This article is more than 5 years old. Information may no longer be current.

Cognitive processing therapy, prolonged exposure improve military-related PTSD despite high non-response rates

A review of randomized clinical trials shows cognitive processing therapy and prolonged exposure led to clinically meaningful improvements for many individuals with military-related PTSD; however, non-response rates were high and many patients continued to have symptoms.

“Over the past 10 years, an increasing number of randomized clinical trials of PTSD treatments in military personnel and veterans have emerged, coinciding with a major policy shift in the Departments of Defense and Veterans Affairs toward therapies considered evidence-based. Psychotherapy is more consistently recommended as first-line treatment for PTSD than medications across clinical practice guidelines and in DoD and VA practice settings,” study researcher Maria M. Steenkamp, PhD, of New York University Langone School of Medicine, and colleagues wrote.

To assess efficacy of psychotherapies for military personnel and veterans with PTSD, researchers reviewed 36 randomized clinical trials of individual and group psychotherapies for PTSD in this population, published from January 1980 to March 2015.

Cognitive processing therapy and prolonged exposure were the most frequently studied psychotherapies for military-related PTSD.

Researchers analyzed five randomized clinical trials on cognitive processing therapy (with a combined cohort of 481 patients) and four on prolonged exposure (with a combined cohort of 402 patients).

According to an analysis of intent-to-treat outcomes, cognitive processing therapy and prolonged exposure had large within-group posttreatment effect sizes, and outperformed waitlist and treatment-as-usual control conditions.

Of the study participants receiving cognitive processing therapy and prolonged exposure, 49% to 70% had clinically meaningful symptom improvement.

However, 60% to 72% of participants who received cognitive processing therapy and prolonged exposure retained a PTSD diagnosis after treatment. Mean posttreatment scores for both treatments remained at or above clinical criteria for PTSD.

Compared with non–trauma-focused psychotherapy, cognitive processing therapy and prolonged exposure exhibited significantly greater efficacy.

“Two principal clinical conclusions can be drawn from this review. First, the available evidence supports the use of either trauma-focused or structured non–trauma-focused therapies, depending on patient preferences or other factors that might promote treatment retention. Second, there is a need for improvement in existing PTSD treatments as well as the development and testing of novel evidence-based treatment strategies, whether trauma-focused or non–trauma-focused,” Steenkamp and colleagues wrote. “An increasing number of novel therapeutic approaches have been shown efficacious to varying degrees, but progress in the field is unlikely without better understanding of treatment mechanisms, patient preferences, factors influencing treatment engagement and retention, and behavioral and biomarker prediction of differential treatment responses.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.