Document text
Principal Investigator: Rebecca Kaufman Sripada
Organization: VETERANS HEALTH ADMINISTRATION
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: One third of post-9/11 Veterans in VHA suffer from posttraumatic stress disorder (PTSD), and
among those who initiate Cognitive Processing Therapy (CPT), up to 70% drop out before receiving an
adequate dose of treatment. Unfortunately, Veterans who drop out prematurely may never receive the most
effective components of CPT. Thus, there is an urgent need to use empirical approaches to identify the most
effective components of CPT, so that CPT can be adapted into a briefer format. The long-term goal of this line
of research is to adapt, test, and implement brief, evidence-based treatment for Veterans with PTSD. The
overall objective of the current application is to adapt CPT into a brief, effective format. The rationale is that
identifying the most effective intervention components and delivering only those components will make CPT
deliverable in a shorter timeframe, thus improving efficiency, reducing drop-out related to poor treatment
response, and ensuring that Veterans receive the most beneficial components of treatment, which will
significantly improve their quality of life.
Significance/Impact: Upon completion of this project, we expect to have produced an empirically-based, brief
version of CPT. This contribution is likely to improve clinical practice for Veterans with PTSD by providing the
most effective components at an earlier session, thus increasing the overall effectiveness of treatment and
mitigating the negative consequences of untreated PTSD, such as lost productivity, substance use, later-life
physical disability, reduced quality of life, and increased risk of suicide.
Innovation: The status quo for PTSD treatment is lengthy psychotherapy in a specialty mental health setting,
which is rarely delivered in its entirety. The proposed research is innovative because it will use a novel
engineering-inspired framework, the multiphase optimization strategy (MOST), to adapt this effective
psychotherapy into a brief format. Developing a brief, empirically-based version of CPT will open new horizons
for PTSD treatment by expanding CPT access to treatment settings where lengthier treatments are not
feasible. It will also provide effective options for Veterans who desire a briefer treatment course.
Specific Aims: Specific Aim 1: Using a highly efficient experimental design, identify which of five CPT
components contribute meaningfully to reduction in PTSD symptoms. We will test the effectiveness of each
component and each two-way interaction between components. Specific Aim 2: Identify mediators of
component effectiveness. We hypothesize that effects will be mediated by engagement/adherence and change
in posttraumatic cognitions. Exploratory Aim 1: Identify moderators of component effectiveness.
Methodology: The MOST is an innovative engineering-inspired framework that uses an optimization trial to
assess the performance of individual intervention components within a multicomponent intervention such as
CPT. Guided by the MOST framework, the goal of the proposed project is to empirically inform an abbreviated
version of CPT via a highly efficient fractional factorial design. Veterans (N = 270) at two VAMCs with clinically
significant PTSD symptoms who meet minimal inclusion/exclusion criteria will be randomized to receive one or
more CPT components. This design will test the effectiveness of each component and each two-way
interaction between components, as measured by PTSD symptom reduction on the Clinician-administered
PTSD scale for DSM-5 (CAPS-5) across six months of follow-up.
Implementation/Next Steps: Upon completion of these aims, our expected outcome is an adapted,
abbreviated version of CPT that consists of the most effective elements of the intervention. The adapted
intervention will be primed for a future large scale, fully powered effectiveness trial. The adapted intervention
can be easily disseminated through the VA CPT training program and will have a positive impact on the health
and wellbeing of Veterans with PTSD.
Terms: <Abbreviations><Access to Care><Active Follow-up><Address><Adherence><Age><Characteristics><Cognition><Cognitive><DSM-5><DSM-V><DSM5><Diagnostic and Statistical Manual of Mental Disorders, 5th edition><Diagnostic and Statistical Manual of Mental Disorders-V><Distress><Dose><Dropout><Drops><Effectiveness><Elements><Engineering><Ensure><Evidence based treatment><Exclusion Criteria><Experimental Designs><Future><Goals><Health><Health Priorities><Health Services Accessibility><Individual><Institute of Medicine><Institute of Medicine (U.S.)><Intervention><Intervention Strategies><Logistics><Measures><Mediating><Mediator><Mental Health><Mental Hygiene><Methodology><Methods><NAS/IOM><Outcome><PTSD><Participant><Patient Preferences><Performance><Personal Satisfaction><Persons><Post-Traumatic Neuroses><Post-Traumatic Stress Disorders><Posttraumatic Neuroses><Process><Productivity><Provider><Psychological Health><Psychotherapy><QOL><Quality of life><Randomized><Research><Research Priority><Service delivery model><Service model><Severities><Specialty><Symptoms><System><Testing><Therapeutic><Time><Training Programs><Trauma><Treatment Effectiveness><Veterans><Work><access to health services><access to services><access to treatment><accessibility to health services><active followup><ages><alleviate symptom><ameliorating symptom><availability of services><care access><care delivery model><clinical practice><clinical significance><clinically significant><decrease symptom><design><designing><effective intervention><effectiveness testing><effectiveness trial><evidence base><experience><experiment><experimental research><experimental study><experiments><fewer symptoms><follow up><follow-up><followed up><followup><health care delivery model><health service access><health services availability><healthcare delivery model><implementation science><improved><improved outcome><innovate><innovation><innovative><interventional strategy><late life><medical specialties><multi-component intervention><multi-faceted intervention><multi-modal intervention><multicomponent intervention><multifaceted intervention><multimodal intervention><multiphase optimization strategy><novel><personalization of treatment><personalized health intervention><personalized intervention><personalized medicine><personalized therapy><personalized treatment><physical disability><physically disabled><physically handicapped><post 9/11><post-trauma stress disorder><posttrauma stress disorder><precision interventions><premature><prematurity><randomisation><randomization><randomly assigned><reduce symptoms><relieves symptoms><response to therapy><response to treatment><service availability><sex><substance use><substance using><suicidal risk><suicide risk><symptom alleviation><symptom reduction><symptom relief><telehealth><theories><therapeutic response><therapy response><traumatic neurosis><treatment access><treatment response><treatment responsiveness><uptake><well-being><wellbeing>