Veterans' 12-month PTSD and depression outcomes following 2- and 3-week intensive cognitive processing therapy-based treatment.

Background: Growing evidence indicates that daily delivery of evidence-based PTSD treatments (e.g. Cognitive Processing Therapy (CPT)), as part of intensive PTSD treatment programmes (ITPs), is feasible and effective. Research has demonstrated that a 2-week CPT-based ITP can produce equivalent outcomes to a 3-week ITP, suggesting shorter treatment can also be highly effective. However, the extent to which ITP length and composition impact longer-term outcomes needs further study.Objective: We examined whether PTSD and depression symptoms 3-, 6-, and 12-months following completion of a 2-week ITP could be considered non-inferior, or equivalent, to those of a 3-week ITP.Method: Data from 638 veterans who participated in a 2-week CPT-based ITP were evaluated against 496 veterans who participated in a 3-week CPT-based ITP. A Bayes factor approach was used to examine whether PTSD and depression severity outcomes of the 2-week ITP could be considered equivalent to the 3-week ITP.Results: Participants across both ITPs reported large PTSD (d = 0.98) and moderate to large depression symptom reductions (d = 0.69) from baseline to 12-month follow-up. The PTSD and depression symptom reductions seen in the 2-week ITP were determined to be equivalent to those of the 3-week ITP.Conclusions: Low follow-up completion was a limitation. Future research might replicate the present findings using samples with greater follow-up rates and explore whether adjunctive services impact other relevant constructs, such as quality of life and functioning.

This study demonstrated that intensive PTSD treatment programmes for veterans can produce large and lasting PTSD and depression symptoms reductions.A 2-week intensive PTSD treatment programme that offered 37 fewer clinical hours was just as effective as a 3-week programme for veterans, with lasting symptom improvement up to 12 months after treatment.The 2-week programme focused primarily on individual Cognitive Processing Therapy delivered twice per day whereas the 3-week programme combined individual and group CPT and had a much larger number of adjunctive services.

Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs.

Background: Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals' treatment response to more or less comprehensive ITPs is poorly understood.Objective: To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or less comprehensive ITPs.Methods: The PAI was developed and tested on a sample of 747 veterans with PTSD who completed a 3-week (more comprehensive; n = 360) or 2-week (less comprehensive; n = 387) ITP.Results: Approximately 12.32% of the sample had a PAI value that suggests that individuals would have experienced greater PTSD symptom change (5 points) on the PTSD Checklist for DSM-5 in either a more- or less comprehensive ITP. For individuals with the highest 25% of PAI values, effect sizes for the amount of PTSD symptom change between those in their optimal vs. non-optimal programs was d = 0.35.Conclusions: Although a minority was predicted to have benefited more from a program, there generally was not a substantial difference in predicted outcomes. Less comprehensive and thus more financially sustainable ITPs appear to work well for most individuals with PTSD.

A Personalized Advantage Index (PAI) was developed for a 3-week (more comprehensive) and a 2-week (less comprehensive) intensive PTSD treatment program to predict treatment responses.Using the PAI, approximately 12% of the sample was predicted to have experienced meaningfully greater in another program than the one in which they participated.Findings suggest a less comprehensive and more financially sustainable 2-week intensive PTSD treatment program would work well for most veterans in the present study.

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

OBJECTIVE: This study examined whether posttraumatic stress disorder (PTSD) symptom change during a 3- and 2-week intensive treatment program (ITP)-based in cognitive processing therapy was predictive of reduced suicidal ideation (SI) following treatment. METHOD: Veterans completed either a 3-week (n = 274, Mage = 42.35, SD = 9.43, 64.23% male, 65.33% White) or 2-week (n = 177, Mage = 42.90, SD = 9.81, 57.63% male, 66.67% White) ITP and self-reported PTSD, depression, and SI symptoms prior to, during, and 3 months following treatment. RESULTS: Mixed-effects-based two-stage location scale models assessed change in both overall PTSD severity over the course of the 3- and 2-week ITPs, as well as how this change predicted 3-month follow-up SI. Veterans in both programs reported moderate reductions in SI from baseline to posttreatment (3 weeks: d = 0.49; 2 weeks: d = 0.48). Of the 210 veterans across both programs who endorsed at least some SI at baseline, two-thirds (65.24%) reported reductions in SI posttreatment; three-quarters (74.45%) of these maintained posttreatment SI at 3-month follow-up that was lower than baseline levels. CONCLUSIONS: Both baseline SI and greater individual improvement in PTSD symptom severity during the ITPs were associated with lower SI at 3-month follow-up. Overall, study findings suggest that veterans with PTSD who also endorse SI can be successfully treated using the intensive delivery format and are likely to experience a reduction in SI both during and following treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

'Undoing a knot': a qualitative study of massed 1-week Cognitive Processing Therapy.

Introduction: Intensive or massed Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) has been found to result in significant PTSD symptom reductions. However, few studies to date have used qualitative approaches to systematically evaluate client reflections about massed treatment approaches for PTSD. To address this gap, the present study aimed to improve our understanding of trauma survivors' reflections following the completion of 1-week CPT.Method: We conducted semi-structured interviews with seven trauma survivors within 3-months of the completion of 1-week CPT. We used the scissor-and-sort technique to identify themes and subthemes in the qualitative data.Results: Using the scissor-and-sort technique, we generated five main themes and associated subthemes from the data. The main themes were: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Conclusion: Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.

Scant research has examined client reflections about massed treatment approaches for PTSD.Among participants who completed a semi-structured interview about their experiences with 1-week CPT for PTSD, we generated five themes: (a) tangible skills, (b) feasibility, (c) therapeutic process, (d) symptom presentation, and (e) treatment expectations.Collectively, our results suggested that 1-week CPT was feasible and led to changes in PTSD symptoms and improved cognitive and affective coping skills.