Cognitive Processing Therapy (CPT)

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Cognitive Processing Therapy (CPT) has been rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Adults who have experienced a traumatic event and are currently suffering from the symptoms of posttraumatic stress disorder (PTSD) and/or meet criteria for a diagnosis of PTSD

Brief Description

CPT was originally developed for use with rape and crime victims, but it is used with a variety of trauma populations, including both military and civilian samples. CPT focuses on identifying and challenging maladaptive beliefs that develop about, and as a result of, the traumatic event. The therapist helps the client to identify problem areas (i.e., stuck points) in their thinking about the traumatic event, which have impeded their recovery. Therapists then use Socratic dialogue, a form of questioning that encourages clients to examine and evaluate their own beliefs rather than being told in a directive way, to help clients challenge their stuck points. Throughout the treatment, worksheets and Socratic dialogue are used to help clients replace maladaptive beliefs with more balanced alternative statements. CPT can be delivered individually or in a group format.

Note: When CPT was originally developed and for many years after that, it included a trauma narrative as part of the intervention. Since 2011, a number of research studies using CPT without the trauma narrative (known as CPT-C) have been published. In 2017, the developer of CPT made the decision to no longer include the trauma narrative as part its intervention as the primary therapy format (the exceptions are if the clients want to write an account or if they are highly dissociative to piece together the event). Research is being conducted on both versions of the therapy but there is more on CPT than CPT+A (with accounts).

Program Goals:

The goals of Cognitive Processing Therapy (CPT) are:

  • Increase understanding of posttraumatic stress disorder (PTSD) and how it affects life
  • Accept the reality of the traumatic event
  • Feel emotions about the traumatic event and reduce avoidance
  • Develop balanced and realistic beliefs about the event, oneself, others, and the world
  • Decrease the emotions that emanate from maladaptive beliefs about the event (e.g., guilt, shame, anger)
  • Decrease symptoms of PTSD and depression
  • Improve day-to-day living

Essential Components

The essential components of Cognitive Processing Therapy (CPT) include:

  • Educating clients about the symptoms of PTSD
  • Assisting clients to identify and evaluate maladaptive beliefs that they have developed about the traumatic event, themselves, others, and the world
  • Using Socratic Questioning, a form of questioning that encourages clients to examine and evaluate their own beliefs
  • Teaching clients skills to modify their maladaptive thoughts and beliefs with the use of worksheets (e.g., ABC Worksheet, Challenging Beliefs Worksheet)
  • Assigning clients regular out-of-session practice assignments to learn and apply what has been discussed in therapy

Adult Services

Cognitive Processing Therapy (CPT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD) and related symptoms

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Residential Care Facility

Homework

Cognitive Processing Therapy (CPT) includes a homework component:

Homework is assigned every week to expand upon what was learned/discussed in each therapy session. This includes a continuous stuck point log to be compiled by the patient outside of therapy, ABC Worksheets, Challenging Questions Worksheets, Patterns of Problematic Thinking Worksheets, and Challenging Beliefs Worksheets. A trauma impact statement is also assigned at the beginning and end of therapy. A written trauma account is also assigned.

Languages

Cognitive Processing Therapy (CPT) has materials available in languages other than English:

Arabic, Chinese, Finnish, German, Hebrew, Icelandic, Japanese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A quiet, private room for the session to be held in, the materials manual, the therapist manual, and the ability to copy worksheets

Minimum Provider Qualifications

Licensed mental health professionals or those working under the supervision of a licensed mental health professional. Psychology, social, work, and nursing staff can implement CPT in their respective roles. In third world countries, the protocol has been implemented successfully with therapists with high school education.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Onsite, Regional, through the VA National Rollout, agency-arranged workshops with one of the trainers

Number of days/hours:

2 days/16 hours for individual CPT or 3 days/24 hours adding in a group therapy day followed by weekly telephone consultation for 6 months

Additional Resources:

There currently are additional qualified resources for training:

Online training is available at https://cpt.musc.edu/. Manuals as PDF documents are available upon request.

Implementation Information

Since Cognitive Processing Therapy (CPT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Cognitive Processing Therapy (CPT) as listed below:

Pre-implementation assessments are given to training attendees prior to their first day of training and on the last day of training to assess their knowledge and level of comfort with CPT techniques. These are currently only used within VA trainings, and can be obtained from CPTforPTSD@gmail.com. Non-VA workshops require the online training prior to attending.

Formal Support for Implementation

There is formal support available for implementation of Cognitive Processing Therapy (CPT) as listed below:

Training and consultation is available for therapists who are conducting CPT. Refer to cptforptsd.com for more information.

Fidelity Measures

There are fidelity measures for Cognitive Processing Therapy (CPT) as listed below:

A fidelity checklist overviewing each session of CPT is available. Contact CPTforPTSD@gmail.com for a copy.

Implementation Guides or Manuals

There are implementation guides or manuals for Cognitive Processing Therapy (CPT) as listed below:

Resick, P. A.,  Monson, C. M., & Chard K. M. (2017). Cognitive Processing Therapy for PTSD: A comprehensive manual.  New York: Guilford Press. 

The book includes free downloads of all the treatment materials on the Guilford website.

For manuals in other languages, please refer to CPTforPTSD.com for PDF copies of the manuals.

Research on How to Implement the Program

Research has not been conducted on how to implement Cognitive Processing Therapy (CPT).

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C, & Feuer, C. A. (2002). A comparison of Cognitive-Processing Therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Counseling and Clinical Psychology, 70(4), 867-879.

Type of Study: Randomized controlled trial
Number of Participants: 171

Population:

  • Age — Mean=32 years
  • Race/Ethnicity — 71% White, 25% African American, and 4% Other
  • Gender — 100% Female
  • Status — Participants were female rape victims.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to compare Cognitive Processing Therapy (CPT) [now referred to as CPT+A since it used the narrative] with prolonged exposure (PE) and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression.  Subjects were randomly assigned to one of the three groups. Measures utilized the Clinician-Administered PTSD Scale (CAPS), the Structured Interview for DSM–IV—Patient Version (SCID), Standardized trauma interview, the PTSD Symptom Scale, the Structured Clinical Interview for DSM–IV, the Beck Depression Inventory, the Trauma-Related Guilt Inventory (TRGI), and the Expectancy of Therapeutic Outcome Scale. Results indicated that CPT and PE treatments were superior to MA. The 2 therapies had similar results except that CPT produced better scores on 2 of 4 guilt subscales. Among those who completed the treatments as designed, the effect sizes for both treatments were quite large. There was a slight advantage in effect sizes and end-state functioning favoring CPT over PE through the 3-month follow-up. Limitations include concerns regarding generalization beyond rape traumas.

Length of postintervention follow-up: 3 months. Some women also received a 9-month follow-up.

*Chard, K. (2005). An evaluation of Cognitive Processing Therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Counseling and Clinical Psychology, 73(5), 965-971.

Type of Study: Randomized controlled trial
Number of Participants: 71

Population:

  • Age — 18-56 years
  • Race/Ethnicity — 81.4% White; 14% African American; 3.5% Hispanic, Latin, or Mexican American; and 1% Other
  • Gender — 100% Female
  • Status — Participants were women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse.

Location/Institution: Center for Traumatic Stress Research

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared the effectiveness of Cognitive Processing Therapy (CPT) [now referred to as CPT+A since it used the narrative]   for sexual abuse survivors with that of the minimal attention (MA) given to a wait-listed control group. Women were randomly assigned to one of the 3 groups. Measures include the Structured Clinical Interview for DSM–IV Non-Patient Versions-I and II (SCID-I; SCID-II); Standardized Trauma Interview; Sexual Abuse Exposure Questionnaire, Part 1 (SAEQ); Modified PTSD Symptom Scale (MPSS); Beck Depression Inventory-II (BDI-II); and Dissociative Experiences Scale-II (DES-II). Results indicate that CPT is more effective for reducing trauma-related symptoms than is MA. Limitations include small sample size and concerns about generalizability of the sample.

Length of postintervention follow-up: 3 months and 1 year.

Resick, P. A., Galovski, T. A., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of Cognitive Processing Therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243-258.

Type of Study: Randomized controlled trial
Number of Participants: 150

Population:

  • Age — 19 to 68 years
  • Race/Ethnicity — 62% White, 34% African-American, 3% Hispanic, and 4% Other
  • Gender — 100% Women
  • Status — Participants were adult women with posttraumatic stress disorder (PTSD).

Location/Institution: St. Louis, MO

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this experiment was to conduct a dismantling study of Cognitive Processing Therapy in which the protocol including the narrative [now called CPT+A] was compared with its constituent components—cognitive therapy only (CPT-C) [now called Cognitive Processing Therapy (CPT)] and written accounts (WA)—for the treatment of PTSD and comorbid symptoms. Subjects were randomized into 1 of the 3 conditions. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM–IV Axis I Disorders—Patient Edition (SCID), the Standardized Trauma Interview, the Beck Depression Inventory-II (BDI-II), the Experience of Shame Scale (ESS), the Personal Beliefs and Reactions Scale (PBRS), the Posttraumatic Stress Diagnostic Scale (PDS), the State-Trait Anger Expression Inventory (STAXI), State-Trait Anxiety Inventory (STAI), the Therapeutic Outcome Questionnaire, and the Trauma-Related Guilt Inventory (TRGI). Results indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. Limitations of the study include a focus only on interpersonal violence and the inclusion of only female participants.

Length of postintervention follow-up: 6 months.

Morland, L. A., Hynes, A. K., Mackintosh, M. A., Resick, P. A., & Chard, K. M. (2011). Group Cognitive Processing Therapy delivered to veterans via Telehealth: A pilot cohort.  Journal of Traumatic Stress, 24(4), 465-469. doi:10.1002/jts.20661

Type of Study: Randomized controlled trial
Number of Participants: 13

Population:

  • Age — 18-33 years (33.2 mean years)
  • Race/Ethnicity — 57.1% Native Hawaiian/Pacific Islander , 14.3% African American, 14.3% Caucasian, and 14.3% Asian
  • Gender — 100% Male
  • Status — U.S. Army male soldiers diagnosed with PTSD on active duty reserves, guard, and veterans who were being treated at VA clinicson participating Hawaiian Islands.

Location/Institution: Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
(To include comparison groups, outcomes, measures, notable limitations) The purpose of this study is to report preliminary clinical and feasibility data from a large, ongoing 4-year RCT  evaluating the efficacy of group CBT utilizing Cognitive Processing Therapy – Cognitive-only version (CPT-C) [now called Cognitive Processing Therapy (CPT)] for PTSD delivered via video teleconferencing (VT) compared to in-person (NP) delivery in a sample of male veterans with combat-related PTSD living in rural areas. Participants were randomly assigned to either group CPT-C delivered via VT or NP-delivered CPT-C.  Measures utilized include the Clinician-Administered PTSD Scale (CAPS). Results indicate that CPT-C is robust to changes in diversity of treatment populations and offer preliminary support for the clinical effectiveness of group CPT-C delivered via VT. Limitations include small sample size, lower follow-up rates, and generalizability due to gender.

Length of postintervention follow-up: None

Forbes, D., Lloyd, D., Nixon, R. D. V., Elliott, P., Varkera, T., Perry, D.,...Creamer, M. (2012). A multisite randomized controlled effectiveness trial of Cognitive Processing Therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(5), 442-452.

Type of Study: Randomized controlled trial
Number of Participants: 59

Population:

  • Age — Mean=53 years
  • Race/Ethnicity — 100% White
  • Gender — 97% Male
  • Status — Participants were veterans with posttraumatic stress disorder (PTSD).

Location/Institution: Veterans and Veterans’ Families Counseling Service (VVCS) offices in three states of Australia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tests the effectiveness of community-administered Cognitive Processing Therapy (CPT) for military-related PTSD. Participants were randomized to CPT or an equivalent period of usual treatment at veterans’ community based counseling services. Measures utilized include Mini International Neuropsychiatric Interview version 5.5 (MINI), the Combat Exposure Scale (CES), the Clinician Administered PTSD Scale (CAPS), the PTSD Checklist (PCL), the Beck Depression Inventory (BDI-II), and the Working Alliance Inventory (WAI). Results found significantly greater improvement for participants receiving CPT over usual treatment. CPT also produced greater improvements in anxiety, depression, social and dyadic relationships than usual treatment. Limitations include modest sample size, concerns regarding generalizability to civilian populations and non-randomization of therapists.

Length of postintervention follow-up: 3 months.

Galovski, T. E., Blain, L. M., Mott, J. M., Elwood, L., & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of Cognitive Processing Therapy. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030600

Type of Study: Randomized controlled trial
Number of Participants: 100

Population:

  • Age — 19-68 years
  • Race/Ethnicity — 51% Black, 42% White, and 7% Hispanic
  • Gender — 69 Women and 31 Men
  • Status — Not Specified

Location/Institution: Greater St. Louis, MO area

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tested a modified cognitive processing therapy (MCPT) intervention designed to test the relative efficacy of the MCPT intervention compared with a symptom-monitoring delayed treatment (SMDT) condition and to assess within-group variation in change interpersonal trauma survivors with posttraumatic stress disorder (PTSD). After the conclusion of SMDT, participants crossed over to MCPT. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM–IV Axis I Disorders—Patient Edition (SCID), the Standardized Trauma Interview, the Posttraumatic Stress Diagnostic Scale (PDS), the Beck Depression Inventory-II (BDI-II), the Trauma-Related Guilt Inventory (TRGI), the Quality of Life Inventory (QOLI), and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Results revealed that MCPT evidenced greater improvement on all primary (PTSD and depression) and secondary (guilt, quality of life, general mental health, social functioning, and health perceptions) outcomes compared with SMDT. Limitations include high attrition rate. 

Length of postintervention follow-up: 3 months.

Iverson, K. A., Resick, P. A., Suvak, M. K., Walling, S., & Taft, C. T. (2012). Intimate partner violence exposure predicts PTSD treatment engagement and outcome in Cognitive Processing Therapy. Journal of Behavior Therapy, 42(2), 236-248.

Type of Study: Randomized controlled trial
Number of Participants: 150

Population:

  • Age — Mean=35.4 years
  • Race/Ethnicity — 62% Caucasian, 34% African American, and 4% Other
  • Gender — 100% Women
  • Status — Participants were women with posttraumatic stress disorder (PTSD).

Location/Institution: St. Louis, MO

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Resnick et al, 2008. The aims of this study were to conduct a secondary analysis of a randomized controlled trial of Cognitive Processing Therapy (CPT) for PTSD among interpersonal trauma survivors to examine interpersonal violence (IPV) status as a predictor of (a) treatment engagement (i.e., starting and completing therapy); and (b) treatment outcome, defined as reductions in self-reported PTSD and depressive symptoms. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM–IV Axis I Disorders—Patient Edition (SCID), the Standardized Trauma Interview, the Beck Depression Inventory-II (BDI-II), the Experience of Shame Scale (ESS), the Personal Beliefs and Reactions Scale (PBRS), the Posttraumatic Stress Diagnostic Scale (PDS), the State-Trait Anger Expression Inventory (STAXI), State-Trait Anxiety Inventory (STAI), the Therapeutic Outcome Questionnaire, and the Trauma-Related Guilt Inventory (TRGI). Results indicate that women in a current intimate relationship with recent IPV (i.e., past year) were less likely to begin treatment relative to women who reported past IPV only or no history of IPV. For women who began treatment, IPV exposure was not predictive of whether or not they completed treatment. Among women who began treatment, the frequency of IPV was associated with treatment outcome such that women who experienced more frequent IPV exhibited larger reductions in PTSD and depression symptoms over the course of treatment, but experienced similar levels of PTSD and depression severity. Limitations include study include a focus only on interpersonal violence and the inclusion of only female participants.

Length of postintervention follow-up: 6 months.

*Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80, 201-210.

Type of Study: Randomized controlled trial
Number of Participants: 144

Population:

  • Age — 32 years
  • Race/Ethnicity — 71% White, 25% African American, and 4% Other
  • Gender — 100% Female
  • Status — Participants were female rape victims.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Resick et al, 2002. This study conducted a long-term follow-up assessment of participants from a randomized controlled trial (Resick et al., 2002, below) which compared Cognitive Processing Therapy (CPT) with Prolonged Exposure (PE) for Posttraumatic Stress Disorder. Of the 171 participants, 144 were assessed 5–10 years after participating in the original study. Measures utilized the Clinician-Administered PTSD Scale (CAPS), the Structured Interview for DSM–IV—Patient Version (SCID), Standardized trauma interview, the PTSD Symptom Scale, the Structured Clinical Interview for DSM–IV, the Beck Depression Inventory, the Trauma-Related Guilt Inventory (TRGI), and the Expectancy of Therapeutic Outcome Scale. Results indicated substantial decreases in symptoms due to treatment were maintained throughout the follow-up period, as evidenced by little change over time from posttreatment through follow-up. No significant differences emerged during the follow-up between the treatment conditions and maintenance of improvements could not be attributed to further therapy or medications. Limitations of the study include generalizability.

Length of postintervention follow-up: 5-10 years (mean=6 years).

Surís, A., Link-Malcolm, J., Chard, K., Ahn, C., & North, C. (2013). A randomized clinical trial of Cognitive Processing Therapy for veterans with PTSD related to military sexual trauma. Journal of Traumatic Stress, 26, 1-10.

Type of Study: Randomized controlled trial
Number of Participants: 86

Population:

  • Age — Mean=46.1 years
  • Race/Ethnicity — 44% White Non-Hispanic, 41% African-American, and 15% Other
  • Gender — 85% Female and 15% Male
  • Status — Participants were veterans with posttraumatic stress disorder (PTSD) from military sexual trauma.

Location/Institution: VA North Texas Health Care System, Dallas VA Medical Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study 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. Participants received 12 individual sessions of either CPT or present-centered therapy (PCT). Measures utilized include the Clinician Administered PTSD Scale (CAPS), the PTSD Checklist (PCL), the Quick Inventory of Depressive Symptomatology (QIDS), and a demographic questionnaire. Results indicated 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. Limitations include treatment fidelity issues.

Length of postintervention follow-up: 6 months.

Bass, J. K., Annan, J., Murray, S. M., Kaysen, D., Griffiths, S., Centinoglu, T.,...Bolton, P. (2013). Controlled trial of psychotherapy for Congolese Survivors of Sexual Violence. The New England Journal of Medicine, 368, 2182-2192.

Type of Study: Randomized controlled trial
Number of Participants: 405

Population:

  • Age — 33.8-36.9 years
  • Race/Ethnicity — 100% Congolese
  • Gender — 100% Women
  • Status — Participants were women who had experienced or witnessed sexual violence.

Location/Institution: 14 villages in South Kivu province and 2 villages on the border in North Kivu province of the Democratic Republic of Congo

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated villages that were provided Cognitive Processing Therapy (1 individual session and 11 group sessions) or individual support to female sexual-violence survivors with high levels of posttraumatic stress disorder (PTSD) symptoms and combined depression and anxiety symptoms. Measures utilized include Hopkins Symptom Checklist (HSCL-25) and the PTSD Checklist — Civilian Version. Results indicate that depression and anxiety improved in the individual-support group at the end of treatment, after treatment, but improvements were significantly greater in the therapy group at the end of treatment and after treatment. Similar patterns were observed for PTSD and functional impairment. Limitations include the small number of village clusters (six) made randomization less likely to result in comparability, detection bias due to the fact that the psychosocial assistants recruiting patients knew ahead of time whether they would be providing therapy or individual support and performance bias due to use of measures of unknown validity for identifying clinical cases of PTSD and combined depression and anxiety.

Length of postintervention follow-up: 1 month and 6 months.

Morland, L. A., Mackintosh, M. A., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015). Telemedicine versus in‐person delivery of cognitive processing therapy for women with posttraumatic stress disorder: a randomized noninferiority trial. Depression and anxiety, 32(11), 811-820.

Type of Study: Randomized controlled trial
Number of Participants: 126

Population:

  • Age — Mean: 46 years
  • Race/Ethnicity — 60 Caucasian, 18 Asian, 15 Pacific Islander, 33 other
  • Gender — 100% Female
  • Status — Participants were women veterans, reserves, and guard, and civilian women with PTSD.  

Location/Institution: National Center for PTSD in the Department of Veterans Affairs (VA) in Honolulu, Hawaii

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examined the effectiveness of telemedicine Cognitive Processing Therapy (CPT) versus In-Person Cognitive Processing Therapy (CPT) to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Participants were randomly assigned to either In person (CPT) or to a video teleconferencing (VTC) Cognitive Processing Therapy. Measures utilized include the Treatment Expectancy Questionnaire (TEQ), the Working Alliance Inventory (WAI) short form, the Charleston Psychiatric Outpatient Satisfaction Scale-VA version (CPOSS-VA) and the Telemedicine Satisfaction and Acceptance Scale (TSAS).Results indicate improvements in PTSD symptoms in the VTC condition were non-inferior to outcomes in the NP condition. When both conditions were pooled together demonstrated that PTSD symptoms declined substantially post-treatment and gains were maintained at 3- and 6-month follow-up. Veterans demonstrated smaller symptom reductions post-treatment than civilian women.  Limitations include small sample size, may not generalize to all veterans presenting for PTSD treatment in the VA system, or to veterans in general, and lack of control group.

Length of postintervention follow-up: 3 and 6 months

Resick, P. A., Wachen, J. S., Mintz, J., Young-McCaughan, S., Roache, J. D., Borah, A. M., ... Peterson, A. L. (2015). A randomized clinical trial of group cognitive processing therapy compared with group Present-Centered Therapy for PTSD among active duty military personnel. Journal of Consulting and Clinical Psychology. Advance online publication. doi:10.1037/ccp0000016

Type of Study: Randomized controlled trial
Number of Participants: 108

Population:

  • Age — 31-32 years
  • Race/Ethnicity — 62 White, 22 Black, 15 Hispanic, and 9 Other
  • Gender — 100 Men and 8 Women
  • Status — Participants were U.S. Army soldiers diagnosed with posttraumatic stress disorder (PTSD) following military deployment.

Location/Institution: Fort Hood, Texas

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to determine whether group therapy improves symptoms of posttraumatic stress disorder (PTSD), by utilizing Cognitive Processing Therapy (cognitive-only version; CPT-C) [now called Cognitive Processing Therapy (CPT)] with group present-centered therapy (PCT) for active duty military personnel. Measures utilized include the PTSD Checklist (Stressor Specific Version; PCL-S), Life Events Checklist (LEC), Beck Depression Inventory-II (BDI-II) and the Posttraumatic Stress Symptom Interview (PSS-I). Participants were randomized into CPT-C or PCT groups when 16 to 20 participants had been enrolled, resulting in 8 to 10 participants per group (two groups running simultaneously, with six cohorts total). Patients attended 90-minute groups twice weekly for 6 weeks. Independent assessments were administered at baseline, weekly before sessions, and 2 weeks, 6 months, and 12 months posttreatment. Results indicate that both treatments resulted in large reductions in PTSD severity, but improvement was greater in CPT-C. CPT-C also reduced depression, with gains remaining during follow-up. In PCT, depression only improved between baseline and before Session 1. There were few adverse events associated with either treatment. Limitations include small sample size, lower follow-up rates, and generalizability due to gender. 

Length of postintervention follow-up: Varies (2 weeks, 6 months and 12 months).

Butollo, W., Karl, R., Konig, J. & Rosner, R. (2016). A randomized controlled trial of dialogical exposure therapy versus cognitive processing therapy for adult outpatients suffering from PTSD after Type I trauma in adulthood. Psychotherapy and psychosomatics, 85(1), 16-26.

Type of Study: Randomized controlled trial
Number of Participants: 141

Population:

  • Age — Not Specified
  • Race/Ethnicity — Not Specified
  • Gender — 65% Female
  • Status — Recruited from consecutive patients seeking treatment at an outpatient clinic.

Location/Institution: Germany

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tested an integrative gestalt-derived intervention, dialogical exposure therapy (DET), against an established cognitive-behavioral treatment (cognitive processing therapy, CPT) for possible differential effects in terms of symptomatic outcome and drop-out rates. Methods: They randomized 141 treatment-seeking individuals with a diagnosis of PTSD to receive either DET or CPT. Therapy length in both treatments was flexible with a maximum duration of 24 sessions. Results: Dropout rates were 12.2% in DET and 14.9% in CPT. Patients in both conditions achieved significant and large reductions in PTSD symptoms (Impact of Event Scale – Revised; Hedges’ g = 1.14 for DET and d = 1.57 for CPT) which were largely stable at the 6-month follow-up. At the post-treatment assessment, CPT performed statistically better than DET on symptom and cognition measures. For several outcome measures, younger patients profited better from CPT than older ones, while there was no age effect for DET.recruited from consecutive patients seeking treatment at an outpatient clinic

Length of postintervention follow-up: 6 months

Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., … the STRONG STAR Consortium. (2017). Effect of group vs. individual cognitive processing therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74, 28-36. doi:10.1001/jamapsychiatry.2016.2729

Type of Study: Randomized controlled trial
Number of Participants: 268

Population:

  • Age — 18-33 years (Mean=33.2 years)
  • Race/Ethnicity — 108 White, 75 Black, 62 Hispanic, and 23 Other
  • Gender — 244 Male and 24 Female
  • Status — Participants were U.S. Army soldiers diagnosed with PTSD after deployments to or near Iraq or Afghanistan.

Location/Institution: Fort Hood, Texas

Summary: (To include comparison groups, outcomes, measures, notable limitations)
To determine the effects of Cognitive Processing Therapy (CPT) on PTSD and co-occurring symptoms and whether they differ when administered in an individual or a group format. Participants were randomized to group or individual CPT.  Participants received CPT in 90-minute group sessions of 8 to 10 participants (15 cohorts total; 133 participants) or 60-minute individual sessions (135 participants) twice weekly for 6 weeks. Measures utilized include the Posttraumatic Symptom Scale–Interview Version (PSS-I), the Posttraumatic Stress Disorder Checklist (PCL-S),  the Beck Depression Inventory–II (BDI-II), the Beck Scale for Suicidal Ideation (BSSI), the 10-item Alcohol Use Disorders Identification Test–Interview Version (AUDIT), and the Mini-International Neuropsychiatric Interview 25 modules C  and K. Results indicate participants improvement in PTSD severity at posttreatment was greater when CPT was administered individually compared with the group format.  Significant improvements were maintained with the individual and group formats, with no differences in remission or severity of PTSD at the 6-month follow-up. Symptoms of depression and suicidal ideation did not differ significantly between formats.  Limitations include small sample size, generalizability due to participants being in military service, and length of follow-up.

Length of postintervention follow-up: 6 months.

References

Chard, K. M., Resick, P. A., Monson, C. M., & Kattar, K. A. (2009). Cognitive Processing Therapy therapist group manual: Veteran/military version. Washington, DC: Department of Veterans’ Affairs.

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A comprehensive manual. Guilford Press: New York.

Contact Information

Name: Patricia A. Resick, PhD, ABPP
Agency/Affiliation: Duke University
Email:

Date Research Evidence Last Reviewed by CEBC: October 2017

Date Program Content Last Reviewed by Program Staff: August 2017

Date Program Originally Loaded onto CEBC: June 2013