More Is Not Always Better: 2 Weeks of Intensive Cognitive Processing Therapy-Based Treatment Are Noninferior to 3 Weeks

Objective: Although there is mounting evidence that massed treatment for PTSD is both feasible and effective, many questions remain about the optimal length of intensive treatment programs (ITPs), as well as the role of adjunctive services, such as psychoeducation, mindfulness, and yoga. Our setting...

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Bibliographic Details
Published in:Psychological trauma 2023-01, Vol.15 (1), p.100-109
Main Authors: Held, Philip, Smith, Dale L., Pridgen, Sarah, Coleman, Jennifer A., Klassen, Brian J.
Format: Article
Language:English
Subjects:
Adjunctive Treatment
Bayes Theorem
Cognitions
Cognitive Behavioral Therapy - methods
Cognitive Processes
Cognitive Processing Therapy
Female
Human
Humans
Major Depression
Male
Mindfulness
Posttraumatic Stress Disorder
Satisfaction
Stress Disorders, Post-Traumatic - psychology
Stress Disorders, Post-Traumatic - therapy
Treatment Duration
Treatment Outcome
Veterans - psychology
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Summary:Objective: Although there is mounting evidence that massed treatment for PTSD is both feasible and effective, many questions remain about the optimal length of intensive treatment programs (ITPs), as well as the role of adjunctive services, such as psychoeducation, mindfulness, and yoga. Our setting recently transitioned from a three-week ITP to a two-week program. Adjunctive services were reduced, but the amount of individual CPT between programs remained similar. The present study examined the effectiveness of a two-week ITP based on twice daily individual CPT sessions and evaluated the program's noninferiority to an established three-week ITP using a Bayesian analytical approach. Method: Bayesian linear mixed regression models were used to explore PTSD and depression changes over time, as well as predictors of change. Noninferiority of the two-week ITP to a three-week ITP was also established using a Bayes factor approach. Results: Results indicate that program participants change meaningfully in both PTSD and depression severity over the course of treatment, and that changes in posttraumatic cognitions predict subsequent changes in these outcomes. Further, the two-week ITP can be considered noninferior to the three-week ITP in both clinical outcomes and overall satisfaction. Conclusions: In the context of intensive PTSD treatment, the content of the ITP appears to matter more than its overall length. Shorter programs have the potential to increase access and treatment capacity. Our findings demonstrate the importance of continuous and rigorous program evaluation. Limitations as well as future directions for research, such as identifying the most effective treatment components, are discussed. Clinical Impact Statement The present study compared 2 intensive treatment programs for veterans with posttraumatic stress disorder (PTSD). The 2- and 3-week-long programs were based on daily Cognitive Processing Therapy (CPT) as well as adjunctive services. The two-week program had fewer overall service hours but offered a comparable amount of CPT. Both programs produced large and equivalent PTSD and depression severity reductions. The findings suggest that the more/longer treatment is not necessarily better and that content of the intensive PTSD treatment programs appears to matter more than its overall length. Shorter PTSD treatment programs have the potential to increase access and capacity.
ISSN:1942-9681
1942-969X
DOI:10.1037/tra0001257