Cognitive Processing Therapy + Memory Support for PTSD

Overseen By Joseph Carpenter, PhD MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston University

Disqualifiers: Unstable bipolar, Psychosis, Severe SUD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 3

Duration: 12 weeks

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve therapy for PTSD (posttraumatic stress disorder) by testing whether adding Memory Support (MS) to Cognitive Processing Therapy (CPT) enhances patients' ability to remember therapy content. The study will compare the standard CPT approach, which helps individuals process trauma-related thoughts, with CPT plus additional memory aids. Participants will be adults diagnosed with PTSD who are either veterans or on a stable dose of psychiatric medication. The goal is to determine if those receiving the memory-enhanced therapy show greater improvements in their PTSD symptoms. As an unphased trial, this study allows participants to contribute to innovative PTSD treatment research.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it requires that any psychiatric medication dose be stable for the past four weeks before participating.

What prior data suggests that integrating Memory Support into Cognitive Processing Therapy is safe for PTSD treatment?

Research has shown that Cognitive Processing Therapy (CPT) is a well-accepted treatment for PTSD. Studies have found it to be safe and effective for individuals with PTSD, including military personnel and veterans. These studies have reported no major safety issues.

Cognitive Processing Therapy with Memory Support (CPT+MS) builds on the CPT approach. Although specific safety data for CPT+MS is not yet available, it incorporates techniques already used safely in therapy for depression. This suggests that CPT+MS will likely be well-tolerated, as it combines these safe practices. However, this trial will provide more detailed information about its safety and effectiveness in treating PTSD. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Cognitive Processing Therapy combined with Memory Support (CPT + MS) for PTSD because it builds on existing therapy methods to improve treatment outcomes. Unlike standard treatments like traditional CPT or prolonged exposure therapy, CPT + MS uniquely incorporates strategies to enhance memory and learning. These memory support strategies are specifically designed to help patients retain and apply crucial therapeutic insights and skills, potentially leading to more effective and lasting relief from PTSD symptoms. This innovative approach could mark a significant advancement in how PTSD is treated, offering new hope for patients seeking better recovery results.

What evidence suggests that this trial's treatments could be effective for PTSD?

Research has shown that Cognitive Processing Therapy (CPT), a treatment in this trial, effectively reduces PTSD symptoms. Studies also indicate that CPT helps with related issues like depression and thoughts of self-harm by changing unhelpful beliefs about trauma.

Another treatment arm in this trial combines CPT with Memory Support (CPT+MS). Early studies suggest that this combination may enhance memory of important therapy components, potentially improving recovery. While more research is needed, this approach might increase CPT's effectiveness in treating PTSD. ^{1 2 5 6 7}

Who Is on the Research Team?

Joseph Carpenter, PhD MA

Principal Investigator

VA Boston Healthcare System, BUSM Psychiatry Dept.

Are You a Good Fit for This Trial?

Adults with PTSD can join this study. They must have a stable dose of psychiatric meds for the last month if they're taking any, and veterans are specifically welcomed. People with unstable bipolar disorder, psychosis, severe substance abuse, or past severe brain injury cannot participate. Also excluded are those with high verbal memory skills or significant cognitive impairment.

Inclusion Criteria

Veteran status

My psychiatric medication dose has been the same for the last month.

I have been diagnosed with PTSD by a professional.

Exclusion Criteria

Current DSM-5 diagnoses of unstable bipolar disorder, past or present psychosis, or organic mental disorder

Significant cognitive impairment as indicated by a score <10th percentile on the Montreal Cognitive Assessment

History of moderate or severe traumatic brain injury (TBI) based on the Ohio State University TBI Identification Method and Veterans Administration/ Department of Defense (VA/DOD) guidelines

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Cognitive Processing Therapy (CPT) with or without Memory Support (MS) for PTSD

12 weeks

Weekly therapy sessions

Mid-treatment

Assessment of memory of therapy content and client satisfaction

6 weeks

1 assessment visit

Post-treatment

Evaluation of changes in PTSD symptoms, depression, and cognitive functioning

12 weeks

1 assessment visit

Follow-up

Participants are monitored for long-term changes in PTSD symptoms and memory of therapy content

6 months

1 follow-up visit

What Are the Treatments Tested in This Trial?

Interventions

• Cognitive Processing Therapy (CPT)
• Memory Support (MS)

Trial Overview The trial is testing whether adding Memory Support (MS) to Cognitive Processing Therapy (CPT) helps people remember therapy content better than CPT alone. It's a small-scale test involving 52 adults to see if it's feasible and acceptable to combine these treatments for PTSD.

How Is the Trial Designed?

Group I: Cognitive Processing Therapy + Memory Support (CPT + MS) Experimental Treatment 2 Interventions

CPT + MS will involve the same treatment strategies as CPT while incorporating deliberate and frequent use of memory and learning support strategies. MS strategies are designed to enhance the memory of specific treatment points, defined as any insight, skill or strategy determined to be important for the patient to remember and/or implement. MS is not designed to enhance memory functioning generally, but rather improve the encoding, consolidation and retrieval of specific components of therapeutic learning.

Group II: Cognitive Processing Therapy (CPT) Active Control 1 Intervention

CPT is a manualized, trauma-focused therapy for PTSD. Treatment consists of psychoeducation on the cognitive model of PTSD, identification of trauma-related stuck points (i.e. dysfunctional beliefs), and cognitive challenging techniques to help participants identify more realistic and adaptive ways of viewing their trauma, themselves, and the world.

Cognitive Processing Therapy (CPT) is already approved in United States, European Union for the following indications:

Approved in United States as Cognitive Processing Therapy for:

• Posttraumatic Stress Disorder (PTSD)

Approved in European Union as Cognitive Processing Therapy for:

• Posttraumatic Stress Disorder (PTSD)

Who Is Running the Clinical Trial?

Boston University

Lead Sponsor

Trials

494

Recruited

9,998,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

VA Boston Healthcare System

Collaborator

Trials

73

Recruited

971,000+

Published Research Related to This Trial

In a study of 268 active-duty servicemembers, individual cognitive processing therapy (CPT) was found to be more effective than group CPT in reducing PTSD severity, with significant improvements noted immediately after treatment.

Both individual and group formats of CPT led to reductions in depression and suicidal ideation, but about 50% of participants still experienced PTSD symptoms after treatment, highlighting the need for improved or new therapeutic options in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Group vs Individual Cognitive Processing Therapy in Active-Duty Military Seeking Treatment for Posttraumatic Stress Disorder: A Randomized Clinical Trial. Resick, PA., Wachen, JS., Dondanville, KA., et al.[2022]

This study aims to evaluate the efficacy of Cognitive Processing Therapy (CPT) for treating PTSD in Japanese patients through a 16-week trial involving 58 participants, comparing CPT combined with usual treatment against usual treatment alone.

The primary outcome will be measured using the Clinician-Administered PTSD Scale, with an expected effect size of 1.4, indicating that CPT may significantly improve PTSD symptoms in this population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study protocol for a randomised controlled trial of cognitive processing therapy for post-traumatic stress disorder among Japanese patients: the Safety, Power, Intimacy, Esteem, Trust (SPINET) study. Ito, M., Horikoshi, M., Resick, PA., et al.[2019]

Cognitive Processing Therapy (CPT) is an effective evidence-based treatment for PTSD, particularly for individuals who have experienced combat, assault, or interpersonal violence, as supported by randomized controlled trials.

The Department of Veterans Affairs has successfully implemented CPT across its healthcare system, with trained clinicians showing good adoption of the therapy and significant improvements in patients' PTSD and depressive symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dissemination and experience with cognitive processing therapy. Chard, KM., Ricksecker, EG., Healy, ET., et al.[2022]

The CPTPTSD study will investigate how cognitive functioning affects the response to Cognitive Processing Therapy (CPT) in 105 veterans with PTSD, focusing on memory and cognitive abilities before treatment begins.

By identifying the relationship between cognitive deficits and treatment outcomes, this research aims to develop more personalized and effective PTSD therapies, potentially improving the efficacy of existing psychotherapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neurocognitive Predictors of Treatment Outcomes in Cognitive Processing Therapy for Post-traumatic Stress Disorder: Study Protocol. Cenkner, DP., Asnaani, A., DiChiara, C., et al.[2022]

Cognitive Processing Therapy (CPT) significantly improved PTSD and depression symptoms in 19 sexual assault survivors after 12 weekly group sessions, with benefits maintained for 6 months post-treatment.

In contrast, a comparison group of 20 individuals who waited for therapy showed no improvement, highlighting the efficacy of CPT in treating PTSD symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive processing therapy for sexual assault victims. Resick, PA., Schnicke, MK.[2022]

A 12-week course of modified Cognitive Processing Therapy (CPT-C) effectively improved PTSD symptoms and reduced alcohol dependence in a combat veteran, showing promise for treating co-occurring conditions.

The veteran maintained significant improvements in both PTSD and alcohol-related issues 12 weeks after completing the treatment, suggesting the long-term efficacy of this enhanced therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case report on the use of cognitive processing therapy-cognitive, enhanced to address heavy alcohol use. McCarthy, E., Petrakis, I.[2022]

Cognitive processing therapy (CPT) is an effective treatment for PTSD in veterans, but many do not complete the full program, often receiving only four sessions instead of the full 12, highlighting the need for a more efficient treatment format.

A study involving 270 veterans used a fractional factorial design to identify the most effective components of CPT, aiming to create a shorter version that could reduce dropout rates and improve treatment accessibility for PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using the multiphase optimization strategy to adapt cognitive processing therapy (CPT MOST): study protocol for a randomized controlled factorial experiment. Sripada, RK., Peterson, CL., Dziak, JJ., et al.[2023]

In a study of 107 adults with PTSD undergoing 12 sessions of cognitive processing therapy (CPT), feelings of detachment and being upset by trauma reminders were identified as central symptoms at the start of treatment, indicating their significance in the PTSD symptom network.

By midtreatment, these symptoms became less central, suggesting that CPT effectively reduces their impact, while strong negative emotions emerged as key symptoms at the end of treatment, highlighting their role in influencing overall PTSD symptom improvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Examination of PTSD symptom networks over the course of cognitive processing therapy. Graziano, RC., LoSavio, ST., White, MA., et al.[2023]

Cognitive Processing Therapy (CPT) effectively reduced PTSD symptoms in a study of 18 patients, with 15 participants showing statistically significant improvements in their symptom scores.

The study highlights the successful adaptation of the CPT protocol to address specific barriers faced by trauma survivors, demonstrating its potential for broader implementation in similar treatment settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive processing therapy for posttraumatic stress disorder in a residential treatment setting. Zappert, LN., Westrup, D.[2019]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39908018/

Cognitive Processing Therapy for Posttraumatic Stress ... In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in ...

2. ptsd.va.gov ptsd.va.gov/professional/treat/txessentials/cpt_for_ptsd_pro.asp

Cognitive Processing Therapy for PTSD To date, CPT has been shown to improve common comorbid symptoms and clinical correlates of PTSD such as depression (12,33), suicidal ideation (34), health- ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S2589979124000027

Effectiveness of Cognitive Processing Therapy for PTSD in ... Results: The results demonstrated statistically significant changes in PTSD and depression symptoms and improvement in end-state functioning. Conclusion: ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2829857

Cognitive Processing Therapy for Posttraumatic Stress ... In this randomized clinical trial of CPT-TAU vs WL-TAU, CPT was superior in reducing PTSD symptoms. These results strengthen the evidence for use of CPT in ...

5. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/30332919/

A meta-analytic review of cognitive processing therapy for ... These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3336190/

Long-Term Outcomes of Cognitive–Behavioral Treatments ... CPT and PE resulted in lasting changes in PTSD and related symptoms over an extended period of time for female rape victims with extensive histories of trauma.

7. clinicaltrials.gov clinicaltrials.gov/study/NCT04230668

NCT04230668 | Cognitive Processing Therapy (CPT) for ... A pilot effectiveness trial of cognitive processing therapy augmented with suicide risk management for individuals with comorbid PTSD and BPD conditions.