Variable-length Cognitive Processing Therapy for posttraumatic stress disorder in active duty military: Outcomes and predictors

• Published in: Behaviour research and therapy 2021-06, Vol.141, p.103846-103846, Article 103846
• Main Authors: Resick, Patricia A., Wachen, Jennifer Schuster, Dondanville, Katherine A., LoSavio, Stefanie T., Young-McCaughan, Stacey, Yarvis, Jeffrey S., Pruiksma, Kristi E., Blankenship, Abby, Jacoby, Vanessa, Peterson, Alan L., Mintz, Jim
• Format: Article
• Language: English
• Subjects: African Americans; Clinical research; Clinical trials; Cognition; Cognitive ability; Cognitive processing therapy; Demography; Information processing; Internalization; Military; Patients; Personality; Personality traits; Post traumatic stress disorder; Posttraumatic stress disorder; PTSD; Race; Racial differences; Remission; Remission (Medicine); Servicemen; Temperament; Trauma; Treatment predictors; Veterans
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/j.brat.2021.103846

Cognitive Processing Therapy (CPT) is an evidence-based therapy recommended for posttraumatic stress disorder (PTSD). However, rates of improvement and remission are lower in veterans and active duty military compared to civilians. Although CPT was developed as a 12-session therapy, varying the number of sessions based on patient response has improved outcomes in a civilian study. This paper describes outcomes of a clinical trial of variable-length CPT among an active duty sample. Aims were to determine if service members would benefit from varying the dose of treatment and identify predictors of treatment length needed to reach good end-state (PTSD Checklist-5 ≤ 19). This was a within-subjects trial in which all participants received CPT (N = 127). Predictor variables included demographic, symptom, and trauma-related variables; internalizing/externalizing personality traits; and readiness for change. Varying treatment length resulted in more patients achieving good end-state. Best predictors of nonresponse or needing longer treatment were pretreatment depression and PTSD severity, internalizing temperament, being in precontemplation stage of readiness for change, and African American race. Controlling for differences in demographics and initial PTSD symptom severity, the outcomes using a variable-length CPT protocol were superior to the outcomes of a prior study using a fixed, 12-session CPT protocol. NCT023818. •Varying the length of CPT resulted in some active duty members stopping treatment early or improving with more sessions.•Thirteen percent achieved good end-state in less than 12 sessions, 9% in exactly 12 sessions, and 12% with more sessions.•Pretreatment depression, internalizing temperament, and PTSD severity predicted nonresponse or needing longer treatment.•Other predictors were being in the precontemplation stage of readiness to change or African American race.•Compared to a prior 12-session study, variable-length CPT resulted in more patients achieving reliable clinical change.