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Individual cognitive processing therapy had better PTSD improvement

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Individual sessions of cognitive processing therapy (CPT) – a trauma-focused treatment that teaches patients more balanced thinking about traumatic events – were better at reducing the severity of posttraumatic stress disorder (PTSD) in active-duty military members, although group sessions also were effective, according to an article published online by JAMA Psychiatry.

PTSD is a serious problem among active-duty military personnel, especially those returning from combat deployment. More data are needed on the efficacy of individual and group therapy treatment for active-duty personnel.

Patricia A. Resick, Ph.D., of the Duke University Medical Center, Durham, N.C., and coauthors conducted a randomized clinical trial of 268 active-duty personnel seeking treatment for PTSD at Fort Hood, Texas, after being deployed near Iraq or Afghanistan. The participants were nearly all men (91 percent) with an average age of 33.

The participants were assigned to CPT in either 90-minute group sessions (n=133 participants) or 60-minute individual sessions (n=135 participants) twice weekly for six weeks. The 12 sessions (group and individual) were conducted concurrently. Assessment tools were used to measure PTSD severity, as well as the secondary outcomes of depression and suicidal ideation.

The authors report greater improvement in PTSD severity when participants received CPT in individual compared with group sessions, although improvements were maintained during the six-month follow-up in both groups, according to the results. Patients assigned to individual CPT had about twice as much improvement.

Depression and suicidal ideation improved equally with both forms of CPT. Still, about 50 percent of the participants, including those receiving individual CPT, still had PTSD and significant symptoms.

Possible explanations for why patients in individual CPT may have fared better include that those in group received less individual attention and those who missed group CPT sessions missed content that could not be replaced, the authors report.

Limitations to the study include patients lost to treatment because of military discontinuation.

"Cognitive processing therapy delivered in an individual format was more efficacious in treating symptoms of PTSD compared with CPT delivered in a group format. Significant reductions in PTSD were maintained during a six-month follow-up. To our knowledge, these findings are the strongest to date with regard to existing treatments for PTSD in active-duty military and veterans, but more work is required to improve outcomes," the study concludes.

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(JAMA Psychiatry. Published online November 23, 2016. doi:10.1001/ jamapsychiatry.2016.2729; available pre-embargo at the For The Media website.)

Editor's Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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