None listed
Conditions
Brief summary
This study seeks to determine the feasibility of Cognitive Processing Therapy for young people with Posttraumatic Stress Disorder (PTSD) receiving care in residential treatment for substance use disorder (SUD). Research has demonstrated symptom reduction for both disorders when treatment for PTSD and comorbid SUD is integrated (Brown, Stout, & Gannon-Rowley, 1998; Najavits, Sullivan, Schmitz, Weiss, & Lee, 2004; Roberts, Roberts, Jones, & Bisson, 2015; Watts et al., 2013). CPT is considered a ‘gold-standard’ treatment for PTSD, and has been shown to be more efficacious than other evidence-based treatments such as exposure-based interventions (Asmundson et al., 2019; Holliday, Holder, & Surís, 2018; Lenz, Bruijn, Serman, & Bailey, 2014; Roberts et al., 2015). Despite this, trials of CPT for PTSD with comorbid SUD has generally been restricted to adult and veteran samples from the U.S. (Kaysen et al., 2014; Pearson, Kaysen, Huh, & Bedard-Gilligan, 2019), which include people with a high proportion of substance misuse, but not individuals with PTSD and concurrent SUD exclusively. Residential treatment for Alcohol and Other Drug (AOD) use may provide a safe environment to deliver PTSD therapy and reduce drop-out rates, as they offer ongoing mental health and AOD recovery support which PTSD and SUD diagnosed individuals may not otherwise have access to (Pearson et al., 2019; Reif et al., 2014). However, the feasibility of integrated PTSD/SUD treatment within the residential AOD environment and the effectiveness of integrated CPT for comorbid PTSD/SUD for young people is not yet established. We plan to determine the preliminary feasibility of CPT for PTSD/SUD in the residential AOD setting through an uncontrolled feasibility trial. Our sample size goal is 50 participants. Mean differences will be examined from pre-to-post baseline and at 3 and 6 month follow-up time points. The study will allow a better understanding of the effectiveness of CPT for PTSD and as a novel intervention for SUD. The findings of this study will additionally inform the mechanisms of change in CPT, and why some individuals with PTSD/SUD (and other comorbidities) may have a better treatment response to CPT .
Interventions
Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events including child abuse, combat, rape and natural disasters (Resick et al., 2016). CPT will be delivered by a trained clinician (provisional psychologist supervised by a board-approved, endorsed clinical psychologist) on an individual, twice-weekly basis, over 6-8 weeks, with 90-minute session
Cognitive processing therapy (CPT) is a specific type of cognitive behavioral therapy that has been effective in reducing symptoms of PTSD that have developed after experiencing a variety of traumatic events including child abuse, combat, rape and natural disasters (Resick et al., 2016). CPT will be delivered by a trained clinician (provisional psychologist supervised by a board-approved, endorsed clinical psychologist) on an individual, twice-weekly basis, over 6-8 weeks, with 90-minute sessions. Sessions are delivered through both telehealth (video) and in-person delivery. Session 1 - The goals for the first session of CPT are to engage the client in treatment and provide psychoeducation on the relationship between PTSD and AOD use. The therapist also explains the rationale behind CPT: giving client’s tools to examine their thoughts and emotions, feeling the natural emotions arising from the trauma, and changing thoughts around trauma that are keeping client’s stuck (referred to as stuck points in CPT). Sessions 2-3 - Sessions 2-3 will focus on identifying stuck points that have interfered with the client’s recovery after their trauma(s), including the role of AOD use. These sessions are foundational to developing the client’s association between thoughts and feelings and the client is taught to identify and self-monitor these associations. Sessions 4- 5 - The goal for these sessions are for the client to be able to label events, thoughts, and emotions and to understand the connections among them. These sessions will also introduce categorising thoughts objectively as well as challenging the client’s individual thoughts that can be related to the trauma or AOD use behaviour. Sessions 6-7 - The first goal of sessions 6 and 7 are to teach the clients to become their own cognitive therapists. Secondly, the clients are asked to identify their patterns of problematic thinking in relation to the traumatic event(s) and AOD use. Sessions 8-10 - The primary goals of sessions 8-10 is to examine the themes of Safety, Trust, Power, and Control related to the traumatic event. In addition, the client and therapist continue to integrate any unresolved ‘stuck points’ relevant to the index trauma. The session structure over the 6-8 period is as follows: Sessions 1 and 2 - Week 1 Sessions 2 and 3 - Week 2 Sessions 4 and 5 - Week 3 Sessions 6 and 7 - Week 4 Sessions 8 and 9 - Week 5 Session 10 - Week 6 The sessions are to be delivered throughout six weeks given participants attend the twice-weekly session structure. An extension to eight weeks is provided for participants who miss sessions within the six-week time period. Treatment fidelity of the intervention will be monitored through: a) de-identified audio recordings which will be assessed at the end of treatment by independent CPT clinicians, b) session checklists for clinicians during sessions, and c) weekly supervision of clinicians by a trained, board-approved clinical supervisor specializing in the delivery of CPT.
Sponsors
The University of Queensland
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
Clients attending Lives Lived Well services with a provisional DSM-5 Diagnosis of PTSD on the PTSD Checklist (PCL-5) may be offered CPT (a score of 31+ or 26+ for sub-threshold symptoms). The PCL-5 is a measure used to assess PTSD symptomatology based on the DSM-5 criteria. This requires the client to need at least: 1 B item (questions 1-5), 1 C item (questions 6-7), 2 D items (questions 8-14), 2 E items (questions 15-20) on the PCL-5.
Exclusion criteria
Following CPT protocol recommendations (Resick et al., 2016), participants will be excluded from therapy if they meet any of the following: a) non-fluent in English b) acutely suicidal c) current diagnosis of schizophrenia, currently manic bipolar, or intellectual disability d) Experienced a trauma that had occurred before the age of three (as there is an inability to remember the trauma)
Outcome results
None listed