title: The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.
abstract: OBJECTIVE
  To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program.
  
  
  METHODS
  Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome.
  
  
  RESULTS
  Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p < .001, b = 6.25, 95% CI [3.06, 9.44], and other measures. In addition, significantly more patients treated with CPT were classified as "recovered" or "improved" at discharge, χ2(1, N = 197) = 4.93, p = .032.
  
  
  CONCLUSIONS
  There is still room for improvement, as substantial numbers of veterans continue to experience significant symptoms even after treatment with CPT in a residential program. However, CPT appears to produce significantly more symptom improvement than treatment conducted before the implementation of CPT. The implementation of this empirically supported treatment in VHA settings is both feasible and sustainable and is likely to improve care for male veterans with military-related PTSD.
authors: Department of Veterans Affairs Palo Alto Health Care System, Menlo Park, CA 94025, USA. jennifer.alvarez@va.gov
authors: Jennifer
authors: J
authors: Alvarez
authors: Caitlin
authors: C
authors: McLean
authors: Alex H S
authors: AH
authors: Harris
authors: Craig S
authors: CS
authors: Rosen
authors: Josef I
authors: JI
authors: Ruzek
authors: Rachel
authors: R
authors: Kimerling
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods; D012114:Residential Treatment; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D000078329:Workforce