Posttraumatic stress disorder and service utilisation outcomes following delivery of Cognitive Processing Therapy in a community mental health setting

ABSTRACT

Objective

The effectiveness of Cognitive Processing Therapy (CPT) for posttraumatic stress disorder (PTSD) in Australian community mental health settings is understudied as is its impact on other mental health service utilisation.

Method

Adults (N = 155) with PTSD were seen at a large public health service. PTSD severity was measured at pretreatment, during treatment, and at posttreatment. Additional mental health outcomes and therapeutic processes were indexed (e.g., depression and therapeutic alliance) as was mental health service utilisation by participants in the 12-months prior to and 12-months after receiving CPT.

Results

Significant improvements across all symptom measures and large effect sizes for PTSD outcomes were observed (Cohen’s d = 1.03–1.66). Analysis of the whole sample (intent-to-treat) demonstrated 46.4% of the sample fell below the probable-PTSD cut-off, and 34.1% achieved remission. On average, participants’ use of mental health services (e.g., inpatient hospitalisations and outpatient services) halved in the 12 months following CPT relative to the same period prior to treatment. No significant adverse outcomes were reported.

Conclusion

CPT is a safe and effective therapy for PTSD which can be delivered in a routine public mental health setting. Further research should be undertaken to formally establish health cost savings from delivering CPT in the Australian health care system.

KEY POINTS

What is already known about this topic:

(1) Clients with PTSD or complex PTSD frequently present to community mental health settings.

(2) Organisational and clinician factors can reduce the likelihood of clients receiving effective trauma treatment.

(3) Cognitive Processing Therapy (CPT) is an evidence-based psychological therapy with substantial empirical support although most of this is derived in non-Australian contexts.

What this topic adds:

(1) The results replicate international findings that CPT is a safe, effective therapy for PTSD in community mental health settings.

(2) CPT can be effectively delivered in routine mental health settings with appropriate organisational support and clinician training.

(3) Although qualified by the use of an open trial design, the findings showed clients reduced use of mental health services by approximately half following CPT relative to pre-CPT usage.

KEYWORDS:

• PTSD
• Cognitive Processing Therapy
• routine care
• health service utilisation
• cost

Acknowledgment

The authors wish to acknowledge the contributions of the clinicians who delivered therapy, Dr Samantha Angelakis who provided ongoing CPT supervision during the training phase of the project, Dr Lisa Hardman for comments on an earlier draft of the manuscript, and the clients who courageously engaged in their trauma work.

This study was supported by the Mental Health Program at Monash Health.

Disclosure statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: R.D.V.N. conducts clinical workshops for treating PTSD, including Cognitive Processing Therapy and receives royalties from a book on Cognitive Processing Therapy.

Data availability statement

The data that support the findings of this study are available from the corresponding authors upon reasonable request.

Notes

1. Actual ITT sample analysed = 155 (see Figure 1 for details).

2. There were no statistical differences on pretreatment or posttreatment PCL scores between those who did or did not attend the one-month follow-up session (ps > .20).