None listed
Conditions
Brief summary
Cognitive Processing Therapy (CPT) is a first-line psychological treatment for posttraumatic stress disorder (PTSD). The original, standard form of CPT consisted of 12 one-hour sessions, typically delivered once or twice per week. Research shows that variants in its delivery (e.g., guided self-help, massed or intensive therapy over 1-2 weeks, or longer duration) can also be efficacious. Research in psychotherapy shows that when clients have choice over therapy options, this can improve adherence and possibly engagement. In an uncontrolled design, the project will test the outcomes of CPT when clients are given the choice of a range of formats of CPT, including self-help, guided self-help (i.e., with clinician support), abbreviated CPT (less than 12 sessions), and standard and flexible length CPT. Primary outcomes are PTSD and depression symptoms, and treatment adherence. The project uses a pretreatment, posttreatment, and 3-month follow-up design.
Interventions
Cognitive Processing Therapy (CPT) will be offered in four different formats. 1) self-help, 2) guided self-help, 3) abbreviated CPT protocol, 4) standard CPT protocol. Australian and international guidelines consistently have listed Cognitive Processing Therapy (CPT) as a recommended, manualised treatment for PTSD. CPT typically consists of 12 sessions that focus on examining the unhelpful cognitions surrounding a traumatic event (i.e., “stuck points”). The modules each focus on a different topi
Cognitive Processing Therapy (CPT) will be offered in four different formats. 1) self-help, 2) guided self-help, 3) abbreviated CPT protocol, 4) standard CPT protocol. Australian and international guidelines consistently have listed Cognitive Processing Therapy (CPT) as a recommended, manualised treatment for PTSD. CPT typically consists of 12 sessions that focus on examining the unhelpful cognitions surrounding a traumatic event (i.e., “stuck points”). The modules each focus on a different topic (e.g., education about PTSD, the link between events, thoughts and emotions) and teach clients to examine their unhelpful thoughts and beliefs through a range of worksheets. CPT can be used in a range of different formats (e.g., standard, telehealth, face-to-face, online modules, self-help book). The present study is a pragmatic open trial in which clients can choose between four formats of Cognitive Processing Therapy. All four formats cover the same content (as described above), it is just delivered with varied therapist input and varied duration. Namely, (1) self-help CPT, (2) guided self-help CPT, (3) CPT over 8 sessions [CPT-8], and (4) CPT over 12 sessions [CPT-12]. In format (1), self-help, you receive a self-help manual that guides you through weekly exercises to complete it and you will complete a brief weekly questionnaire to check your progress. It is anticipated it will take approximately 12- weeks to complete and has minimal therapist input. In format (2), guided self-help, you will be given weekly 60-minute modules (pdf workbooks) and practise exercises to complete. You will receive weekly feedback from your therapist via email on your progress and exercises. Format (3) and (4) consist of weekly 60 minutes sessions either face-to-face or via telehealth. As a part of the current study, in consultation with your therapist, you can choose during therapy to move to another format (e.g., to move from guided self-help to CPT-8, or move from CPT-12 down to CPT-8). There might also be occasions where the therapist will discuss moving into another format if you are not noticing improvements. Clients are eligible for a maximum of 18 sessions across CPT formats, which would take approximately 18 weeks post enrolment. Participants will be screened to ensure eligibility, and once enrolled, will complete assessments at baseline, 2 weeks post treatment and at 3 months post-treatment, as well as brief measures weekly. Session attendance checklists and homework completion will be logged per client throughout treatment. Therapists involved are either registered psychologists or currently undertaking clinical psychology training. All therapists will have training in the CPT protocol and receive weekly supervision from the chief investigator (clinical psychologist).
Sponsors
Flinders University College of Education, Psychology and Social Work
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
All participants must be over 18 years of age and have been directly or indirectly exposed (through witnessing) to a traumatic event (e.g. assault, motor vehicle accident, homicide etc.) four or more weeks prior to inclusion in the study and have met criteria for PTSD (full or subthreshold).
Exclusion criteria
Exclusion criteria includes individuals with moderate to severe traumatic brain injury, individuals with unmanaged psychosis or current substance dependence, those with a significant risk of harm (e.g. in a current domestic violence situation) or those with active suicidality. Exclusion criteria are on the basis that the nature of the therapy (cognitive behavioural techniques) requires a level of cognition and functioning that enables active participation in therapy, thus higher levels of traumatic brain injury are excluded. Unmanaged substance abuse or psychosis are also exclusions for treatment, given the nature of the therapy and the need for these issues to be managed either concurrently or before treatment occurs. The rationale for the exclusion of participants who are at significant risk of harm reflects that if someone is in imminent danger, or is a danger to themselves or others, then treatment of PTSD should not be the most immediate treatment goal.
Outcome results
None listed