Academic journal article Journal of Mental Health Counseling

Effectiveness of Cognitive Processing Therapy for Treating Posttraumatic Stress Disorder

Academic journal article Journal of Mental Health Counseling

Effectiveness of Cognitive Processing Therapy for Treating Posttraumatic Stress Disorder

Article excerpt

Analyzing 11 studies, we evaluated the effectiveness of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD) and co-occurring depression symptoms in individuals diagnosed with PTSD. Separate meta-analytic procedures for between-group studies using waitlist or alternative treatment comparisons yielded large to very large effect sizes for CPT versus waitlist, and medium to large effect sizes when CPT was compared to alternative treatments. Implications for evidence-supported practice and study limitations are discussed.


Posttraumatic stress disorder (PTSD) is a clinical syndrome characterized by intrusive memories, emotional avoidance, and heightened physiological arousal following exposure to a traumatic event (American Psychiatric Association [APA], 2000, 2013). The National Institute for Mental Health (2005) estimated that about 21 million individuals within the United States experience symptoms associated with PTSD; however, there is a burgeoning perception that prolonged military engagements may presage an increase in prevalence over the next decade (Hoge, Auchterlone, & Milliken, 2006; Schell & Marshall, 2008). Over the lifespan women report PTSD symptoms to a greater degree than men (Ditlevson & Elklit, 2010; Kessler et al., 2005) and the degree to which an individual is exposed to deleterious influences, such as highly perilous vocations, partner violence, poverty, and lack of social support may heighten the risk for PTSD (Brewin, Andrews, & Valentine, 2000; Taylor & Baker, 2007). The prevalence of this syndrome across population subgroups is worrisome given that mood disorders like PTSD are among those most frequently associated with disability (Social Security Administration, 2011) and lethality (Nepon, Belik, Bolton, & Sareen, 2010; Sabri et al., 2013).

When comparing individuals with PTSD to those without, researchers have identified a number of pervasive and detrimental trends, such as restricted peer relations (Laffaye, Cavella, Drescher, & Rosen, 2008); low academic achievement (Borofsky, Kellerman, Baucom, Oliver, & Margolin, 2013; Boyraz, Horne, Owens, & Armstrong, 2013); difficulty maintaining gainful employment (Kunst, 2011; Strauser, Lustig, Cogdal, & Uruk, 2006); hopelessness and despondency (Hammock, Cooper, & Lezak, 2012; Pinna, Johnson, & Delahanty, 2013); and risk of self-injury (Gradus et ah, 2010). Given its increasing prevalence (Hoge et ah, 2006; Schell & Marshall, 2008) and its consequences, it is prudent for counseling professionals to undertake interventions that promise better outcomes.

When working with individuals diagnosed with PTSD, counselors often target decreasing the severity of (a) recurrent and intrusive distressing memories of the traumatic event, (b) emotional avoidance, and (c) heightened physiological arousal (Makinson & Young, 2012; Marotta, 2000). Outcomes may include decreasing aggressive outbursts, hypervigilance, and sleep disturbance that appeared or increased in intensity after exposure to the traumatic event (APA, 2013; Seligman & Reichenberg, 2012). Sledjeski, Speisman, and Dierker (2008) noted that in a sample of 9,282 randomly selected individuals, those meeting the criteria for PTSD were more likely to suffer from such co-occurring medical complications as chronic pain and cardiovascular, respiratory, and neurological conditions. Individuals diagnosed with PTSD who do present with these medical conditions tend to use medical services to a greater degree and have a markedly lower life expectancy (Deacon, Lickel, & Abramowitz, 2008). As a consequence, individuals with PTSD are susceptible to co-occurring psychiatric conditions, notably major depressive disorder, substance abuse/ dependence, and bipolar disorder (APA, 2013; Spinazzola, Blaustein, & van de Kolk, 2005).

Among co-occurring psychiatric disorders, some mental health professionals have suggested, depression may be most prevalent--and most lethal (Gradus et ah, 2010; Hammock et ah, 2012; Palgi, Ben-Ezra, Langer, & Essar, 2009; Pinna et ah, 2013). …

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