A recent study by Resick et al. (40) attempted to dismantle the
components of cognitive processing therapy and determine their relative
contributions to treatment efficacy. In this study, 150 adult women
with PTSD were randomized into one of three conditions: 1) full
cognitive processing therapy, which included both exposure (i.e.,
writing and reading a detailed account of the trauma) and cognitive
therapy (i.e., challenging patient assertions about the meaning
of the trauma and the implications for the patient's life);
2) cognitive therapy without the writing and reading component;
and 3) the writing and reading component without cognitive therapy.
All conditions included 2 hours of therapy per week for 6 weeks.
Patients were assessed for PTSD (using CAPS) and depression in a
blinded manner weekly, 2 weeks after the last session of therapy,
and at 6 months. At the conclusion of the study, all treatment completers
still met criteria for PTSD. However, substantial improvement was
observed in all three treatment groups on primary PTSD and depression
outcomes as well as on secondary measures of anxiety, guilt, and shame.
Cognitive therapy without exposure was associated with greater improvement
than the exposure-only condition, suggesting that the cognitive
component of this therapy (i.e., altering the meaning of the traumatic
event) may be an active treatment mechanism that may occur without
repeated and explicitly evoked fear memories. It also suggests that
cognitive processing therapy might be characterized as a more cognitive
than exposure-based therapy. Similar dismantling studies are under
way and will be important to further clarify the active components
of various psychotherapies for PTSD. Research questions include
how cognitive components as compared with exposure components may
be variably effective depending on factors such as the stage of
the disorder (e.g., early compared with late), the presence of particular symptoms
(e.g., dissociation, high levels of arousal, avoidance), and, of
course, therapist variables.