Although periods of combat can bring horrific things, they do benefit the field of medicine and research. For over a decade this trend has continued by allowing treatments for PTSD to be researched to see if they can be as successful with combat trauma as with other types of trauma. Thankfully, over a decade of research evidence continues to support that there are very successful treatments for PTSD with our combat veterans, Cognitive Processing Therapy (CPT) being one of them.
As the CPT research has progressed, different questions have been raised. One such question pertained to why CPT worked, prompting Dr. Patricia Resick, co-creator of CPT, to conduct a dismantling study with her colleagues, published in 2008 (citation can be found at the end of this section). The dismantling study compared 3 conditions, CPT standard, CPT-C (cognitive only, no written account), and a written account only. The goal was to determine which component was producing the greater results in reducing PTSD symptoms. Study results found all conditions significantly worked in improving PTSD symptoms, but CPT-C led to a faster decline in symptoms by the fifth session than the other conditions. This finding surprised the researchers and led to questions regarding if it would be more advantageous to simply use CPT-C.
This leads me to the current article by Walters et al, “Comparing Effectiveness of CPT and CPT-C Among U.S. Veterans in an Interdisciplinary Residential PTSD/TBI Treatment Program” published in August 2014 (full citation can be found at the end of this section). This study has 3 aims: to continue looking at the effectiveness of CPT and CPT-C when working with TBI patients, to try to replicate a previous study results which found that TBI severity was predictive of the outcome of CPT treatment, and to continue comparing the effectiveness of CPT and CPT-C overall to see if the previous findings of the dismantling study replicate. Is there a significant difference between CPT and CPT-C regarding how fast symptoms reduction occurs?
I am thrilled to report that the current findings support previous research that both CPT and CPT are very effective in reducing PTSD and depression symptoms in combat veterans with a history of TBI. But after the excitement from the dismantling study that there might be a difference between CPT and CPT-C and how fast symptoms reduced, this finding was not found in the present study. Why? The initial dismantling study was a pretty robust study including 150 female sexual assault survivors. The present study also had a large cohort of 86 male veterans. So why was there a difference between the two variants of CPT in the dismantling study but not this one?
Part of the answer may be in those two previous sentences….. the different studies compared different populations experiencing different types of traumas. Not only are the populations different in terms of gender and trauma type, but in treatment setting – residential vs. outpatient. Maybe this study is a step toward starting to answer the question of which treatment is most effective for specific patients in specific settings. After all, isn’t that the next logical step for research to take? We know there are a variety of treatments that work well in reducing symptoms of PTSD. Research is repeatedly proving this. And while current research is continuing to expand our confidence that these treatment work with a variety of different trauma populations, my fingers are crossed that, sooner rather than later, our research eyes will turn toward figuring out which populations respond best to which specific treatments.
I am repeatedly awed and excited that there are equally effective PTSD treatments out there. It is great to know I’m not locked in to a one-size-fits-all method for my patients. While there are logical reasons to pick specific treatments for individual patients, I am hopeful that in this study I am seeing the start of a trend for evidence-based support for this logic. Maybe eventual evidence will support circumstances in which to use the various treatments that we haven’t even thought of yet. Wouldn’t that be fantastically amazing?
Dr. Debra Nofziger is a Cognitive Processing Therapy for PTSD trainer with the Center for Deployment Psychology. She currently holds the CDP position at Brooke Army Medical Center in San Antonio Texas.
Resick, P. A., Galovski, T. E., Uhlmansiek, M. Ol, Scher, C. D., Clum, G. A., & Young-Xi, 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. Doi: 10.1037/0022-006X.76.2.243
Walter, K. H., Dickstein, B. D., Barnes, S. M. & Chard, K. M. (2014). Comparing effectiveness of CPT to CPT-C among u.s. veterans in an interdisciplinary residential ptsd/tbi treatment program. Journal of Traumatic Stress, 27, 438-445.