Open trial of an adaptation of cognitive processing therapy for message-based delivery.

Abstract

Cognitive Processing Therapy (CPT) has been found to be effective in individual and in group therapy formats for Posttraumatic Stress Disorder (PTSD). However, many people in need of evidence-based PTSD treatment do not receive therapy due to distance from or availability of CPT-trained therapists, work and family obligations, and other barriers to in-person treatment. One way to expand the reach of CPT is through an asynchronous messaging format. To assess feasibility and preliminary effectiveness, CPT-Text was developed and pilot tested in an open trial (N = 28) and then compared to a matched comparison sample of people receiving messaging therapy as usual (TAU; n = 23) for PTSD through the same platform. The CPT-Text completion rate (63%) was comparable to face-to-face and telehealth-delivered CPT in previous studies. Word count and use of video meetings were comparable or lower than TAU, suggesting feasibility of delivery of a structured, trauma-focused intervention in a texting format. CPT-Text resulted in improvement in both PTSD and depression in fewer days than required for clinically significant change in the TAU sample. This effect for PTSD was greater than for TAU and the pre-post and between-conditions effect size for change was large. This first examination of a structured, trauma-focused intervention delivered through a messaging therapy platform suggests that with further testing and refinement, asynchronous CPT delivered via text may be a feasible, efficient, and effective PTSD intervention.