Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1006 — An Evaluation of Cognitive Processing Therapy to Treat Male Veterans in a PTSD Residential Rehabilitation Program

Alvarez J (Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University) , Drescher K (National Center for PTSD, VA Palo Alto Health Care System), Rosen C (Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University), Loew D (National Center for PTSD, VA Palo Alto Health Care System), Jenkins R (National Center for PTSD, VA Palo Alto Health Care System), Kimerling R (Center for Health Care Evaluation and National Center for PTSD, VA Palo Alto Health Care System), Ruzek J (National Center for PTSD, VA Palo Alto Health Care System)

Objectives:
It is unclear whether empirically supported psychotherapies for PTSD in non-veteran populations can be successfully implemented with veterans treated in a group-therapy format in existing VA settings. The purpose of this study was to conduct the first evaluation of Cognitive Processing Therapy (CPT), a VA-approved treatment for PTSD, which has been shown to be efficacious in female outpatients, to treat male veterans in the context of a PTSD residential rehabilitation program (PRRP).

Methods:
Participants were two cohorts of male veterans in a PTSD residential rehabilitation program (PRRP). Ninety-four men treated with CPT groups were compared to 103 men who participated in treatment-as-usual prior to the implementation of CPT. Cohorts were compared on changes from pre- to post-treatment using the PTSD Symptom Checklist (PCL), Beck Depression Inventory (BDI), and other measures of functioning. Minorities represented 39% of the sample and the mean age was 52 (SD = 9.18). The CPT group was significantly younger, which likely reflects group differences in period of service; therefore, age was included as a covariate in all group comparisons.

Results:
Paired-samples t-tests indicated that men in both treatment groups improved significantly on nearly all outcome measures. Pre-post effect sizes on the PCL and BDI were large for CPT (d = .73 and .83, respectively) and medium for treatment-as-usual (d = .43 and .34, respectively). ANCOVAs conducted with an intent-to-treat sample, controlling for age and intake symptom levels, revealed that CPT participants evidenced more symptom improvement at discharge than treatment-as-usual participants on the PCL (F(3, 145) = 6.94, p < .01), BDI (F(3, 140) = 11.56, p < .01), and other measures of functioning. Analyses conducted with a completer sample yielded similar results.

Implications:
Results indicate that CPT can be effectively disseminated and delivered in the context of a VA residential rehabilitation treatment program for male veterans with military-related PTSD. Moreover, CPT appears to produce significantly more symptom improvement than treatment-as-usual conducted before the dissemination of CPT.

Impacts:
The dissemination and implementation of this empirically supported treatment in VA settings is feasible and likely to improve care for veterans with military-related PTSD.