Variable-Length Cognitive Processing Therapy for Combat-Related PTSD
Patricia Resick, PhD
Evaluate the effectiveness of Cognitive Processing Therapy-cognitive only version (CPT-C) for combat-related PTSD when treatment length is adjusted to fit the individual needs of service members. Identify factors that can help predict how quickly an individual will respond to treatment. Determine how well CPT improves related problems (e.g., depression, difficulties in social and family functioning).
People are different. Traumatic experiences are different. So it's understandable that different people with different life experiences and personality traits, and who live through a trauma unique to them, might respond differently to the same form of treatment for posttraumatic stress disorder, or PTSD.
In an age when doctors see more and more the benefits of individualized medicine, investigators affiliated with the STRONG STAR Consortium see the need to personalize PTSD care. Recent research supports that idea.
Civilian studies with Cognitive Processing Therapy (CPT), delivered in its standard format for 12 sessions, have shown that it is successful in treating 80% of PTSD patients to the point of remission. But one study showed that more than half (58%) of CPT patients did not need the full course of treatment; they recovered in fewer than 12 sessions. However, 27% still met diagnostic criteria for PTSD after 12 sessions but improved with additional treatment. Three months after treatment, only 2 of the 50 participants (4%) still had a PTSD diagnosis.
Now Dr. Patricia Resick of Duke University Medical Center, the developer of CPT and CPT-C, wants to see if similar results can be achieved with an active duty military population affected by combat-related PTSD. She and STRONG STAR colleagues Dr. Jennifer Wachen, PhD and Dr. Alan Peterson have designed a study with CPT-C that allows clinicians to adjust the length of treatment to meet individual patient needs, with a limit of 24 treatment sessions.
By doing away with a "one-size-fits-all" approach to PTSD care and tailoring treatment to the individual, these researchers hope to achieve several goals:
- Improve the overall efficacy of CPT-C for combat-related PTSD.
- Identify predictors of who will benefit from shorter or longer courses of treatment, helping guide therapists in the treatment of future patients.
- Evaluate the effect of variable-length CPT-C on co-occurring psychological problems (e.g., depression), health risk factors (e.g., substance abuse), and psychosocial functioning (e.g., return to work, family functioning).
Expected benefits for the military, mental health providers, and patients
Because this research is being conducted in a military setting, study findings should be directly applicable to military mental health providers. They will be better enabled to tailor CPT-C to meet the needs of individual patients, both by adjusting the length of treatment and more directly targeting individual factors that influence treatment outcomes.
For patients, the greatest expected benefit is an overall improvement in the quality of their care, and with that, a greater chance at defeating PTSD. The variable format may improve patient satisfaction with CPT and encourage them to complete treatment. Those who are able to shorten the required treatment time will be able to resume their daily responsibilities more quickly. On the other hand, those who respond to treatment more slowly will be able to extend their care and increase their chance of full recovery.