Cognitive processing therapy superior to treatment as usual in PTSD at 17 weeks
Key takeaways:
- Mean CAPS-5 scores dropped significantly more in those given CPT vs. treatment as usual at 17 weeks.
- Mean score changes in metrics for other psychiatric conditions suggested positive, sustained effects of CPT.
Introduction of cognitive processing therapy to treatment as usual was superior to standard treatment alone to address PTSD at 17 weeks, according to data published in JAMA Network Open.
“Treatment guidelines and a systematic review have consistently reported that trauma-focused types of cognitive behavioral therapy are the first-line treatment of choice for individuals with PTSD,” Masaya Ito, PhD, a psychologist at the National Center for Cognitive Behavioral Therapy and Research, and National Center of Neurology and Psychiatry in Tokyo, and colleagues wrote. “However, most previous studies have been limited to veterans or active military contexts.”
Ito and colleagues sought to evaluate the efficacy of cognitive processing therapy (CPT) for treating PTSD among non-military Japanese individuals.
Their 16-week, single-center, randomized, parallel-group clinical trial examined the efficacy of CPT in conjunction with treatment as usual (CPT-TAU) vs. waiting list with TAU (WL-TAU) from April 2016 through December 2022. A total of 60 individuals (mean age, 36.9 years; 90% women) diagnosed with PTSD from a national psychiatric referral hospital in Tokyo were randomly assigned on a 1:1 basis to receive either CPT-TAU consisting of 12 weekly individual CPT sessions, or WL-TAU, which offered clinical monitoring, psychotherapy, pharmacotherapy and other counseling support. Patients in the CPT intervention group were allowed a maximum of 16 weeks to complete the course, but researchers considered therapy complete at 12 sessions.
For the primary outcome, Ito and colleagues utilized the Clinician-Administered PTSD Scale (CAPS-5) score to assess PTSD at 17 weeks. For secondary outcomes, they employed the PTSD Checklist–5 (PCL-5) to analyze patient self-reported PTSD symptoms and responder status at 17 weeks, while other aspects of patient-reported mental health were evaluated by industry-standard metrics for each during study follow up.
Results showed that mean CAPS-5 scores for CPT-TAU and WL-TAU were 35.97 and 37.81 at baseline and 22.36 and 38.23 at 17 weeks, respectively, while eight of 29 individuals in the CPT-TAU group and two of 31 in the WL-TAU group demonstrated a treatment response at 17 weeks.
The researchers additionally reported mean change differences in a range of psychiatric conditions including depression (8.83; 95% CI, 6-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.9-12.43), clinical global impression (0.84; 95% CI, 0.41-1.26) and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81) during follow up, suggesting a positive and sustained treatment effect.
Further, no serious adverse events were found in the CPT-TAU group, while three such events were recorded in the WL-TAU group.
“These findings are notable because many clinicians assume that focusing on and discussing traumatic events is more distressing than other types of psychotherapy,” Ito and colleagues wrote.