Comparison of Prolonged Exposure vs Cognitive Processing Therapy for Treatment of Posttraumatic Stress Disorder Among US Veterans

Autor:	Schnurr, Paula P., Chard, Kathleen M., Ruzek, Josef I., Chow, Bruce K., Resick, Patricia A., Foa, Edna B., Marx, Brian P., Friedman, Matthew J., Bovin, Michelle J., Caudle, Kristina L., Castillo, Diane, Curry, Kyle T., Hollifield, Michael, Huang, Grant D., Chee, Christine L., Astin, Millie C., Dickstein, Benjamin, Renner, Kerry, Clancy, Carolina P., Collie, Claire, Maieritsch, Kelly, Bailey, Su, Thompson, Karin, Messina, Michael, Franklin, Laurel, Lindley, Steve, Kattar, Karen, Luedtke, Brandi, Romesser, Jennifer, McQuaid, John, Sylvers, Patrick, Varkovitzky, Ruth, Davis, Lori, MacVicar, David, Shih, Mei-Chiung
Jazyk:	angličtina
Rok vydání:	2022
Předmět:	Psychiatry Adult Male Cognitive Behavioral Therapy Research Implosive Therapy Middle Aged behavioral disciplines and activities United States Stress Disorders Post-Traumatic Online Only Treatment Outcome mental disorders Humans Female Original Investigation Veterans
Zdroj:	JAMA Network Open
ISSN:	2574-3805 0192-8732
Popis:	Key Points Question How do prolonged exposure and cognitive processing therapy compare for the treatment of posttraumatic stress disorder (PTSD)? Findings In this randomized clinical trial among 916 veterans of 2 evidence-based psychotherapies for PTSD, PTSD symptoms improved in both treatment groups. Prolonged exposure was more effective than cognitive processing therapy for reducing PTSD symptoms, but the difference between treatments did not reach the predetermined threshold for clinical significance. Meaning These findings suggest that although prolonged exposure had an advantage over cognitive processing therapy for PTSD symptoms, patient preferences should be considered because both treatments resulted in meaningful improvements and did not differ in their effects on other outcomes. This randomized clinical trial compares the effectiveness of prolonged exposure vs cognitive processing therapy for treating posttraumatic stress disorder in veterans. Importance Posttraumatic stress disorder (PTSD) is a prevalent and serious mental health problem. Although there are effective psychotherapies for PTSD, there is little information about their comparative effectiveness. Objective To compare the effectiveness of prolonged exposure (PE) vs cognitive processing therapy (CPT) for treating PTSD in veterans. Design, Setting, and Participants This randomized clinical trial assessed the comparative effectiveness of PE vs CPT among veterans with military-related PTSD recruited from outpatient mental health clinics at 17 Department of Veterans Affairs medical centers across the US from October 31, 2014, to February 1, 2018, with follow-up through February 1, 2019. The primary outcome was assessed using centralized masking. Tested hypotheses were prespecified before trial initiation. Data were analyzed from October 5, 2020, to May 5, 2021. Interventions Participants were randomized to 1 of 2 individual cognitive-behavioral therapies, PE or CPT, delivered according to a flexible protocol of 10 to 14 sessions. Main Outcomes and Measures The primary outcome was change in PTSD symptom severity on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from before treatment to the mean after treatment across posttreatment and 3- and 6-month follow-ups. Secondary outcomes included other symptoms, functioning, and quality of life. Results Analyses were based on all 916 randomized participants (730 [79.7%] men and 186 [20.3%] women; mean [range] age 45.2 [21-80] years), with 455 participants randomized to PE (mean CAPS-5 score at baseline, 39.9 [95% CI, 39.1-40.7] points) and 461 participants randomized to CPT (mean CAPS-5 score at baseline, 40.3 [95% CI, 39.5-41.1] points). PTSD severity on the CAPS-5 improved substantially in both PE (standardized mean difference [SMD], 0.99 [95% CI, 0.89-1.08]) and CPT (SMD, 0.71 [95% CI, 0.61-0.80]) groups from before to after treatment. Mean improvement was greater in PE than CPT (least square mean, 2.42 [95% CI, 0.53-4.31]; P = .01), but the difference was not clinically significant (SMD, 0.17). Results for self-reported PTSD symptoms were comparable with CAPS-5 findings. The PE group had higher odds of response (odds ratio [OR], 1.32 [95% CI, 1.00-1.65]; P
Databáze:	OpenAIRE
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