Treating posttraumatic stress disorder at home in a single week using 1‐week virtual massed cognitive processing therapy

Abstract

Posttraumatic stress disorder (PTSD) treatments are increasingly delivered in massed formats and have shown comparable results to standard, weekly treatment. To date, massed cognitive processing therapy (CPT), delivered daily, has been delivered primarily in combination with adjunctive services and among veteran populations, but it has not been rigorously evaluated as a standalone intervention. The present study evaluated 1‐week massed CPT delivered virtually (i.e., via telehealth) to a community sample of trauma‐exposed individuals (N = 24). Using a single‐arm open‐label design, participants received CPT twice per day for 5 days. The results indicated that most participants completed treatment (n = 23, 95.8%), and no adverse events were reported. Participants exhibited large reductions in clinician‐rated, d = 2.01, and self‐reported PTSD symptoms, d = 2.55, as well as self‐reported depressive symptoms, d = 1.46. On average, participants reported a 5‐point PTSD symptom reduction and 1‐point reduction in depressive symptoms for each treatment day. Reductions in PTSD and depressive symptoms were maintained at 3‐month follow‐up. Overall, 1‐week massed CPT delivered virtually was shown to be feasible and to result in rapid symptom reductions that were sustained over time. Virtual massed CPT has the potential to increase access to effective treatments and help trauma survivors restore aspects of their lives in short amounts of time.

More is not always better: 2 weeks of intensive cognitive processing therapy-based treatment are noninferior to 3 weeks.

“…The novel two-week ITP was designed around 50-minute individual CPT sessions delivered twice per day (16 total CPT sessions), each of which was followed by 60 minutes dedicated to complete assigned CPT homework. This schedule was based on promising insights from a recently completed clinical trial of twice-daily individual CPT with dedicated homework time (Held et al, 2022). Participants received thirteen hours of combined mindfulness and yoga, as well as five and a half total hours of art therapy, two hours of group psychoeducation, seven-and-a-half hours of group CPT or dialectical behavior therapy skill-based groups, as well as five hours of case management services.…”

Moving toward precision PTSD treatment: predicting veterans' intensive PTSD treatment response using continuously updating machine learning models

“…Support comes from randomized controlled trials (Monson et al, 2006;Resick, Nishith, Weaver, Astin, & Feuer, 2002;Resick et al, 2008Resick et al, , 2015Resick et al, , 2017b as well as clinical research (Asmundson et al, 2019;Held, Smith, Pridgen, Coleman, & Klassen, 2022c;Lloyd et al, 2015). CPT has been successfully delivered in different formats such as the traditional 12 sessions delivered on a weekly basis (Monson et al, 2006;Resick et al, 2002Resick et al, , 2008Resick et al, , 2015Resick et al, , 2017b and massed/intensive treatments which deliver a full course of treatment in as little as one to three weeks (Galovski et al, 2021;Held et al, 2022aHeld et al, , 2022c. Effect sizes for PTSD severity reduction in CPT are generally large and meaningful when delivered weekly or in massed format (e.g.…”

Predicting suicidal ideation 3 months following intensive posttraumatic stress disorder treatment.

“…This may be especially critical for veterans who also present with SI, as SI is one of several risk factors predicting eventual suicide attempts (e.g., Lee et al, 2018; May & Klonsky, 2016). Although the two programs utilized differ in timeline and program elements, they have been previously demonstrated to be similar with respect to outcomes (Held et al, 2022). If the present findings can be replicated in other intensive treatments, quickly reducing PTSD and thereby decreasing SI via intensive treatment has the potential to reduce suicide rates among veterans with PTSD.…”

“…Intensive PTSD treatment programs typically include daily treatment sessions, generally for 1 and 3 weeks, and often combine evidence-based PTSD treatments with adjunctive services such as skills groups and yoga (Held et al, 2019; Ragsdale et al, 2020). Intensively-delivered CPT provided standalone over the course of 1 week (Galovski et al, 2021; Held et al, 2022), 2 weeks as part of an ITP that combined CPT with adjunctive services (Bryan et al, 2022; Held et al, 2023), and 3 weeks as part of an ITP that combined individual and group CPT with adjunctive services (Held et al, 2020; Zalta et al, 2018) has been shown to reduce PTSD symptoms at similar levels to traditional, weekly CPT in shorter time periods. Because intensive and weekly PTSD treatments have been shown to be similarly effective (Sciarrino et al, 2020), there is reason to believe that SI may improve similarly across massed/intensive and traditional, weekly delivery formats.…”