In a significant advancement for PTSD treatment beyond military contexts, researchers have demonstrated the superior efficacy of cognitive processing therapy (CPT) in treating post-traumatic stress disorder among Japanese civilians. The findings, published in JAMA Network Open, represent a crucial expansion of evidence-based PTSD treatments in non-military populations.
The single-center randomized clinical trial, conducted at a national psychiatric referral hospital in Tokyo, enrolled 60 participants with diagnosed PTSD, predominantly women (90%), with a mean age of 36.9 years. The study spanned from April 2016 through December 2022, comparing cognitive processing therapy combined with treatment as usual (CPT-TAU) against a waiting list with treatment as usual (WL-TAU).
Clinical Outcomes and Efficacy Measures
The research team, led by Masaya Ito, PhD, from the National Center for Cognitive Behavioral Therapy and Research, observed substantial improvements in the CPT-TAU group. Mean CAPS-5 scores decreased from 35.97 at baseline to 22.36 at 17 weeks in the CPT-TAU group, while the control group's scores remained virtually unchanged (37.81 to 38.23).
Treatment response rates further validated CPT's effectiveness, with eight out of 29 individuals in the CPT-TAU group showing significant improvement compared to only two out of 31 in the control group at the 17-week mark.
Comprehensive Mental Health Benefits
The study revealed broader positive impacts beyond PTSD symptoms. Participants receiving CPT showed meaningful improvements across multiple psychiatric measures:
- Depression scores improved by 8.83 points (95% CI, 6-11.66)
- Suicidal ideation decreased by 6.73 points (95% CI, 1.25-12.22)
- Disability measures improved by 8.16 points (95% CI, 3.9-12.43)
- Clinical global impression showed positive changes of 0.84 points (95% CI, 0.41-1.26)
Notably, 59.09% of CPT-TAU participants no longer met the principal PTSD diagnosis criteria by the study's end.
Safety and Implementation Implications
The safety profile of CPT proved excellent, with no serious adverse events reported in the treatment group, compared to three such events in the control group. This finding challenges the common clinical assumption that trauma-focused therapy might be more distressing for patients.
"Treatment guidelines and a systematic review have consistently reported that trauma-focused types of cognitive behavioral therapy are the first-line treatment of choice for individuals with PTSD," noted Dr. Ito and colleagues, highlighting the importance of expanding these therapeutic approaches beyond military contexts.
The study's structured approach included 12 weekly individual CPT sessions, with flexibility allowing up to 16 weeks for completion. This protocol was implemented alongside standard care, which included clinical monitoring, psychotherapy, pharmacotherapy, and counseling support, demonstrating the feasibility of integrating CPT into existing treatment frameworks.
