Publication year
2011
Citation Title
The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
79
Issue Number
5
Page Numbers
590-599
DOI
10.1037/a0024466
Summary
Researchers examined the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) at a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Participants were two cohorts of male patients who were treated either with cognitive processing therapy or treatment as usual. Measures on PTSD, depression, quality of life, coping, and psychological distress were compared at intake and discharge with those Veterans who received cognitive processing therapy therapy showing significantly more symptomatic improvement.
Key Findings
Veterans treated with cognitive processing therapy as opposed to TAU exhibited more symptom improvement on PTSD symptoms and depression, psychological quality of life, coping skills, and psychological distress (depression, anxiety, and psychoticism).
No significant differences were found between the treatments groups regarding physical or social quality of life.
Cognitive processing therapy groups were significantly more likely to be classified as recovered or improved on the PTSD Checklist.
When expert consultation was provided to therapists, the cognitive processing therapy participants showed greater improvements in depression and psychological distress measures.
Implications for Program Leaders
Enhance education, activities, and curriculum related to coping behaviors and dealing with mental health symptoms
Disseminate information regarding possible symptoms of mental health problems Service members may face after deployment and where individuals and families can find help for those problems
Offer workshops based on cognitive behavioral therapy during reintegration to help families and Service members adjust to the Service member’s return, especially when the deployment has included combat exposure
Implications for Policy Makers
Continue to support programs and efforts to address mental health issues among Service members and their families
Recommend partnerships among military-based and community-based programs to help military families feel more comfortable participating in leisure activities that are not on installations
Recommend training for community providers to educate them about unique factors that contribute to mental health symptoms for military couples
Methods
Veterans enrolled in a VHA PTSD residential rehabilitation program who participated in trauma focused treatment as usual (TAU) were compared to those who participated in group cognitive processing therapy (CPT) on PTSD and depression symptoms and quality of life and coping.
Outcomes were also compared for those in cognitive processing therapy between the year when clinicians participated in expert-led consultation to the year without consultation.
Statistical analyses were used to examine differences in changes from intake to discharge between treatment groups (CPT versus TAU).
Participants
Participants were military Veterans from the following service branches: Army (58%), Marines (24%), Navy (12%), Air Force (7%).
The sample size was 197 males (104 cognitive processing therapy cohort, 93 treatment as usual cohort), which an average age of 52 years (SD = 9.2 years).
Racial/ethnic composition of the sample was predominately White (59%); no specifics were provided about the other racial/ethnic groups.
Limitations
This investigation was not a randomized controlled trial and lacks the ability to make causal inferences solely to the implementation of cognitive processing therapy.
This study relied on self-report measures of PTSD rather than a clinician administered measure, hence, PTSD scores may be influenced by demographic variables, symptoms, personality, and compensation-seeking.
The results may not generalize to outpatient settings or other military populations such as female Service members.
Avenues for Future Research
Explore the role of age and period of military service on PTSD treatment outcomes as the population of Service members seeking services changes
Examine the effectiveness of cognitive processing therapy using a randomized controlled trial as well as longitudinal follow-ups to examine the rate of inpatient and outpatient treatment utilization after treatment with cognitive processing therapy
Gather more data from Service members of diverse racial and ethnic backgrounds and assess the role of culture in the treatment of PTSD
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p < .001, b = 6.25, 95% CI [3.06, 9.44], and other measures. In addition, significantly more patients treated with CPT were classified as “recovered” or “improved” at discharge, ?2(1, N = 197) = 4.93, p = .032. Conclusions: There is still room for improvement, as substantial numbers of veterans continue to experience significant symptoms even after treatment with CPT in a residential program. However, CPT appears to produce significantly more symptom improvement than treatment conducted before the implementation of CPT. The implementation of this empirically supported treatment in VHA settings is both feasible and sustainable and is likely to improve care for male veterans with military-related PTSD.
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