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Comparative effectiveness of evidence-based psychotherapies for PTSD delivered in VA residential PTSD treatment

Published online by Cambridge University Press:  27 March 2023

Lauren M. Sippel Open the ORCID record for Lauren M. Sippel [Opens in a new window] ,
Georgina M. Gross Open the ORCID record for Georgina M. Gross [Opens in a new window] ,
Tobias R. Spiller ,
Or Duek ,
Noelle Smith ,
Rani Hoff  and
Ilan Harpaz-Rotem
Lauren M. Sippel*
Affiliation:
Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA National Center for PTSD, Evaluation Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
Georgina M. Gross
Affiliation:
Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA National Center for PTSD, Evaluation Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
Tobias R. Spiller
Affiliation:
Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
Or Duek
Affiliation:
Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
Noelle Smith
Affiliation:
Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
Rani Hoff
Affiliation:
Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA National Center for PTSD, Evaluation Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
Ilan Harpaz-Rotem
Affiliation:
Northeast Program Evaluation Center, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA National Center for PTSD, Evaluation Division, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA Department of Psychiatry, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA Department of Psychology and the Wu Tsai Institute, Yale University, New Haven, CT 06510, USA
*
Author for correspondence: Lauren M. Sippel, E-mail: lauren.m.sippel@dartmouth.edu
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Abstract

Background

Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are first-line treatments for posttraumatic stress disorder (PTSD). There have been few direct comparisons of CPT and PE intended to determine their comparative effectiveness, none of which have examined outcomes among military veterans receiving these treatments in a residential setting such as the Department of Veterans Affairs (VA) residential rehabilitation treatment programs (RRTPs). Such work is essential given that these veterans are among the most complex and severely symptomatic patients with PTSD treated in VA. In this study we compared changes in PTSD and depressive symptoms across admission, discharge, four months and 12 months following discharge among veterans who received CPT or PE within VA RRTPs.

Methods

Using linear mixed models conducted on program evaluation data derived from the electronic medical record and follow-up surveys, we compared self-reported PTSD and depressive symptom outcomes among 1130 veterans with PTSD who were treated with individual CPT (n = 832, 73.5%) or PE (n = 297, 26.5%) in VA PTSD RRTPs in fiscal years 2018–2020.

Results

PTSD and depressive symptom severity did not significantly differ at any time points. The CPT and PE groups both showed large-sized reductions in PTSD (CPT d = 1.41, PE d = 1.51) and depression (CPT d = 1.01, PE d = 1.09) from baseline to 12-month follow-up.

Conclusions

Outcomes for PE and CPT do not differ among a highly complex population of veterans with severe PTSD and several comorbid conditions that can make it difficult to engage in treatment.

Keywords

Cognitive processing therapyempirically-supported treatmentposttraumatic stress disorderprolonged exposuretreatment outcomeveteran
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 14 , October 2023 , pp. 6859 - 6866
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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Footnotes

*

Equal contribution as first author.

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