Massed Cognitive Processing Therapy for Combat-related PTSD

Cognitive Processing Therapy (CPT) is identified as one of the most effective treatments for
posttraumatic stress disorder (PTSD) in a wide range of trauma populations, with a higher
effect size than any other evidence-based treatments for PTSD. However, CPT has been shown to
be somewhat less effective in active duty and veteran populations when compared to civilian
trauma victims. One reason may be that service members have difficulty committing to a
six-week course of therapy due to the demanding nature of active duty military operations
schedules. In addition, limited availability of clinical providers may reduce access to care.
One way to address these barriers may be to administer CPT in an intensive, 5-day format.
This format may increase rates of treatment completion and produce faster symptom improvement
than the standard administration of CPT. This study will test the efficacy of massed CPT
(MCPT) compared to standard CPT delivery. MCPT will be delivered in an intensive outpatient
setting (12 sessions in 5 days) composed of both group and individual sessions. Standard
delivery of CPT consists of 12 sessions over 6 weeks and involves only individual sessions.

The sample includes 140 active duty service members randomized to receive either MCPT or
standard CPT. Participants will be assessed 4 times during the course of the study. In order
to test the equivalence of the treatment conditions, outcomes will be compared at a
consistent number of weeks posttreatment for each condition (e.g., at baseline, and one month
and 4 months following the conclusion of the therapy). Additionally, in order to compare the
treatment groups at the same point in actual time, each group will be assessed at the one
month posttreatment time point for the other condition. The timing of these assessment
intervals allows for the comparison groups to be assessed similarly at each important
juncture of therapy (baseline and post-treatment) and also to be assessed for maintenance of
treatment gains following a similar passage of time (4 months post-treatment). Those who drop
out of treatment will be asked to return for the follow-up assessments based on their
projected end date for inclusion in the intent to treat analyses.

Aim 1: To evaluate the efficacy of massed CPT in a sample of active duty military in
reductions of clinician-rated and self-reported PTSD symptoms, as well as secondary outcomes
including depression, psychosocial functioning, and physical health after treatment
completion (assessed at one month and 4 months posttreatment for each condition). Rates of
treatment completion and speed of recovery will also be compared between conditions.

Aim 2: To examine predictors of symptom reduction in each treatment condition including
demographic characteristics, military factors, psychosocial variables, and comorbid mental
health symptoms.

Aim 3 (Exploratory): To evaluate the tolerability of massed versus standard administration of
CPT. Important nonspecific factors such as therapeutic alliance, patient preference,
treatment expectancy, perceived burden, and emotional factors such as anxiety and avoidance
will be examined with regard to treatment outcome.

Inclusion Criteria:

- Adult male or female (age 18+) active duty military seeking treatment for PTSD

- Diagnosis of PTSD determined by a clinician-administered Posttraumatic Stress Scale
(CAPS-5)

- Speak and read English

Exclusion Criteria:

- Current suicide or homicide risk meriting crisis intervention

- Active psychosis

- Moderate to severe brain damage (as determined by the inability to comprehend the
baseline screening questionnaires)