Summary description: Cognitive Processing Therapy (CPT) is a 12-session intervention for adolescents or adults proven to improve symptoms of PTSD and related conditions (depression, anxiety, substance use, suicidal ideation) and to improve functioning. CPT is intended for individuals exposed to traumatic events suffering from PTSD. CPT can be delivered remotely and at scale. CPT has been successfully delivered by non-specialists in low and middle income countries and by specialists in high income countries.

**Access to the intervention manual: ** Main manual is published by Guilford; Other manuals can be requested via this site https://cptforptsd.com/cpt-resources/

Access to training: Access to the LMIC adapted manuals only available after training or just prior to training.

Intended users/ Implementers: Trained and supervised non-specialist provider

Therapeutic strategies: CPT provides psychoeducation and training in cognitive restructuring. CPT works to reduce trauma-related avoidance and to teach the client to identify thoughts and emotions and how to question their own beliefs to generate more adaptive and accurate ones. CPT addresses beliefs about the traumatic event and themes affected by trauma (safety, trust, power/control, esteem, intimacy).

Intervention format: CPT can be delivered in group, individual, or a combined format. In individual CPT people are seen for 12 sessions, at least once a week. CPT can be delivered up to daily. Individual CPT sessions are 50 minutes long with independent practice of strategies between sessions. Group CPT sessions are 90-120 minutes delivered at least once a week, with independent practice of strategies between sessions. Both individual and group CPT have been tested via face-to-face and via video teleconference.

Target population: Adolescents or Adults exposed to traumatic events with mild to severe post-traumatic stress disorder.

Significant effects found on symptoms of: Improvements in PTSD, Depression, Anxiety, Traumatic grief, Alcohol use, Illicit drug use, Hopelessness, Suicidal ideation, Guilt, moral injury, Anger, Health concerns, cardiovascular functioning, Eating disorders, Dissociation, Occupational function/economic status, Social/leisure involvement, Intimacy/Sexual concerns.

Key innovative or differentiating features of this intervention: CPT has demonstrated good cultural adaptability and consistent large to medium effect sizes on PTSD and depression. Outside of the U.S., CPT trials have been conducted in Canada, Australia, Japan, Germany, the Democratic Republic of Congo, Northern Iraq, Southern Iraq, Egypt, and Tanzania. It has been tested outside of specialty care in primary care settings, and new research has tested it delivered via asynchronous texting. Two long-term follow-up studies have been conducted with CPT, one in the US and one in the Democratic Republic of Congo, that have demonstrated long-term (5+ years) maintenance of treatment gains.

Summary of Evidence: The literature on CPT is quite extensive, and the treatment is recommended as a first-line treatment for individuals with PTSD across several treatment guidelines. There are 40+ published randomized controlled trials (RCTs) of CPT. Exclusion criteria are not extensive, with individuals being excluded from trials for active suicidal intent, active psychosis or mania, and recent medication changes. Inclusion criteria are PTSD (or subthreshold PTSD in some studies).

Different populations where the intervention has been used: Results from both RCTs and effectiveness studies have demonstrated that CPT works well across a wide range of populations, including community samples, veterans, and service members in outpatient and residential settings, and when delivered in-person, in-home, and via telehealth, CPT has been effective across trauma types, such as interpersonal violence, gender-based violence, torture, childhood abuse and combat, including when traumas are perceived as moral injuries, and when patients have experienced multiple and repeated lifetime traumas.

Restrictions or requirements for its use: CPT is intended for individuals who have experrienced a traumatic event and who are experiencing mild-severe symptoms and functional impairment. CPT is not intended as a universal program. CPT is not suitable for people at imminent risk of suicide (e.g. people with a plan to end their life in the near future), or with active psychotic symptoms or mania. Supervisors and trainers are ideally mental health professionals who are competent and experienced in delivering psychological interventions and who are trained in, and deliver CPT.

Requirements / qualifications for trainers and supervisors: Supervisors are ideally mental health professionals who are competent and experienced in delivering psychological interventions, and who have learned to deliver CPT with fidelity. Training and consultation are standardized across North America and in other high-resource settings, comprising a 2-day workshop (with an option of an additional day for group CPT training) followed by 6 months of consultation with at least two training cases.

Information provided by Debra Kaysen on 4 October 2024.