suvak, Monson, & Gradus, 2012). A recent meta-analysis found CPT to have the highest average effect size of any treatment for PTSD (Watts et al., 2013). "
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    ABSTRACT: Numerous studies and reports document the prevalence of combat-related posttraumatic stress disorder (PTSD) in military personnel returning from deployments to Iraq and Afghanistan. The Department of Veterans Affairs and Department of Defense recommend cognitive processing therapy (CPT) as one of two first-line treatment options for patients with PTSD. CPT is an evidence-based, trauma-focused cognitive treatment for PTSD that has been shown to be efficacious in a wide variety of populations, but has just begun to be implemented with active duty military. The purpose of this article is to describe treatment considerations that may be pertinent to active duty populations, including stigma related to mental health treatment and minimization of symptoms, duty obligations, and special factors related to rank and occupational specialties. We provide recommendations for navigating these issues within the CPT protocol. Additionally, we discuss common themes that may be especially relevant when conducting CPT with an active duty military population, including blame/responsibility, the military ethos, erroneous blame of others, just-world beliefs, traumatic loss, fear of harming others, and moral injury. Case examples illustrating the use of CPT to address these themes are provided.
    Full-text · Article · Sep 2015 · Cognitive and Behavioral Practice
    • "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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    ABSTRACT: Posttraumatic stress disorder (PTSD) and smoking are often comorbid, and both problems are in need of improved access to evidence-based treatment. The combined approach could address two high-priority problems and increase patient access to both treatments, but research is needed to determine whether this is feasible and has promise for addressing both PTSD and smoking. We collected data from 15 test cases that received a treatment combining two evidence-based treatments: cognitive processing therapy-cognitive version (CPT-C) for PTSD and integrated care for smoking cessation (ICSC). We explored two combined treatment protocols including a brief (six-session) CPT-C with five follow-up in-person sessions focused on smoking cessation (n= 9) and a full 12-session CPT-C protocol with ICSC (n= 6). The combined interventions were feasible and acceptable to patients with PTSD making a quit attempt. Initial positive benefits of the combined treatments were observed. The six-session dose of CPT-C and smoking cessation resulted in 6-month bioverified smoking abstinence in two of nine participants, with clinically meaningful PTSD symptom reduction in three of nine participants. In the second cohort (full CPT-C and smoking treatment), both smoking and PTSD symptoms were improved, with three of six participants abstinent from smoking and four of six participants reporting clinically meaningful reduction in PTSD symptoms. Results suggested that individuals with PTSD who smoke are willing to engage in concurrent treatment of these problems and that combined treatment is feasible.
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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.
    Full-text · Article · Aug 2015
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