Study Suggests Cognitive Processing Therapy Improves PTSD Symptoms More than Usual Care among Veterans in Residential Rehabilitation Program
BACKGROUND:
The prevalence of PTSD increased among VA healthcare users by 60% between 2001 and 2007, from 4.8% to 7.6%. This increase is likely due, in part, to an influx of newly returning Veterans: nearly one in four OEF/OIF Veterans treated within the VA healthcare system have received a diagnosis of PTSD. As a result, it is important to evaluate the comparative effectiveness and sustainability of evidence-based treatments for PTSD. This study examined one VA PTSD Residential Rehabilitation Program and compared clinical outcomes for two cohorts of male Veterans with PTSD that were treated with either cognitive processing therapy (CPT) over 14 sessions (n=104), or trauma-focused group treatment as usual (TAU) over 15 sessions prior to the implementation of CPT (n=93). CPT is an evidence-based, cognitive behavioral psychotherapy that involves: learning about PTSD symptoms; identifying the connection between thoughts and feelings; processing trauma-related emotions; learning skills to help question/challenge thoughts; and, eventually, changing dysfunctional beliefs related to the traumatic experience, oneself, and the world. Data on self-reported severity of PTSD symptoms were compared for both cohorts at intake and at discharge from the program. Investigators also assessed self-reported patient demographics, depression symptoms, psychological distress, quality of life, and coping.
FINDINGS:
- Veterans treated with CPT experienced more improvement of PTSD and depression symptoms, psychological quality of life, coping, and psychological distress than Veterans who received TAU. In the CPT cohort, more Veterans reported PTSD symptoms that were classified as recovered or improved (16% and 41%, respectively), compared to the TAU cohort (4% and 38%).
- There was no significant difference between treatment groups in reported physical or social quality of life.
- Veterans in the CPT cohort were younger, more likely to have served in Iraq/Afghanistan – or periods other than Vietnam – and were less likely to be service-connected for PTSD. However, none of these variables were significantly associated with symptom outcomes.
LIMITATIONS:
- This study did not include measures of treatment adherence or therapist competency, which are typically included in randomized clinical trials.
- This study did not include a clinician-administered measure of PTSD because this assessment was not part of routine clinical care in this particular setting.
- This study relied on self-report measures, which may be influenced by demographic variables, symptoms, personality, and compensation seeking.
AUTHOR/FUNDING INFORMATION:
This study was funded by the DoD and VA. Drs. Harris, Rosen and Kimerling are part of HSR&D’s Center for Health Care Evaluation in Palo Alto, CA; Drs. Rosen and Kimerling are also part of the VA National Center for PTSD in Palo Alto.
Alvarez J, McLean C, Harris A, Rosen C, Ruzek J, and Kimerling R. The Comparative Effectiveness of Cognitive Processing Therapy for Male Veterans Treated in a VHA Post-traumatic Stress Disorder Residential Rehabilitation Program. Journal of Consulting and Clinical Psychology 2011 Oct;79(5):590-99.
