Cognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID-19 Pandemic

John C Moring, Katherine A Dondanville, Brooke A Fina, Christina Hassija, Kathleen Chard, Candice Monson, Stefanie T LoSavio, Stephanie Y Wells, Leslie A Morland, Debra Kaysen, Tara E Galovski, Patricia A Resick, John C Moring, Katherine A Dondanville, Brooke A Fina, Christina Hassija, Kathleen Chard, Candice Monson, Stefanie T LoSavio, Stephanie Y Wells, Leslie A Morland, Debra Kaysen, Tara E Galovski, Patricia A Resick

Abstract

The global outbreak of COVID-19 has required mental health providers to rapidly rethink and adapt how they provide care. Cognitive processing therapy (CPT) is a trauma-focused, evidence-based treatment for posttraumatic stress disorder that is effective when delivered in-person or via telehealth. Given current limitations on the provision of in-person mental health treatment during the COVID-19 pandemic, this article presents guidelines and treatment considerations when implementing CPT via telehealth. Based on lessons learned from prior studies and clinical delivery of CPT via telehealth, recommendations are made with regard to overall strategies for adapting CPT to a telehealth format, including how to conduct routine assessments and ensure treatment fidelity.

© 2020 International Society for Traumatic Stress Studies.

References

    1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
    1. American Psychological Association (2020, April 9). Telepsychiatry and COVID‐19: Update on Telehealth Restrictions in Response to COVID‐19 .
    1. Bovin, M. J. , Marx, B. P. , Weathers, F. W. , Gallagher, M. W. , Rodriguez, P. , Schnurr, P. P. , & Keane, T. M. (2016). Psychometric properties of the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (PCL‐5) in veterans. Psychological Assessment, 28, 1379–1391. 10.1037/pas0000254
    1. Brown, F. W. (2017). Telepsychiatry and health technologies: A guide for mental health professionals. The American Journal of Psychiatry, 174, 1126–1126. 10.1176/appi.ajp.2017.17040418
    1. Bryan, C. J. , Clemans, T. A. , Hernandez, A. M. , Mintz, J. , Peterson, A. L. , Yarvis, J. S. , Resick, P. A. , & the STRONG STAR Consortium . (2016). Evaluating potential iatrogenic suicide risk in trauma‐focused group cognitive behavioral therapy for the treatment of PTSD in active duty military personnel. Depression and Anxiety, 33, 549–557. 10.1002/da.22456
    1. Center for Disease Control and Prevention (2020, April 8). Coronavirus (COVID‐19) .
    1. Chard, K.M. (2005). An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 965–971. 10.1037/0022-006X.73.5.966
    1. Chew, N. W. , Lee, G. K. , Tan, B. Y. , Jing, M. , Goh, Y. , Ngiam, N. J. , Yeo, L. L. , Ahmad, A. , Khan, F. A. , Shanmugam, G. N. , & Sharma, A. K. (2020). A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID‐19 outbreak. Brain, Behavior, and Immunity. Advance online publication. 10.1016/j.bbi.2020.04.049
    1. Cuijpers, P. , Noma, H. , Karyotaki, E. , Cipriani, A. , & Furukawa, T. A. (2019). Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: A network meta‐analysis. JAMA Psychiatry, 76, 700–707. 10.1001/jamapsychiatry.2019.0268
    1. Fortney J. C., Heagerty, P. J. , Bauer, A. M. , Cerimele, J. M. , Kaysen, D. , Pfeiffer, P. N. , Zielinski, M. J. , Pyne, J. M. , Bowen, D. , Russo, J. , & Ferro, L. (2020). Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics. Contemporary Clinical Trials, 90, 105873. 10.1016/j.cct.2019.10587
    1. Galovski, T. E. , Blain, L. , Mott, J. , Elwood, L. , & Houle, T. (2012). Manualized therapy for PTSD: Flexing the structure of cognitive processing therapy. Journal of Consulting and Clinical Psychology, 80, 968–981. 10.1037/a0030600
    1. Greene‐Shortridge, T. M. , Britt, T. W. , & Castro, C. A. (2007). The stigma of mental health problems in the military. Military Medicine, 172, 157–161. 10.7205/MILMED.172.2.157
    1. Gros, D. F. , Lancaster, C. L. , López, C. M. , & Acierno, R. (2018). Treatment satisfaction of home‐based telehealth versus in‐person delivery of prolonged exposure for combat‐related PTSD in veterans. Journal of Telemedicine and Telecare, 24, 51–55. 10.1177/1357633X16671096
    1. Hassija, C. M. , & Gray, M. J. (2011). The effectiveness and feasibility of videoconferencing technology to provide evidence‐based treatment to rural domestic violence and sexual assault populations. Telemedicine and e‐Health, 17, 309–315. 10.1089/tmj.2010.0147
    1. U.S. Department of Health and Human Services (2020). Notification of enforcement discretion for telehealth remote communications during the COVID‐19 nationwide public health emergency .
    1. Hoge, C. W. , Grossman, S. H. , Auchterlonie, J. L. , Riviere, L. A. , Milliken, C. S. , & Wilk, J. E. (2014). PTSD treatment for soldiers after combat deployment: Low utilization of mental health care and reasons for dropout. Psychiatric Services, 65, 997–1004. 10.1176/appi.ps.201300307
    1. Kazdin, A. E. , & Blasé, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37. 10.1177/1745691610393527
    1. Kroenke, K. , Spitzer, R.L. , & Williams, J. B. (2001). The PHQ‐9: Validity of a brief depression severity measure. Journal of Internal Medicine, 16, 606–613. 10.1046/j.1525-1497.2001.016009606.x
    1. Maieritsch, K. P. , Smith, T. L. , Hessinger, J. D. , Ahearn, E. P. , Eickhoff, J. C. , & Zhao, Q. (2016). Randomized controlled equivalence trial comparing videoconference and in person delivery of cognitive processing therapy for PTSD. Journal of Telemedicine and Telecare, 22, 238–243. 10.1177/1357633X15596109
    1. McGeary, D. D. , McGeary, C. A. , & Gatchel, R. J. (2012). A comprehensive review of telehealth for pain management: Where we are and the way ahead. Pain Practice, 12, 570–577. 10.1111/j.1533-2500.2012.00534.x
    1. Monson, C. M. , Schnurr, P. P. , Resick, P. A. , Friedman, M. J. , Young‐Xu, Y. , & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military‐related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907. 10.1037/0022-006X.74.5.898
    1. Morland, L. A. , Mackintosh, M. A. , Greene, C. J. , Rosen, C. , Chard, K. , Resick, P. , & Frueh B. C. (2014). Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: A randomized noninferiority clinical trial. Journal of Clinical Psychiatry, 75, 470–476. 10.4088/JCP.13m08842
    1. Morland, L. A. , Mackintosh, M. , Rosen, C. S. , Willis, E. , Resick, P. , Chard, K. , & Frueh, B. C. (2015). Telemedicine vs. in‐person delivery of cognitive processing therapy for women with posttraumatic stress disorder: A randomized non‐inferiority trial. Depression and Anxiety, 32, 811–820. 10.1002/da.22397
    1. Peterson, A. L. , Mintz, J. , Moring, J. C. , Nabity, P. S. , Bira, L. M. , McCaughan‐Young, S. , Hale, W. J. , McGeary, C. A. , Litz, B. T. , McGeary, D. D. , Velligan, D. I. , Macdonald, A. , Mata‐Galan, E. , Holliday, S. L. , Dillon, K. H. , Roache, J. D. , & Resick, P. A. , for the STRONG STAR Consortium . (2019, October). In‐office, in‐home, and telebehavioral health cognitive processing therapy for combat‐related PTSD: Preliminary results of a randomized clinical trial. Paper presented at the San Antonio Combat PTSD Conference, San Antonio, TX.
    1. Prins, A. , Bovin, M. J. , Kimerling, R. , Kaloupek, D. G. , Marx, B. P. , Pless Kaiser, A. , & Schnurr, P. P. (2015). Primary Care PTSD Screen for DSM‐5 (PC‐PTSD‐5) . [Measurement instrument].
    1. Resick, P. A. , Galovski, T. E. , Uhlmansiek, M. O. , Scher, C. D. , Clum, G. A. , & Young‐Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243–258. 10.1037/0022-006X.76.2.243
    1. Resick, P. A. , Monson, C. M. , & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. New York, NY: Guilford Press.
    1. Resick, P. A. , Wachen, J. S. , Dondanville, K. A. , Pruiksma, K. E. , Yarvis, J. S. , Peterson, A. L. , & Mintz, J. , for the STRONG STAR Consortium . (2017). Effect of group vs. individual cognitive processing therapy in active‐duty military seeking treatment for posttraumatic stress disorder: A randomized clinical trial. JAMA Psychiatry, 74, 28–36. 10.1001/jamapsychiatry.2016.2729
    1. Rosner, R. , Rimane, E. , Frick, U. , Gutermann, J. , Hagl, M. , Renneberg, B. , Schreiber, F. , Vogel, A. , & Steil, R. (2019). Effect of developmentally adapted cognitive processing therapy for youth with symptoms of posttraumatic stress disorder after childhood sexual and physical abuse: A randomized clinical trial. JAMA Psychiatry, 75, 484–491. 10.1001/jamapsychiatry.2018.4349
    1. Richardson, L. K. , Frueh, B. C. , Grubaugh, A. L. , Egede, L. , & Elhai, J. D. (2009). Current directions in videoconferencing tele‐mental health research. Clinical Psychology Science and Practice, 16, 323–338. 10.1111/j.1468-2850.2009.01170.x
    1. Wang, C. , Pan, R. , Wan, X. , Tan, Y. , Xu, L. , McIntyre, R. S. , Choo, F. N. , Tran, B. , Ho, R. , Sharma, V. K. , & Ho, C. (2020). A longitudinal study on the mental health of general population during the COVID‐19 epidemic in China. Brain, Behavior, and Immunity. Advance online publication. 10.1016/j.bbi.2020.04.028
    1. Weathers, F. W. , Blake, D. D. , Schnurr, P. P. , Kaloupek, D. G. , Marx, B. P. , & Keane, T. M. (2013). The Life Events Checklist for DSM‐5 (LEC‐5) . Instrument available from the National Center for PTSD at
    1. Weathers, F. W. , Litz, B. T. , Keane, T. M. , Palmieri, P. A. , Marx, B. P. , & Schnurr, P. P. (2013). The PTSD Checklist for DSM‐5 (PCL‐5). Scale available from the National Center for PTSD at

Source: PubMed

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