CPT vs PE Large Study

[DynamicDidactic]

Thought it may be of interest to the board

Prolonged Exposure vs Cognitive Processing Therapy for Posttraumatic Stress Disorder Among Veterans

This randomized clinical trial compares the effectiveness of prolonged exposure vs cognitive processing therapy for treating posttraumatic stress disorder in veterans.

jamanetwork.com

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[WisNeuro]

Interesting study. I'd love to see this study outside of the VA. Just way too many confounds with the SC system. Just look at that dropout rate. This gels with my experience of doing PE/CPT in and outside of the VA. I can only remember one non-VA pt drop out of my PTSD treatments, but in the VA, we always just assumed that we'd only get 3-5 sessions and anything after that was bonus time.

 

[Ollie123]

Very interesting. I had the same thought as WisNeuro - wondering about potential moderating effects of that comparison. Actually had limited experience treating PTSD despite my best efforts to get it so have only done CPT (and even that only a handful of cases), but my experience there was definitely that people vary tremendously in their "psychological mindedness" and the value of certain components seems to depend more heavily on that than I imagine would be the case for PE. I could also see differences as a function of the nature of the index trauma. Some experiences are inherently more "cognitive" than others. Even the broad categories (i.e. military combat, sexual violence) have tremendous within-category variation.

Is exposure itself the only active ingredient in both? I'm reminded of the behavioral activation/ vs general CBT for depression literature. In general, BA seems to be the primary driver of outcomes. The literature disagrees with me, but I'm still not convinced that is necessarily reality. There are many potential moderators we haven't explored to the degree that would satisfy me and cognitive constructs in general are tougher to measure.

Clinically, myself and virtually everyone I know who has done depression treatment has encountered patients who do better with more cognitive work than a pure BA approach. Its complicated though, because the patients who "want" a more cognitive approach are also not necessarily the ones who do better with it.

 

[cara susanna]

Thanks for sharing, we've been talking a lot about this study in the VA PTSD world. One criticism I saw is that dropout from CPT might have been early completion.

In the VA, it's pretty easy to get people to complete CPT, but I don't have many who complete PE.

 

[Shiori]

Regardless of how faithfully I try to stick with the protocol, I usually end up doing elements of both with a sprinkling of ACT.

You're supposed to feel stuff. Your brain is doing what it is supposed to do. Now go do the meaningful thing and we'll talk about all the scary stuck points that surface before and after until you get tired of showing up for therapy or until I feel like we're treading the same ground.

 

[summerbabe]

In the VA, it's pretty easy to get people to complete CPT, but I don't have many who complete PE.

The amount of people who've completed CPT and can't recall anything specific about the treatment versus people who've had as little a single post-initial PE session and can talk in depth about how horrible of an experience it was is truly impressive.

 

[PsyDr]

No SVTs in a compensation seeking setting. So base rate of ~ 40-60% of the n=916 would be expected to fail validity measures. Mean effect size for effort is what? d=1.35-1.55?

 

[Sanman]

The amount of people who've completed CPT and can't recall anything specific about the treatment versus people who've had as little a single post-initial PE session and can talk in depth about how horrible of an experience it was is truly impressive.

The real question is how many recall the exact amount of their disability check.

 

[WisNeuro]

The real question is how many recall the exact amount of their disability check.

The more important number is how much more that check will be with an extra 10%+ tacked on to the SC.