A Randomized Clinical Trial of Cognitive Processing Therapy for Veterans With PTSD Related to Military Sexual Trauma

Abstract

In this randomized controlled clinical trial, the authors evaluated the effectiveness of cognitive processing therapy (CPT) in the treatment of self-reported and clinician-assessed posttraumatic stress disorder (PTSD) related to military sexual trauma (MST), along with depressive symptoms. Eighty-six veterans (73 female, 13 male) randomly assigned to receive 12 individual sessions of either CPT or present-centered therapy (PCT) were included in analyses. Blinded assessments occurred at baseline, posttreatment, and 2, 4, and 6 months posttreatment. Mixed-effects model analysis revealed a significant interaction between groups (p = .05, d = -0.85): At posttreatment, veterans who received CPT had a significantly greater reduction in self-reported, but not clinician-assessed, PTSD symptom severity compared to veterans who received PCT. All three primary outcome measures improved significantly, both clinically and statistically, across time in both treatment groups. Pre- and posttreatment effect sizes were mostly moderate to large (d = 0.30-1.02) and trended larger in the CPT group. Although the study was impacted by treatment fidelity issues, results provide preliminary evidence for the effectiveness of CPT in reducing self-reported PTSD symptoms in a population of veterans with MST, expanding on established literature that has demonstrated the effectiveness of CPT in treating PTSD related to sexual assault in civilian populations.

Lessons learned in a clinical trial for military sexual trauma-related posttraumatic stress disorder

“…Veterans were frequently asked to make a decision between completing study-related follow-up sessions or beginning a new course of treatment or medication. In our RCT, participants were more committed to treatment phases of the study in comparison to follow-up visits, with 31 percent of participants unable/unwilling to complete psychotherapy treatment and 44 percent unable/unwilling to complete all follow-up sessions [2].…”

“…However, when clinical trials are conducted within Department of Veterans Affairs (VA) Medical Center (VAMC) settings, several additional and unique factors contribute to the difficulty of conducting RCTs. The challenges and strategies to address them, described in this editorial, are based on an RCT conducted to determine the effectiveness of an evidence-based therapy to treat Veterans with military sexual trauma (MST)-related posttraumatic stress disorder (PTSD) [2].…”

Treating Persons With Traumatic Brain Injury

“…Prolonged exposure provides therapist-supported, repeated situational and imagined exposure to aspects of the trauma incident [34]. Cognitive processing therapy is a manualized cognitive behavioral therapy that includes education about emotional and thought responses to trauma, cognitive restructuring, and writing of trauma narratives [35]. These 2 methods are currently being tested in a large, multisite comparative effectiveness trial [21].…”

Therapeutic treatments for PTSD : does type of treatment impact help seeking behaviors in a military sample?

“…Both treatments outperformed the wait-list with regard to PTSD symptom reduction. CPT showed significantly greater improvement than PE for both guilt cognitions and health related concerns (Resick et al, 2002;Galovski, Monson, Bruce, & Resick, 2009 Suris et al, 2013). An emerging treatment for PTSD that does not explore the trauma experience/ memory is present-centered therapy (PCT; also known as present-focused therapy).…”

“…Since its development, PCT has evolved to include the creation of treatment manuals and trainings designed to demonstrate faithful implementation in research trials (e.g., Classen et al, 2011;McDonagh et al, 2005;Schnurr et al, 2003;Schnurr, et al, 2007;Suris, Link-Malcolm, Chard, Ahn, & North, 2013). According to the present- for PCT, when compared to evidence-based treatments, were small and non-significant.…”