Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial

To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Participants with current PTSD/AUD (N = 101; mean a...

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Vydané v:	PloS one Ročník 17; číslo 11; s. e0276111
Hlavní autori:	Simpson, Tracy L., Kaysen, Debra L., Fleming, Charles B., Rhew, Isaac C., Jaffe, Anna E., Desai, Sruti, Hien, Denise A., Berliner, Lucy, Donovan, Dennis, Resick, Patricia A.
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 29.11.2022 Public Library of Science (PLoS)
Predmet:	Abstinence Addictions Addictive behaviors Adult Alcohol use Alcoholism Alcoholism - complications Alcoholism - epidemiology Alcoholism - therapy Avoidance behavior Biology and Life Sciences Care and treatment Clinical trials Cognitive ability Cognitive Behavioral Therapy Cognitive therapy Comorbidity Comparative analysis Consent Drinking Drinking behavior Drug abuse Drug use Female Humans Information processing Intervention Male Medicine and Health Sciences Mental disorders Mental health Post traumatic stress disorder Posttraumatic stress disorder Prevention Psychological stress Randomization Research and Analysis Methods Secondary Prevention Sex crimes Social Sciences Stress Disorders, Post-Traumatic - complications Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - therapy Substance abuse treatment Suicides & suicide attempts United States
ISSN:	1932-6203, 1932-6203
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Abstract	To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. The trial is registered at clinicaltrials.gov (NCT01663337).
AbstractList	To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. The trial is registered at clinicaltrials.gov (NCT01663337). Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Method Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. Results At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity ( b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Conclusion Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. Trial registration The trial is registered at clinicaltrials.gov (NCT01663337). Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. Method Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. Results At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. Conclusion Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. Trial registration The trial is registered at clinicaltrials.gov (NCT01663337). To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD.OBJECTIVETo compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD.Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days.METHODParticipants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days.At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days.RESULTSAt post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days.Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care.CONCLUSIONTreatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care.The trial is registered at clinicaltrials.gov (NCT01663337).TRIAL REGISTRATIONThe trial is registered at clinicaltrials.gov (NCT01663337).
Audience	Academic
Author	Fleming, Charles B. Hien, Denise A. Kaysen, Debra L. Berliner, Lucy Donovan, Dennis Resick, Patricia A. Jaffe, Anna E. Rhew, Isaac C. Desai, Sruti Simpson, Tracy L.
AuthorAffiliation	2 Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America 4 Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America 8 Alcohol and Drug Abuse Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America 1 Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care, Seattle, WA, United States of America 5 Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States of America PhD, PLOS, UNITED KINGDOM 6 Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Center of Alcohol & Substance Use Studies, Piscataway, NJ, United States of America 9 Department of Psychiatry and Behavioral Sciences, Duke
AuthorAffiliation_xml	– name: 1 Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care, Seattle, WA, United States of America – name: 5 Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States of America – name: 7 Harborview Center for Sexual Assault and Traumatic Stress, University of Washington, Seattle, WA, United States of America – name: 2 Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America – name: 9 Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, NC, United States of America – name: 8 Alcohol and Drug Abuse Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America – name: 6 Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Center of Alcohol & Substance Use Studies, Piscataway, NJ, United States of America – name: 4 Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America – name: PhD, PLOS, UNITED KINGDOM – name: 3 Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
Author_xml	– sequence: 1 givenname: Tracy L. surname: Simpson fullname: Simpson, Tracy L. – sequence: 2 givenname: Debra L. orcidid: 0000-0001-7961-2787 surname: Kaysen fullname: Kaysen, Debra L. – sequence: 3 givenname: Charles B. surname: Fleming fullname: Fleming, Charles B. – sequence: 4 givenname: Isaac C. surname: Rhew fullname: Rhew, Isaac C. – sequence: 5 givenname: Anna E. orcidid: 0000-0001-8679-7564 surname: Jaffe fullname: Jaffe, Anna E. – sequence: 6 givenname: Sruti surname: Desai fullname: Desai, Sruti – sequence: 7 givenname: Denise A. orcidid: 0000-0002-6954-2882 surname: Hien fullname: Hien, Denise A. – sequence: 8 givenname: Lucy surname: Berliner fullname: Berliner, Lucy – sequence: 9 givenname: Dennis orcidid: 0000-0003-2237-4292 surname: Donovan fullname: Donovan, Dennis – sequence: 10 givenname: Patricia A. surname: Resick fullname: Resick, Patricia A.
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/36445895$$D View this record in MEDLINE/PubMed
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CitedBy_id	crossref_primary_10_1007_s40429_023_00533_z crossref_primary_10_1002_jts_23183 crossref_primary_10_1007_s10461_025_04777_w crossref_primary_10_2196_49557 crossref_primary_10_1016_j_janxdis_2025_102976 crossref_primary_10_1080_13284207_2024_2347643 crossref_primary_10_1007_s10508_025_03123_4 crossref_primary_10_1002_jts_23049 crossref_primary_10_1016_j_beth_2024_04_003 crossref_primary_10_1111_ajad_13557 crossref_primary_10_1016_j_cct_2024_107670 crossref_primary_10_1016_j_brat_2025_104847
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Notes	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Feature-3 ObjectType-Evidence Based Healthcare-1 ObjectType-Undefined-1 content type line 23 TLS and DLK are Joint First authors to this work. Competing Interests: Dr. Kaysen is a co-author of a book on Cognitive Processing Therapy published by Elsevier for which she receives royalties. In addition she has conducted clinical workshops on Cognitive Processing Therapy for which she has received speakers fees, which could constitute a conflict of interest. Dr. Resick is a co-author on the Cognitive Processing Therapy treatment manual for which she receives royalties and she conducts clinical workshops on Cognitive Processing Therapy for which she receives speakers’ fees, which could constitute a conflict of interest. The other co-authors have no conflicts of interest to declare pertinent to this submission. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
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Snippet	To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention;... Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse... Objective To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse...
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SubjectTerms	Abstinence Addictions Addictive behaviors Adult Alcohol use Alcoholism Alcoholism - complications Alcoholism - epidemiology Alcoholism - therapy Avoidance behavior Biology and Life Sciences Care and treatment Clinical trials Cognitive ability Cognitive Behavioral Therapy Cognitive therapy Comorbidity Comparative analysis Consent Drinking Drinking behavior Drug abuse Drug use Female Humans Information processing Intervention Male Medicine and Health Sciences Mental disorders Mental health Post traumatic stress disorder Posttraumatic stress disorder Prevention Psychological stress Randomization Research and Analysis Methods Secondary Prevention Sex crimes Social Sciences Stress Disorders, Post-Traumatic - complications Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - therapy Substance abuse treatment Suicides & suicide attempts
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Title	Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial
URI	https://www.ncbi.nlm.nih.gov/pubmed/36445895 https://www.proquest.com/docview/2741301310 https://www.proquest.com/docview/2742658007 https://pubmed.ncbi.nlm.nih.gov/PMC9707793 https://doaj.org/article/249f97cd586546b5a7b0762824d2df5c http://dx.doi.org/10.1371/journal.pone.0276111
Volume	17
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