Examination of Cognitive Processing Therapy Outcomes in Veterans with Posttraumatic Stress Disorder, with or without Chronic Pain and with or without Pharmacological Treatment for Pain

Abstract

Posttraumatic stress disorder (PTSD) and chronic pain are two of the most prevalent conditions affecting the veteran population, with approximately 20% of veterans holding a PTSD diagnosis (Fisher, 2014) and roughly 55% suffering from a chronic pain condition (National Institute of Health, 2015). It is estimated that over 60% of veterans with PTSD also hold a chronic pain diagnosis (Asmundson, 2014). Scholars have theorized about the unique relationships between PTSD and chronic pain, including a mutual maintenance model (Sharp & Harvey, 2001) and a shared vulnerability model (Asmundson et al., 2002). Given this rising comorbid prevalence and associated theoretical foundation, the present study aimed to examine treatment outcomes of cognitive processing therapy (CPT), in Veterans with PTSD, with or without chronic pain, and with or without pharmacological treatment for pain, in the reduction of both PTSD and depression symptoms, utilizing the Posttraumatic Stress Disorder Checklist (PCL) and Beck Depression Inventory, Second Edition (BDI-II). A retrospective chart review resulted in a sample of 94 veterans across three distinct cohorts; Cohort 1: veterans with a chronic pain condition and pharmacological treatment for pain, Cohort 2: veterans with a chronic pain condition and no pharmacological treatment or any other identified treatment for pain, and Cohort 3: veterans without a chronic pain condition. A MANOVA was conducted using the sample’s pre-treatment and post-treatment PCL and BDI-II scores to examine the symptom reduction across and among the three cohorts. Significant differences were observed between pre-treatment and post-treatment measures of both the PCL and BDI-II, across all cohorts. Significance in between-group differences on PCL score change across CPT was not significant, however demonstrated marginal significance. Between-cohort differences on BDI-II score changes were significant through the MANOVA analysis, however the post-hoc cohort mean comparison failed to reach significance. The study discusses the significance of results in the context of existing literature as well as future directions for research.