Prolonged Exposure, Cognitive Processing Therapy Achieve No Greater Results in PTSD

Military veteran comforts young soldier during a support group for soldiers.
Veterans who attended rehabilitation treatment programs reported improvement at discharge, but results did not differ whether or not they received prolonged exposure and cognitive processing therapy.

Veterans being treated for posttraumatic stress disorder (PTSD) in residential rehabilitation treatment programs (RRTPs) that adopted prolonged exposure or cognitive processing therapy for most or all of their patients did not experience more improvement than veterans treated in RRTPs with less or no adoption of either program, according to results published in Psychiatric Services.

This observational study included 171 healthcare providers, including psychologists, social workers, psychiatrists, and nurses. Providers from 39 US Department of Veterans Affairs RRTPs completed web-based surveys and telephone interviews about how much they used either prolonged exposure or cognitive processing therapy to treat veterans with PTSD during fiscal year 2015. Their responses were categorized into 3 groups: little to no adoption of either therapy, some adoption for selected patients, and high adoption. Veterans (n=3029) completed assessments of PTSD symptoms, length of stay, alcohol and drug use, and distress when they entered the program; 2447 of the veterans completed assessments at program discharge, and 784 completed them at 4 months postdischarge. The number of participants who had 2 or more observations was 2834.

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Study results showed that 8 RRTPs reported little or no adoption of prolonged exposure or cognitive processing therapy (613 veterans), 9 reported some adoption (889 veterans), and 22 reported high adoption (1527 veterans). For all programs, investigators observed improvements over time for PTSD symptoms, distress, and alcohol use. However, after discharge there were increases in PTSD symptoms, distress, and substance use.

After comparing programs with high adoption and programs with little to no adoption of the therapies, investigators did not see greater reductions in PTSD symptoms, depression symptoms, or alcohol use. There were also no significant differences between groups in substance use between admission and 4 months after discharge.

These findings suggest that residential programs are helpful for veterans, but improvements in patient outcomes may not be related to how much programs adopt evidence-based psychotherapies for PTSD.

The investigators concluded, “More carefully controlled research is needed to ensure more complete data capture outside routine clinical care and to more specifically document the treatments actually received, as well as the amount and quality of [evidence-based psychotherapy] provided.”


Cook JM, Schnurr PP, Simiola V, Thompson R, Hoff R, Harpaz-Rotem I. Adoption by VA residential programs of two evidence-based psychotherapies for PTSD: effect on patient outcomes [published online April 10, 2019]. Psychiatr Serv. doi:10.1176/