Cognitive Processing Therapy May Improve PTSD Symptoms
Combining cognitive processing therapy (CPT) with treatment as usual (TAU) for patients with post-traumatic stress disorder (PTSD) may be better at reducing PTSD symptoms, according to recent results from a randomized clinical trial published in JAMA Network Open.
Researchers used a 16-week, single-center, assessor-blinded, parallel-group superiority study to examine the efficacy of CPT with treatment as usual (CPT-TAU) versus waiting list with TAU (WL-TAU) from April 2016 through December 2022. Participants were adult patients with PTSD in Tokyo, Japan. Participants were randomized 1:1 to either CPT-TAU (n = 29) with 12 weekly individual CPT sessions, or WL-TAU (n = 31), with clinical monitoring and/or pharmacotherapy. The main study outcome was the Clinician-Administered PTSD Scale (CAPS-5) score for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) at 17 weeks. Secondary outcomes included self-reported PTSD symptoms assessed by the PTSD Checklist–5 and responder status at 17 weeks. Analysis was performed between February 1, 2024, to April 30, 2024.
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A total of 60 participants were included in the final study, with a mean age of 36.9 years; 90% were women. The CPT-TAU group showed a mean reduction in CAPS-5 scores of 14.00 points, with a low dropout rate (2 of 29 [6.9%]). Patients in the CPT-TAU group showed improvement in all secondary and other outcomes. The mean change difference was observed in depression (8.83; 95% CI, 6.00-11.66), suicidal ideation (6.73; 95% CI, 1.25-12.22), disability (8.16; 95% CI, 3.90-12.43), clinical global impression scale (0.84; 95% CI, 0.41-1.26), and loss of principal PTSD diagnosis (59.09; 95% CI, 37.19-81.00). There were no serious adverse events in the CPT-TAU group and 3 serious adverse events in the WL-TAU group.
“The CPT-TAU group showed significant improvements compared with the WL-TAU group in the blinded assessor evaluation of severity and improvement of clinical global impression, responder status, and loss of PTSD diagnosis,” study authors concluded. “The CPT-TAU group maintained improvements in all outcomes from 17 to 34 weeks
This study has several limitations, authors noted. The allocation was not blinded for independent evaluators at 17 and 34 weeks, potentially influencing their assumptions. Additionally, most participants were female, PTSD and complex PTSD diagnoses were not assessed per ICD-11, active control conditions were not used, and pharmacotherapy changes were not restricted to facilitate participant recruitment in Japan.
