Abstract
BackgroundIntensive delivery of evidence-based treatment for posttraumatic stress disorder (PTSD) is becoming increasingly popular for overcoming barriers to treatment for veterans. Understanding how and for whom these intensive treatments work is critical for optimizing their dissemination. The goals of the current study were to evaluate patterns of PTSD and depression symptom change over the course of a 3-week cohort-based intensive outpatient program (IOP) for veterans with PTSD, examine changes in posttraumatic cognitions as a predictor of treatment response, and determine whether patterns of treatment outcome or predictors of treatment outcome differed by sex and cohort type (combat versus military sexual trauma [MST]).MethodOne-hundred ninety-one veterans (19 cohorts: 12 combat-PTSD cohorts, 7 MST-PTSD cohorts) completed a 3-week intensive outpatient program for PTSD comprised of daily group and individual Cognitive Processing Therapy (CPT), mindfulness, yoga, and psychoeducation. Measures of PTSD symptoms, depression symptoms, and posttraumatic cognitions were collected before the intervention, after the intervention, and approximately every other day during the intervention.ResultsPre-post analyses for completers (N = 176; 92.1% of sample) revealed large reductions in PTSD (d = 1.12 for past month symptoms and d = 1.40 for past week symptoms) and depression symptoms (d = 1.04 for past 2 weeks). Combat cohorts saw a greater reduction in PTSD symptoms over time relative to MST cohorts. Reduction in posttraumatic cognitions over time significantly predicted decreases in PTSD and depression symptom scores, which remained robust to adjustment for autocorrelation.ConclusionIntensive treatment programs are a promising approach for delivering evidence-based interventions to produce rapid treatment response and high rates of retention. Reductions in posttraumatic cognitions appear to be an important predictor of response to intensive treatment. Further research is needed to explore differences in intensive treatment response for veterans with combat exposure versus MST.
Highlights
Intensive delivery of evidence-based treatment for posttraumatic stress disorder (PTSD) is becoming increasingly popular for overcoming barriers to treatment for veterans
For veterans in the MST cohort, effect sizes were medium to large (d = 0.62 to 0.88) whereas effect sizes for veterans in the combat cohorts were large to very large (d = 0.85 to 1.81)
Rates of remission were significantly different based on cohort type with 62.9% of veterans treated in combat cohorts and 35.7% of veterans treated in MST cohorts no longer meeting criteria for probable PTSD at post-treatment (χ2 (1) = 10.81, p = .001)
Summary
Intensive delivery of evidence-based treatment for posttraumatic stress disorder (PTSD) is becoming increasingly popular for overcoming barriers to treatment for veterans. Evidence-based psychotherapies for PTSD such as Cognitive Processing Therapy (CPT) [2, 3] and Prolonged Exposure [4] exist, many veterans do not receive these treatments or fail to receive a sufficient dose of treatment [5]. Research shows that nearly 40% of veterans terminate evidence-based PTSD treatment prior to receiving therapeutic benefit [6]. Several barriers may contribute to low utilization of evidence-based PTSD treatment among veterans including avoidance [7] and poor accessibility of treatment [8, 9]. It is clear that there is a need for greater provision of evidence-based PTSD treatment that is able to address these barriers to its effective utilization. Research has shown that the addition of case management services can reduce dropout from cognitive behavioral therapy in vulnerable populations [10]
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