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Cognitive Processing Therapy (CPT)

Topic Areas
Scientific Rating
Child Welfare Relevance
Trauma Treatment (Adult)
1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Adults who have experienced a traumatic event and are currently suffering from the symptoms of posttraumatic stress disorder (PTSD) and/or meet criteria for a diagnosis of PTSD

Program Overview

CPT was originally developed for use with rape and crime victims, but it is used with a variety of trauma populations, including both military and civilian samples. CPT focuses on identifying and challenging maladaptive beliefs that develop about, and as a result of, the traumatic event. The therapist helps the client to identify problem areas (i.e., stuck points) in their thinking about the traumatic event, which have impeded their recovery. Therapists then use Socratic dialogue, a form of questioning that encourages clients to examine and evaluate their own beliefs rather than being told in a directive way, to help clients challenge their stuck points. Throughout the treatment, worksheets and Socratic dialogue are used to help clients replace maladaptive beliefs with more balanced alternative statements. CPT can be delivered individually or in a group format.

Note: When CPT was originally developed and for many years after that, it included a trauma narrative as part of the intervention. Since 2011, a number of research studies using CPT without the trauma narrative (known as CPT-C) have been published. In 2017, the developer of CPT made the decision to no longer include the trauma narrative as part its intervention as the primary therapy format (the exceptions are if the clients want to write an account or if they are highly dissociative to piece together the event). Research is being conducted on both versions of the therapy but there is more on CPT than CPT+A (with accounts).

Program Goals

The goals of Cognitive Processing Therapy (CPT) are:

  • Increase understanding of posttraumatic stress disorder (PTSD) and how it affects life
  • Accept the reality of the traumatic event
  • Feel emotions about the traumatic event and reduce avoidance
  • Develop balanced and realistic beliefs about the event, oneself, others, and the world
  • Decrease the emotions that emanate from maladaptive beliefs about the event (e.g., guilt, shame, anger)
  • Decrease symptoms of PTSD and depression
  • Improve day-to-day living

Logic Model

The program representative did not provide information about a Logic Model for Cognitive Processing Therapy (CPT).

Essential Components

The essential components of Cognitive Processing Therapy (CPT) include:

  • Educating clients about the symptoms of PTSD
  • Assisting clients to identify and evaluate maladaptive beliefs that they have developed about the traumatic event, themselves, others, and the world
  • Using Socratic Questioning, a form of questioning that encourages clients to examine and evaluate their own beliefs
  • Teaching clients skills to modify their maladaptive thoughts and beliefs with the use of worksheets (e.g., ABC Worksheet, Challenging Beliefs Worksheet)
  • Assigning clients regular out-of-session practice assignments to learn and apply what has been discussed in therapy

Program Delivery

Adult Services

Cognitive Processing Therapy (CPT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD) and related symptoms

Recommended Intensity:

One-on-one: 1-2 sessions per week totaling 12 sessions, with the session lasting 50 minutes; Group: weekly 90-minute sessions

Recommended Duration:

The program is a 12-session treatment; studies have found that in some cases fewer sessions may be needed or extra sessions can be offered if necessary to decrease PTSD symptoms.

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

Cognitive Processing Therapy (CPT) includes a homework component:

Homework is assigned every week to expand upon what was learned/discussed in each therapy session. This includes a continuous stuck point log to be compiled by the patient outside of therapy, ABC Worksheets, Challenging Questions Worksheets, Patterns of Problematic Thinking Worksheets, and Challenging Beliefs Worksheets. A trauma impact statement is also assigned at the beginning and end of therapy. A written trauma account is also assigned.

Languages

Cognitive Processing Therapy (CPT) has materials available in languages other than English:

Arabic, Chinese, Finnish, German, Hebrew, Icelandic, Japanese, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

A quiet, private room for the session to be held in, the materials manual, the therapist manual, and the ability to copy worksheets

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Licensed mental health professionals or those working under the supervision of a licensed mental health professional. Psychology, social, work, and nursing staff can implement CPT in their respective roles. In third world countries, the protocol has been implemented successfully with therapists with high school education.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Onsite, Regional, through the VA National Rollout, agency-arranged workshops with one of the trainers

Number of days/hours:

2 days/16 hours for individual CPT or 3 days/24 hours adding in a group therapy day followed by weekly telephone consultation for 6 months

Additional Resources:

There currently are additional qualified resources for training:

Online training is available at https://cpt2.musc.edu/. Manuals as PDF documents are available upon request.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Cognitive Processing Therapy (CPT) as listed below:

Pre-implementation assessments are given to training attendees prior to their first day of training and on the last day of training to assess their knowledge and level of comfort with CPT techniques. These are currently only used within VA trainings, and can be obtained from CPTforPTSD@gmail.com. Non-VA workshops require the online training prior to attending.

Formal Support for Implementation

There is formal support available for implementation of Cognitive Processing Therapy (CPT) as listed below:

Training and consultation is available for therapists who are conducting CPT. Refer to cptforptsd.com for more information.

Fidelity Measures

There are fidelity measures for Cognitive Processing Therapy (CPT) as listed below:

A fidelity checklist overviewing each session of CPT is available. Contact CPTforPTSD@gmail.com for a copy.

Implementation Guides or Manuals

There are implementation guides or manuals for Cognitive Processing Therapy (CPT) as listed below:

Resick, P. A., Monson, C. M., & Chard K. M. (2017). Cognitive Processing Therapy for PTSD: A comprehensive manual. New York: Guilford Press.

The book includes free downloads of all the treatment materials on the Guilford website.

For manuals in other languages, please refer to https://cptforptsd.com/ for PDF copies of the manuals.

Research on How to Implement the Program

Research has not been conducted on how to implement Cognitive Processing Therapy (CPT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Note: When Cognitive Processing Therapy (CPT) was originally developed and for many years after that, it included a trauma narrative as part of the intervention. Since 2011, a number of research studies using CPT without the trauma narrative (known as CPT-C) have been published. In 2017, the developer of CPT made the decision to no longer include the trauma narrative as part its intervention as the primary therapy format (the exceptions are if the clients want to write an account or if they are highly dissociative to piece together the event). Research is being conducted on both versions of the therapy but there is more on CPT than CPT+A (with accounts).

The CEBC reviews all of the articles that have been published in peer-reviewed journals as part of the rating process. When there are more than 10 published, peer-reviewed articles, the CEBC identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for CPT are summarized below:

Resick, P. A., Nishith, P., Weaver, T. L., Astin, M. C, & Feuer, C. A. (2002). A comparison of Cognitive-Processing Therapy with prolonged exposure and a waiting condition for the treatment of chronic posttraumatic stress disorder in female rape victims. Journal of Counseling and Clinical Psychology, 70(4), 867–879. https://doi.org/10.1037/0022-006X.70.4.867

Type of Study: Randomized controlled trial
Number of Participants: 171

Population:

  • Age — Mean=32 years
  • Race/Ethnicity — 71% White, 25% African American, and 4% Other
  • Gender — 100% Female
  • Status — Participants were female rape victims.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare Cognitive Processing Therapy (CPT) with Prolonged Exposure (PE) and a minimal attention condition (MA) for the treatment of posttraumatic stress disorder (PTSD) and depression. Participants were randomly assigned to either CPT, PE or MA. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Interview for DSM–IV—Patient Version (SCID), Standardized Trauma Interview, the PTSD Symptom Scale, the Structured Clinical Interview for DSM–IV, the Beck Depression Inventory, the Trauma-Related Guilt Inventory (TRGI), and the Expectancy of Therapeutic Outcome Scale. Results indicate that CPT and PE treatments were superior to MA. The two therapies had similar results except that CPT produced better scores on two of four guilt subscales. Among those who completed the treatments as designed, the effect sizes for both treatments were quite large. There was a slight advantage in effect sizes and end-state functioning favoring CPT over PE through the 3-month follow-up. Limitations include concerns regarding generalization due to gender and treatment efficacy beyond rape traumas.

Length of controlled postintervention follow-up: 3 months (for all participants) and 9 months (for participants that opted for alternative treatment after still experiencing PTSD)

Chard, K. (2005). An evaluation of Cognitive Processing Therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Counseling and Clinical Psychology, 73(5), 965–971. https://doi.org/10.1037/0022-006X.73.5.965

Type of Study: Randomized controlled trial
Number of Participants: 71

Population:

  • Age — 18–56 years
  • Race/Ethnicity — 81% White, 14% African American, 4% Hispanic/Latin or Mexican American, and 1% Other
  • Gender — 100% Female
  • Status — Participants were females with posttraumatic stress disorder (PTSD) related to childhood sexual abuse.

Location/Institution: Center for Traumatic Stress Research

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness of Cognitive Processing Therapy (CPT) for sexual abuse survivors with that of the minimal attention (MA) given to a wait-listed control group. Participants were randomly assigned to either CPT or MA. Measures utilized include the Structured Clinical Interview for DSM–IV Non-Patient Versions-I and II (SCID-I; SCID-II); Standardized Trauma Interview; Sexual Abuse Exposure Questionnaire, Part 1 (SAEQ); Modified PTSD Symptom Scale (MPSS); Beck Depression Inventory-II (BDI-II); and Dissociative Experiences Scale-II (DES-II). Results indicate that CPT is more effective for reducing trauma-related symptoms than is MA. Limitations include the small sample size, concerns about generalizability due to small sample size, the small number of minorities recruited for the study, and that the study was conducted without a non-treatment control group design.

Length of controlled postintervention follow-up: 3 months and 1 year.

Resick, P. A., Galovski, T. A., Uhlmansiek, M. O., Scher, C. D., Clum, G. A., & Young-Xu, 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(2), 243–258. https://doi.org/10.1037/0022-006X.76.2.243

Type of Study: Randomized controlled trial
Number of Participants: 150

Population:

  • Age — 19–68 years
  • Race/Ethnicity — 62% White, 34% African American, 3% Hispanic, and 4% Other
  • Gender — 100% Female
  • Status — Participants were adult females with posttraumatic stress disorder (PTSD).

Location/Institution: St. Louis, MO

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to conduct a dismantling study of Cognitive Processing Therapy (CPT) in which the protocol including the narrative (CPT+A) was compared with its constituent components—cognitive therapy only (CPT-C) and written accounts (WA)—for the treatment of posttraumatic stress disorder (PTSD) and comorbid symptoms. Participants were randomized into 1 of the 3 conditions, 1) CPT+A, 2) CPT-C, and WA. Measures utilized include the Clinician-Administered PTSD Scale (CAPS), the Structured Clinical Interview for DSM–IV Axis I Disorders—Patient Edition (SCID), the Standardized Trauma Interview, the Beck Depression Inventory-II (BDI-II), the Experience of Shame Scale (ESS), the Personal Beliefs and Reactions Scale (PBRS), the Posttraumatic Stress Diagnostic Scale (PDS), the State-Trait Anger Expression Inventory (STAXI), State-Trait Anxiety Inventory (STAI), the Therapeutic Outcome Questionnaire, and the Trauma-Related Guilt Inventory (TRGI). Results indicate that patients in all 3 treatments improved substantially on PTSD and depression, the primary measures, and improved on other indices of adjustment. However, there were significant group differences in symptom reduction during the course of treatment whereby the CPT-C condition reported greater improvement in PTSD than the WA condition. Limitations include a focus only on interpersonal violence and the inclusion of only female participants.

Length of controlled postintervention follow-up: 6 months.

Morland, L. A., Hynes, A. K., Mackintosh, M. A., Resick, P. A., & Chard, K. M. (2011). Group Cognitive Processing Therapy delivered to veterans via telehealth: A pilot cohort. Journal of Traumatic Stress, 24(4), 465–469. https://doi.org/10.1002/jts.20661

Type of Study: Randomized controlled trial
Number of Participants: 13

Population:

  • Age — 28–77 years (Mean=50.8 years)
  • Race/Ethnicity — 57% Native Hawaiian/Pacific Islander, 14% African American, 14% Asian, and 14% Caucasian
  • Gender — 100% Male
  • Status — Participants were male U.S. Army soldiers diagnosed with posttraumatic stress disorder (PTSD) who were on active duty reserves, guard, or veterans and were being treated at VA clinics on participating Hawaiian Islands.

Location/Institution: Hawaii

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report preliminary clinical and feasibility data from a large, ongoing 4-year randomized controlled trial evaluating the efficacy of group cognitive-behavioral therapy (CBT) utilizing Cognitive Processing Therapy – Cognitive-only version (CPT-C) [now called Cognitive Processing Therapy (CPT)] for PTSD delivered via video teleconferencing (VT) compared to in-person (NP) delivery in a sample of male veterans with combat-related PTSD living in rural areas. Participants were randomly assigned to either group CPT-C delivered via VT or NP-delivered CPT-C. Measures utilized include the Clinician-Administered PTSD Scale (CAPS). Results indicate that both groups showed clinically meaningful reductions in PTSD symptoms and no significant between-group differences on clinical or process outcome variables. Limitations include small sample size, lack of controlled post-intervention follow-up, and lack of generalizability due to gender.

Length of controlled postintervention follow-up: None.

Bass, J. K., Annan, J., Murray, S. M., Kaysen, D., Griffiths, S., Centinoglu, T., Wachter, K., Murray, L. K., & Bolton, P. A. (2013). Controlled trial of psychotherapy for Congolese survivors of sexual violence. The New England Journal of Medicine, 368(23), 2182–2191. https://doi.org/10.1056/NEJMoa1211853

Type of Study: Randomized controlled trial
Number of Participants: 405

Population:

  • Age — Mean=33.8–36.9 years
  • Race/Ethnicity — 100% Congolese
  • Gender — 100% Female
  • Status — Participants were females who had experienced or witnessed sexual violence.

Location/Institution: 14 villages in South Kivu province and 2 villages on the border in North Kivu province of the Democratic Republic of Congo

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate Cognitive Processing Therapy (CPT) (1 individual session and 11 group sessions) versus individual support that was provided to female sexual-violence survivors with high levels of posttraumatic stress disorder (PTSD) symptoms and combined depression and anxiety symptoms in villages in the Democratic Republic of Congo. Participants were randomized to either CPT or to individual support services. Measures utilized include Hopkins Symptom Checklist (HSCL-25) and the PTSD Checklist — Civilian Version. Results indicate that CPT, as compared with individual support alone, was effective in reducing PTSD symptoms and combined depression and anxiety symptoms and improving functioning. Results also indicate that benefits were large and were maintained 6 months after treatment ended. Participants who received CPT were significantly less likely to meet the criteria for probable depression or anxiety or probable PTSD. Limitations include that the small number of village clusters made randomization less likely to result in comparability, detection bias due to the fact that the psychosocial assistants recruiting patients knew ahead of time whether they would be providing therapy or individual support, and performance bias due to the use of measures of unknown validity for identifying clinical cases of PTSD and combined depression and anxiety.

Length of controlled postintervention follow-up: 1 month and 6 months.

Morland , L. A., Mackintosh, M. A., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015). Telemedicine versus in–person delivery of Cognitive Processing Therapy for women with posttraumatic stress disorder: A randomized noninferiority trial. Depression and Anxiety, 32(11), 811–820. https://doi.org/10.1002/da.22397

Type of Study: Randomized controlled trial
Number of Participants: 126

Population:

  • Age — Mean=46.4 years
  • Race/Ethnicity — 60 Caucasian, 33 Other, 18 Asian, and 15 Pacific Islander
  • Gender — 100% Female
  • Status — Participants were female civilian and veteran, reserve and guard personnel with posttraumatic stress disorder (PTSD).

Location/Institution: National Center for PTSD in the Department of Veterans Affairs (VA) in Honolulu, Hawaii

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of video-teleconferencing (VTC) and in-person (NP) Cognitive Processing Therapy (CPT) to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Participants were randomly assigned to either NP or VTC CPT. Measures utilized include the Treatment Expectancy Questionnaire (TEQ), the Working Alliance Inventory (WAI) short form, the Charleston Psychiatric Outpatient Satisfaction Scale-VA version (CPOSS-VA), and the Telemedicine Satisfaction and Acceptance Scale (TSAS). Results indicate that improvements in PTSD symptoms in the VTC condition were noninferior to outcomes in the NP condition. Clinical outcomes obtained when both conditions were pooled together demonstrated that PTSD symptoms declined substantially posttreatment, and gains were maintained at 3- and 6-month follow-up. Veterans demonstrated smaller symptom reductions posttreatment than civilian women. Limitations include a small sample size, may not generalize to all veterans presenting for PTSD treatment in the VA system or to veterans in general, and the lack of non-treatment control group.

Length of controlled postintervention follow-up: 3 and 6 months.

Resick, P. A., Wachen, J. S., Mintz, J., Young-McCaughan, S., Roache, J. D., Borah, A. M., Borah, E. V., Dondanville, K. A., Hembree, E. A., Litz, B. T., & Peterson, A. L. (2015). A randomized clinical trial of group Cognitive Processing Therapy compared with group present-centered therapy for PTSD among active duty military personnel. Journal of Consulting and Clinical Psychology, 83(6), 1058–1068. https://doi.org/10.1037/ccp0000016

Type of Study: Randomized controlled trial
Number of Participants: 108

Population:

  • Age — 31–32 years
  • Race/Ethnicity — 62 White, 22 Black, 15 Hispanic, and 9 Other
  • Gender — 100 Male and 8 Female
  • Status — Participants were U.S. Army soldiers diagnosed with posttraumatic stress disorder (PTSD) following military deployment.

Location/Institution: Fort Hood, Texas

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether group therapy improves symptoms of posttraumatic stress disorder (PTSD), by utilizing Cognitive Processing Therapy (cognitive-only version; CPT-C) [now called Cognitive Processing Therapy (CPT)] with group present-centered therapy (PCT) for active-duty military personnel. Participants were randomized into CPT-C or PCT groups. Measures utilized include the PTSD Checklist (Stressor Specific Version; PCL-S), Life Events Checklist (LEC), Beck Depression Inventory-II (BDI-II), and the Posttraumatic Stress Symptom Interview (PSS-I). Results indicate that both treatments resulted in large reductions in PTSD severity, but improvement was greater in the CPT-C group. CPT-C also reduced depression, with gains remaining during follow-up. In PCT, depression only improved between baseline and before Session 1. Limitations include the small sample size, higher than expected attrition rates at follow-up, and lack of generalizability due to gender.

Length of controlled postintervention follow-up: 2 weeks, 6 months, and 12 months.

Butollo, W., Karl, R., König, J., & Rosner, R. (2016). A randomized controlled clinical trial of dialogical exposure therapy versus Cognitive Processing Therapy for adult outpatients suffering from PTSD after type I trauma in adulthood. Psychotherapy and Psychosomatics, 85(1), 16–26. https://doi.org/10.1159/000440726

Type of Study: Randomized controlled trial
Number of Participants: 141

Population:

  • Age — 18–78 years
  • Race/Ethnicity — Not specified
  • Gender — 93 Female
  • Status — Participants were recruited from consecutive patients seeking treatment at an outpatient clinic.

Location/Institution: Germany

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to test dialogical exposure therapy (DET) against Cognitive Processing Therapy (CPT) on individuals with posttraumatic stress disorder (PTSD). Participants were randomized to receive either DET or CPT. Measures utilized include the International Diagnostic Checklists for DSM-IV and ICD (IDCL), the Brief Symptom Inventory (BSI), the Global Severity Index, the Posttraumatic Diagnostic Scale, the Posttraumatic Cognitions Inventory (PTCI), and the Inventory of Interpersonal Problems – Circumplex Version (IIP-C). Results indicate that participants in both conditions achieved significant and large reductions in PTSD symptoms which were largely stable at the 6-month follow-up. At the posttreatment assessment, CPT performed statistically better than DET on symptom and cognition measures. For several outcome measures, younger patients profited better from CPT than older ones, while there was no age effect for DET. Limitations include small sample size, reliance on self-report measures of PTSD, and more attrition at the posttest and follow-up time points from the DET condition than the CPT condition.

Length of controlled postintervention follow-up: 6 months.

Resick, P. A., Wachen, J. S., Dondanville, K. A., Pruiksma, K. E., Yarvis, J. S., Peterson, A. L., Mintz, J., & STRONG STAR Consortium. (2017). Effect of group vs individual Cognitive Processing Therapy in active-duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74(1), 28–36. https://doi.org/10.1001/jamapsychiatry.2016.2729

Type of Study: Randomized controlled trial
Number of Participants: 268

Population:

  • Age — 18–33 years (Mean=33.2 years)
  • Race/Ethnicity — 108 White, 75 Black, 62 Hispanic, and 23 Other
  • Gender — 244 Male and 24 Female
  • Status — Participants were U.S. Army soldiers diagnosed with posttraumatic stress disorder (PTSD) after deployments to or near Iraq or Afghanistan.

Location/Institution: Fort Hood, Texas

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine the effects of Cognitive Processing Therapy (CPT) on posttraumatic stress disorder (PTSD) and co-occurring symptoms and whether they differ when administered in an individual or a group format. Participants were randomized to group or individual CPT. Measures utilized include the Posttraumatic Symptom Scale–Interview Version (PSS-I), the Posttraumatic Stress Disorder Checklist (PCL-S), the Beck Depression Inventory–II (BDI-II), the Beck Scale for Suicidal Ideation (BSSI), the 10-item Alcohol Use Disorders Identification Test–Interview Version (AUDIT), and the Mini-International Neuropsychiatric Interview 25 modules C and K. Results indicate that improvement in PTSD severity at posttreatment was greater when CPT was administered individually compared with the group format. Significant improvements were maintained with the individual and group formats, with no differences in remission or severity of PTSD at the 6-month follow-up. Symptoms of depression and suicidal ideation did not differ significantly between formats. Limitations include high attrition at 6-month follow-up the small number of women enrolled in the study prevented examination of sex differences, and lack of generalizability due to participants being in military service.

Length of controlled postintervention follow-up: 6 months.

Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with Cognitive Processing Therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: A randomized clinical trial. JAMA Psychiatry, 77(12), 1235–1245. https://doi.org/10.1001/jamapsychiatry.2020.2148

Type of Study: Randomized controlled trial
Number of Participants: 193

Population:

  • Age — 18–65 years, Mean=36.3 years
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were females with a diagnosis of PTSD (according to the DSM-5) following sexual or physical abuse before age 18 years.

Location/Institution: 3 university outpatient clinics in Mannheim, Frankfurt, and Berlin, Germany

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of dialectical behavior therapy for PTSD (DBT-PTSD) against that of Cognitive Processing Therapy (CPT). Participants were randomized to either DBT-PTSD or CPT. Measures utilized include the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the Global Assessment of Functioning, the PTSD Checklist for DSM-5, the Borderline Symptom List (short version [BSL-23]), the Beck Depression Inventory-II, and the Dissociation Tension Scale. Results indicate that there were significantly improved CAPS-5 scores in both groups and a small but statistically significant superiority of DBT-PTSD. Compared with the CPT group, participants in the DBT-PTSD group were less likely to drop out early and had higher rates of symptomatic remission, reliable improvement, and reliable recovery. Limitations include lack of follow-up, results may be affected by attrition bias, and lack of generalizability due to gender.

Length of controlled postintervention follow-up: None.

Zaccari, B., Higgins, M., Haywood, T. N., Patel, M., Emerson, D., Hubbard, K., Loftis, J. M. & Kelly, U. A. (2023). Yoga vs Cognitive Processing Therapy for military sexual trauma–related posttraumatic stress disorder: A randomized clinical trial. JAMA Network Open, 6(12), e2344862. https://doi.org/10.1001/jamanetworkopen.2023.44862

Type of Study: Randomized controlled trial
Number of Participants: 131

Population:

  • Age — 21–71 years
  • Race/Ethnicity — 73% African American or Black, 19% White, 5% Multiracial, 2% Other, 1% American Indian or Alaska Native, and 1% Asian
  • Gender — 100% Female
  • Status — Participants were female veterans with PTSD related to military sexual trauma (MST).

Location/Institution: Two VA health care systems located in the Southeast and Northwest of the United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of Trauma Center Trauma-Sensitive Yoga (TCTSY) vs first-line Cognitive Processing Therapy (CPT) in female veterans with PTSD related to military sexual trauma (MST) and the hypothesis that PTSD outcomes would differ between the interventions. Participants were randomized to either TCTSY or to CPT. Measures utilized include the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the PTSD Checklist for DSM-5 (PCL-5). Results indicate that both groups improved over time, and none of the group effects or group-by-time effects were significant. Limitations include concerns over bias because the CAPS-5 clinicians were not blinded, confounding variables, and the COVID-19 pandemic adding stressors and moving in-person procedures to virtual delivery for the cohorts.

Length of controlled postintervention follow-up: 2 weeks and 3 months.

Additional References

Chard, K. M., Resick, P. A., Monson, C. M., & Kattar, K. A. (2009). Cognitive Processing Therapy therapist group manual: Veteran/military version. Department of Veterans' Affairs.

Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive Processing Therapy for PTSD: A comprehensive manual. Guilford Press.

Contact Information

Patricia A. Resick, PhD, ABPP
Agency/Affiliation: Duke University
Email:

Date Research Evidence Last Reviewed by CEBC: August 2024

Date Program Content Last Reviewed by Program Staff: August 2017

Date Program Originally Loaded onto CEBC: June 2013