WORKSHOP: Cognitive Processing Therapy in an Intensive Operational Stress Injury Treatment Program
Presenting Author(s): Dr. Kaitlin Chivers-Wilson, MD, FRCPC, MSc, Dr. Thomas Stark
Co-Author(s): Thomas Stark, Erin Talbot, Christina Volstad, Evelyne Felber Charbonneau
Date and time: 23 Mar 2024 from 14:50 to 15:10
Location: Hawthorn B
Learning Objectives
1. Briefly review Cognitive Processing Therapy for the treatment of Posttraumatic Stress Disorder;
2. Present preliminary results of the Operational Stress Injury Clinic's iOSI program; and
3. Examine the Feasibility and Practicality of Implementing an Intensive Outpatient CPT Program.
Literature References
1. Auren, T.J., Klæth J.R., Jensen A.G., & Solem, S. (2022) Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity, European Journal of Psychotraumatology, 13:2,
2. Held P, Klassen BJ, Boley RA, Wiltsey Stirman S, Smith DL, Brennan MB, Van Horn R, Pollack MH, Karnik NS, Zalta AK. (2020) Feasibility of a 3-week intensive treatment program for service members and veterans with PTSD. Psychol Trauma. 12(4):422-430.
3. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613
4. Lambert, M. J., Gregersen, A. T., & Burlingame, G. M. (2004). The Outcome Questionnaire-45
5. Morin, C. M. (1993). Insomnia severity index.https://doi.org/10.1037/t07115-000
6. Ragsdale, K. A., Watkins, L. E., Sherrill, A. M., Zwiebach, L., & Rothbaum, B. O. (2020). Advances in PTSD treatment delivery: Evidence base and future directions for intensive outpatient programs. Current Treatment Options in Psychiatry, 7(3), 291-300.
7. Sherrill, A. M., Maples-Keller, J. L., Yasinski, C. W., Loucks, L. A., Rothbaum, B. O., & Rauch, S. A. M. (2020). Perceived benefits and drawbacks of massed prolonged exposure: A qualitative thematic analysis of reactions from treatment completers. Psychological Trauma: Theory, Research, Practice, and Policy, 14(5), 862–870.
8. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 166(10), 1092-1097
9. Thoresen, I. H., Brynhildsvoll Auren, T. J., Rendum Klæth, J., Gjerde Jensen, A., Engesæth, C., & Langvik, E. O. (2022). Intensive outpatient treatment for PTSD: A thematic analysis of patient experience. European Journal of Psychotraumatology, 13(1)
10. Wagner, S. L., White, N., Fyfe, T., Matthews, L. R., Randall, C., Regehr, C., ... & Fleischmann, M. H. (2020). Systematic review of posttraumatic stress disorder in police officers following routine work‐related critical incident exposure. American Journal of Industrial Medicine, 63(7), 600-615.
11. Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258
12. Weinstein, H. R., Roberge, E. M., & Parker, S. C. (2022). Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans. Cognitive and Behavioral Practice.
13. Wilson, S., Guliani, H., & Boichev, G. (2016). On the economics of post-traumatic stress disorder among first responders in Canada. Journal of Community Safety and Well-Being, 1(2), 26-31
14. Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B., & Litz, B. T. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological assessment, 28(11), 1392
Abstract
Cognitive Processing Therapy (CPT) is an evidenced based therapy that modifies, and challenges individuals’ unhelpful beliefs related to trauma. Intensive evidence-based treatments have resulted in accelerated symptom improvement and increased treatment access and retention. The Operational Stress Injury (OSI) Clinic is piloting an intensive outpatient CPT program for current and former members of the Royal Canadian Mounted Police and Canadian Armed Forces diagnosed with PTSD.
Methods:
Inclusion criteria for the program include PTSD as a primary treatment target, no significant psychiatric comorbidities requiring separate treatment focus, no acute risk, and the patient’s interest and ability to engage. Outcomes will be tracked with the outcome questionnaire (OQ-45), patient health questionnaire (PHQ-9), post-traumatic check-list-DSM5 (PCL-5), generalized anxiety disorder questionnaire (GAD-7), and the insomnia severity index (ISI) pre-treatment, mid-treatment, post-treatment and at 3, 6, 9, 12 months post-treatment.
Results: This program is provided over an 8-week period. At the time of the abstract submission, 18 clients completed the program, and consented to research. All scores decreased over the duration of the program. Specifically, PCL-5 from 37 to 21; OQ-45 from 81 to 54; ISI from 21 to 8; GAD-7 from 10 to 7; and PHQ-9 from 9 to 5. Further, all available follow-up scores remain lower than initial scores.
Conclusion:
This initiative holds promise in validating the efficacy of intensive outpatient PTSD treatment within this population, contributing to the knowledge base on effective intensive PTSD programs.