Veterans receiving a second course of cognitive processing therapy or prolonged exposure therapy: is it better to switch or stay the same?. Issue 6 (2nd November 2022)

• Record Type: Journal Article
• Authors: Holder, Nicholas; Batten, Adam J.; Shiner, Brian; Li, Yongmei; Madden, Erin; Neylan, Thomas C.; Seal, Karen H.; Patterson, Olga V.; DuVall, Scott L.; Maguen, Shira
• Is Part Of: Cognitive behaviour therapy. Volume 51:Issue 6(2022)
• Page Start: 456
• Page End: 469
• Publication Date: 2022-11-02
• Subjects: Post-traumatic stress disorder -- cognitive processing therapy -- prolonged exposure therapy -- treatment sequencing -- Bayesian hierarchical regression; Cognitive therapy -- Periodicals; Behavior therapy -- Periodicals; 616.89142
• DOI: 10.1080/16506073.2022.2058996
• Languages: English
• ISSNs: 1650-6073

Abstract

ABSTRACT: Cognitive processing therapy (CPT) and prolonged exposure therapy (PE) are effective psychotherapies for post-traumatic stress disorder (PTSD). However, these treatments also have high rates of dropout and non-response. Therefore, patients may need a second course of treatment. We compared outcomes for patients who switched between CPT/PE and those who repeated CPT/PE during a second course of treatment. We collected data from Iraq and Afghanistan war veterans ( n = 2, 958) who received a second course of CPT/PE in the Veterans Health Administration from 2001 to 2017 and had symptom outcomes (PTSD checklist; PCL). We measured the association between treatment sequence and change in PCL score over the second course of treatment using hierarchical Bayesian regression, adjusted for sociodemographic and clinical characteristics. All treatment sequences showed a significant reduction in PCL score over time (β = −4.80; HDI95 : −5.74, −3.86). Veterans who switched from CPT to PE had modestly greater PCL reductions during the second course than those who repeated CPT. However, no significant difference in PCL change during the second course was observed between veterans who repeated PE and those who switched from PE to CPT. Veterans participating in a second course of CPT/PE can benefit, and switching treatment may be slightly more beneficial following CPT.