Objectives: Cognitive processing therapy (CPT) is a 12-session trauma-focused cognitive psychotherapy for PTSD that has been found in prior research to be highly effective for civilian and veteran populations and is now being implemented widely in military and veteran settings. CPT can be conducted as an individual therapy or in group settings, but most research has been with individual treatment. The purpose of this study will be to compare group and individual CPT in order to determine whether the two are equivalent or whether one type of format is sufficiently superior to warrant recommendation either for or against group administration. A second purpose will be to compare group-administered CPT to a present-focused control group condition in order to determine whether the results of group CPT exceed those of receiving a supportive therapy in a group format and the effects of being in therapy generally.
Research Strategy: Participants will include 500 women and men with post-traumatic stress disorder (PTSD) recruited from three military bases that are part of the STRONG STAR (South Texas Research Organizational Network Guiding Studies on Trauma and Resilience) Consortium: Brooke Army Medical Center and Wilford Hall Medical Center, both in San Antonio, and Darnall Army Medical Center, Fort Hood, Texas. The participants will be assessed with diagnostic and other symptoms measures at pretreatment, 2 weeks post-treatment, and 6-month follow-up. Once accepted into the study, participants will be randomly assigned to one of the three conditions: individual CPT, group CPT, or supportive group therapy. Aside from the objectives listed above, this study will also be able to examine gender, race/ethnicity, and other important variables to predict who responds best to treatment and help to determine if there are treatment non-responders for whom other types of therapy or combinations of therapy will need to be developed.
Applicability of Research: This research is designed to determine how well and for whom group and individual CPT will help those with post-deployment PTSD. The potential clinical benefits are that CPT will reduce the symptoms of PTSD among post-deployment active military as it has with other populations. Although there is some discomfort with recalling and discussing traumatic events, CPT has been found to have the lowest rate of symptom worsening of any treatment for PTSD. Therefore, the risks of this type of treatment are low and the potential benefits are high. The projected time it may take to achieve a consumer-related outcome is immediately after the completion of this 5-year study.
Likely Contributions of the Study: This study has important public policy implications regardless of the outcomes. Group treatment is more cost-effective than individual treatment, so if the two formats are similar, or if group treatment has better outcomes, then group treatment would be recommended for most people with PTSD. If, however, individual therapy is superior, then institutions and providers will need to account for these results in their planning. Information on individual variables that might affect treatment outcome may lead the way to the development or refinement of other types of therapy for difficult or complex symptom presentations that do not respond as well to CPT.