Effectiveness and Comparative Effectiveness of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in Clinical P

Course overview

Course Description: This course is based on material published in Psychological Medicine and is available as an open-access article. While evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) is a first-line treatment, its real-world effectiveness is unknown. We compared cognitive processing therapy (CPT) and prolonged exposure (PE) each to an individual psychotherapy comparator group and CPT to PE in a large national healthcare system. We utilized effectiveness and comparative effectiveness emulated trials using retrospective cohort data from electronic medical records. Participants were veterans with PTSD initiating mental healthcare (N equals 265 566). The primary outcome was PTSD symptoms measured by the PTSD Checklist (PCL) at baseline and 24-week follow-up. Emulated trials were comprised of person-trials, representing 112 discrete 24-week periods of care (10/07-6/17) for each patient. Treatment group comparisons were made with generalized linear models, utilizing propensity score matching and inverse probability weights to account for confounding, selection, and non-adherence bias. There were 636 CPT person-trials matched to 636 non-EBP person-trials. Completing 8 CPT sessions was associated with a 6.4-point greater improvement on the PCL (95 percent CI 3.1-10.0). There were 272 PE person-trials matched to 272 non-EBP person-trials. Completing 8 PE sessions was associated with a 9.7-point greater improvement on the PCL (95 percent CI 5.4-13.8). There were 232 PE person trials matched to 232 CPT person trials. Those completing 8 PE sessions had slightly greater, but not statistically significant, improvement on the PCL (8.3 points; 95 percent CI 5.9-10.6) than those completing 8 CPT sessions (7.0-points; 95 percent CI 5.5-8.5). PTSD symptom improvement was similar and modest for both EBPs. Although EBPs are helpful, research to further improve PTSD care is critical. This course on evidence-based psychotherapies as a treatment for posttraumatic stress disorder is designed for social workers, professional counselors, psychologists, nurses, and substance abuse counselors who do clinical work. In addition, this course is appropriate for intermediate and advanced-level practitioners who wish to develop their knowledge of evidence-based psychotherapies as a treatment for post-traumatic stress disorder. The course material includes a literature review of interventions and research. It may also be useful for licensed clinicians who require continuing clinical education courses for license renewal. The course is based on a journal article that includes research. It contains statistical analysis and data that some clinicians enjoy reading, and others do not. A significant benefit of reading research-based articles for continuing education is they provide practitioners with the latest findings in their field. Authors: Maguen, Madden, Holder, Li, Seal, Neylan, Lujan, Patterson, DuVall, Shiner Learning Objectives: This course will provide the practitioner with detailed information regarding evidence-based psychotherapies as a treatment for posttraumatic stress disorder. Specifically, a professional will: Identify characteristics of prolonged exposure and cognitive processing therapy. Recognize differences in prolonged exposure and cognitive processing therapy in treating posttraumatic stress disorder. Describe implications for the use of prolonged exposure and cognitive processing therapy in treating psychiatric disorders. Citation: Maguen, S., Madden, E., Holder, N., Li, Y., Seal, K. H., Neylan, T. C., Lujan, C., Patterson, O. V., DuVall, S. L., & Shiner, B. (2023). Effectiveness and comparative effectiveness of evidence-based psychotherapies for posttraumatic stress disorder in clinical practice. Psychological medicine, 53(2), 419-428. https://doi.org/10.1017/S0033291721001628