Cognitive Processing Therapy for Posttraumatic Stress Disorder and Co-occurring Lived Experience Stress: A Pilot Randomized Controlled Trial

About This Grant

Populations facing health disparities include groups with significantly higher rates of posttraumatic stress disorder than the general population, whose clinical presentations are complicated by lived experience stress. Lived experience stress is comprised of external stressors and internal stress processes. External stressors have been shown to produce symptoms similar to posttraumatic stress disorder and, among trauma-exposed individuals, influence posttraumatic stress disorder severity. Internalized stress processes are the theorized link between external stressors and a range of mental health disparities. Lived experience stress is not systematically targeted in trauma-focused treatment. There is therefore a critical need for integrated treatments that address symptoms resulting from both Criterion-A and commonly co-occurring external stressors by targeting the relevant intermediate processes. Cognitive Processing Therapy, a first-line treatment for posttraumatic stress disorder that targets cognitive processes, is ideally-suited for augmentation. A proposed adaptation of Cognitive Processing Therapy incorporates key treatment elements developed from the lived experience stress literature and transdiagnostic evidence-based stress interventions. The current study seeks to (a) refine the adapted therapy through expert and patient stakeholder engagement and beta testing with impacted individuals (n = 6; Aim 1); and (b) test the adapted intervention through a pilot randomized controlled trial (n = 52). In line with the goals of a pilot study and an experimental therapeutics approach, the primary objectives will be to demonstrate feasibility and acceptability of the adapted treatment (Aim 2) and engagement with novel intervention targets (i.e., internal stress processes; Aim 3a). An exploratory goal is to examine the preliminary effects of adapted Cognitive Processing Therapy vs. standard treatment on posttraumatic stress disorder severity and lived experience stress (Aim 3b) and the relations between the intervention targets and symptoms (Aim 3c). The proposed study will yield insights about optimizing posttraumatic stress disorder treatment for populations facing health disparities while providing key training opportunities for the candidate, who is a staff psychologist at Veteran Affairs Boston Healthcare System. Research and training activities will take place at Boston University Chobanian & Avedisian School of Medicine and the National Center for Posttraumatic Stress Disorder under a distinguished mentorship team: Drs. Tara Galovski, Nicholas Livingston, Sarah Valentine, and Kisha Holden. The short-term training objectives include gaining expertise in treatment adaptation for priority populations, clinical trial research, and relevant data analytic methods (quantitative, qualitative), as well as receiving mentorship to foster overall professional development. These experiences will provide them with the skills and preliminary data to a) submit an R01 proposing a fully powered trial of adapted Cognitive Processing Therapy and b) achieve their long-term goal of becoming an independent clinical researcher who adapts and develops mental health interventions to mitigate health disparities.