title: Effect of Group vs Individual Cognitive Processing Therapy in Active-Duty Military Seeking Treatment for Posttraumatic Stress Disorder: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Cognitive processing therapy (CPT), an evidence-based treatment for posttraumatic stress disorder (PTSD), has not been tested as an individual treatment among active-duty military. Group CPT may be an efficient way to deliver treatment.
  
  
  OBJECTIVE
  To determine the effects of CPT on PTSD and co-occurring symptoms and whether they differ when administered in an individual or a group format.
  
  
  METHODS
  In this randomized clinical trial, 268 active-duty servicemembers consented to assessment at an army medical center from March 8, 2012, to September 23, 2014, and were randomized to group or individual CPT. Inclusion criteria were PTSD after military deployment and stable medication therapy. Exclusion criteria consisted of suicidal or homicidal intent or psychosis. Data collection was completed on June 15, 2015. Analysis was based on intention to treat.
  
  
  METHODS
  Participants received CPT (the version excluding written accounts) in 90-minute group sessions of 8 to 10 participants (15 cohorts total; 133 participants) or 60-minute individual sessions (135 participants) twice weekly for 6 weeks. The 12 group and individual sessions were conducted concurrently.
  
  
  METHODS
  Primary measures were scores on the Posttraumatic Symptom Scale-Interview Version (PSS-I) and the stressor-specific Posttraumatic Stress Disorder Checklist (PCL-S); secondary measures were scores on the Beck Depression Inventory-II (BDI-II) and the Beck Scale for Suicidal Ideation (BSSI). Assessments were completed by independent evaluators masked to treatment condition at baseline and 2 weeks and 6 months after treatment.
  
  
  RESULTS
  Among the 268 participants (244 men [91.0%]; 24 women [9.0%]; mean [SD] age, 33.2 [7.4] years), improvement in PTSD severity at posttreatment was greater when CPT was administered individually compared with the group format (mean [SE] difference on the PSS-I, -3.7 [1.4]; Cohen d = 0.6; P = .006). Significant improvements were maintained with the individual (mean [SE] PSS-I, -7.8 [1.0]; Cohen d = 1.3; mean [SE] PCL-S, -12.6 [1.4]; Cohen d = 1.2) and group (mean [SE] PSS-I, -4.0 [0.97]; Cohen d = 0.7; mean [SE] PCL-S, -6.3 [1.4]; Cohen d = 0.6) formats, with no differences in remission or severity of PTSD at the 6-month follow-up. Symptoms of depression and suicidal ideation did not differ significantly between formats.
  
  
  CONCLUSIONS
  Individual treatment resulted in greater improvement in PTSD severity than group treatment. Depression and suicidal ideation improved equally with both formats. However, even among those receiving individual CPT, approximately 50% still had PTSD and clinically significant symptoms. In the military population, improving existing treatments such as CPT or developing new treatments is needed.
  
  
  BACKGROUND
  clinicaltrials.gov identifier: NCT02173561.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Resick
authors.affiliation: National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, Massachusetts3Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Jennifer Schuster
authors.initials: JS
authors.lastname: Wachen
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio5Office of Research and Development, South Texas Veterans Health Care System, San Antonio.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Dondanville
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio5Office of Research and Development, South Texas Veterans Health Care System, San Antonio.
authors.forename: Kristi E
authors.initials: KE
authors.lastname: Pruiksma
authors.affiliation: Department of Behavioral Health, Headquarters, Carl R. Darnall Army Medical Center, Ft Hood, Texas.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Yarvis
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio5Office of Research and Development, South Texas Veterans Health Care System, San Antonio7Department of Psychology, The University of Texas at San Antonio.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Peterson
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio5Office of Research and Development, South Texas Veterans Health Care System, San Antonio8Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio.
authors.forename: Jim
authors.initials: J
authors.lastname: Mintz
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio9currently with the School of Social Work at University of Texas, Austin.
authors.forename: Elisa V
authors.initials: EV
authors.lastname: Borah
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Brundige
authors.affiliation: Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hembree
authors.affiliation: Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts11Massachusetts Veterans Epidemiological Research and Information Center, Veterans Affairs Boston Healthcare System, Boston12Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Litz
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: John D
authors.initials: JD
authors.lastname: Roache
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio.
authors.forename: Stacey
authors.initials: S
authors.lastname: Young-McCaughan
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003130:Combat Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011615:Psychotherapy, Group / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*