Abstract
While evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) is a first-line treatment, its real-world effectiveness is unknown. We compared cognitive processing therapy (CPT) and prolonged exposure (PE) each to an individual psychotherapy comparator group, and CPT to PE in a large national healthcare system. We utilized effectiveness and comparative effectiveness emulated trials using retrospective cohort data from electronic medical records. Participants were veterans with PTSD initiating mental healthcare (N = 265 566). The primary outcome was PTSD symptoms measured by the PTSD Checklist (PCL) at baseline and 24-week follow-up. Emulated trials were comprised of 'person-trials,' representing 112 discrete 24-week periods of care (10/07-6/17) for each patient. Treatment group comparisons were made with generalized linear models, utilizing propensity score matching and inverse probability weights to account for confounding, selection, and non-adherence bias. There were 636 CPT person-trials matched to 636 non-EBP person-trials. Completing ⩾8 CPT sessions was associated with a 6.4-point greater improvement on the PCL (95% CI 3.1-10.0). There were 272 PE person-trials matched to 272 non-EBP person-trials. Completing ⩾8 PE sessions was associated with a 9.7-point greater improvement on the PCL (95% CI 5.4-13.8). There were 232 PE person-trials matched to 232 CPT person-trials. Those completing ⩾8 PE sessions had slightly greater, but not statistically significant, improvement on the PCL (8.3-points; 95% CI 5.9-10.6) than those completing ⩾8 CPT sessions (7.0-points; 95% CI 5.5-8.5). PTSD symptom improvement was similar and modest for both EBPs. Although EBPs are helpful, research to further improve PTSD care is critical.
Highlights
Prolonged exposure (PE) and cognitive processing therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) based on clinical practice guidelines (Departments of Veterans Affairs and Defense, 2010, 2017), supported by multiple randomized controlled trials (RCTs; Haagen, Smid, Knipscheer, Kleber, & McHugh, 2015; Monson et al, 2006; Schnurr et al, 2007; Surís, Link-Malcolm, Chard, Ahn, & North, 2013)
The CPT group improved by 7.5-points and the non-evidence-based psychotherapy (EBP) group improved by 2.7-points
CPT initiators had a 4.8-point greater improvement on the PTSD Checklist (PCL)-4 scale, 7.3-percentage points greater improvement relative to baseline, and 7.4% more experienced recovery (2.6-times greater odds) compared to non-EBP initiators. Those completing ⩾8 CPT sessions improved by 8.2-points and those completing ⩾8 non-EBP sessions improved by 1.8-points
Summary
Prolonged exposure (PE) and cognitive processing therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) based on clinical practice guidelines (Departments of Veterans Affairs and Defense, 2010, 2017), supported by multiple randomized controlled trials (RCTs; Haagen, Smid, Knipscheer, Kleber, & McHugh, 2015; Monson et al, 2006; Schnurr et al, 2007; Surís, Link-Malcolm, Chard, Ahn, & North, 2013). Completing ⩾8 CPT sessions was associated with a 6.4-point greater improvement on the PCL (95% CI 3.1–10.0). There were 272 PE person-trials matched to 272 non-EBP persontrials. There were 232 PE person-trials matched to 232 CPT persontrials Those completing ⩾8 PE sessions had slightly greater, but not statistically significant, improvement on the PCL (8.3-points; 95% CI 5.9–10.6) than those completing ⩾8 CPT sessions (7.0-points; 95% CI 5.5–8.5). EBPs are helpful, research to further improve PTSD care is critical
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have