Of all the interviews, the Clinician‐Administered PTSD Scale (CAPS‐1) appears to satisfy these standards most uniformly. The CAPS‐1 is a structured interview for assessing core and associated symptoms of PTSD.

Cognitive Processing Therapy (CPT) is a flexible cognitive therapy protocol based on the theory that people don’t recover from traumatic events because they draw faulty conclusions about the causes and meaning of the events. This results in them being “stuck” with their PTSD symptoms. CPT can be used individually or in groups, with or without written accounts. Although the typical protocol is 12 sessions, preferably implemented twice a week for 6 weeks, there is an outcome-based variable length protocol that was developed by Galovski et al. (2012) that is now being tested with active military personnel. Through this variable length CPT the majority of civilian participants completed treatment in an average of 9 sessions, though a minority needed up to 18 sessions to achieve a good end state. After an education session, clients are asked to write a statement about why they think the traumatic event (starting with the worst PTSD event) happened and what it means about themselves and the world, especially with regard to safety, trust, power/control, esteem and intimacy.

The product of the impact statement is developed into a “Stuck Point” log which is used throughout the therapy to teach clients the difference between facts and thoughts, and what emotions are related to their thoughts. Using a progressive series of worksheets, clients are taught, through Socratic questioning, how to examine their thoughts and assumptions and develop more balanced fact-based thinking. The goal is for the client to learn a new way of thinking about events in general, and to become their own therapist. Cognitive Processing Therapy was first developed with rape victims (Resick et al.

2002; 2012) and then tested with female victims of any type of interpersonal trauma (Resick et al. Not surprisingly, the content of the resulting stuck points were often self-focused (e.g., “what did I do to deserve this?”; “I can’t trust my own decisions”), because in “rape culture” the victim is often blamed for the event.

Although there have been many changes in laws and in the availability of services, more progress in this regard is still needed. By 2006, the first study with Veterans (predominantly Vietnam Veterans) was published (Monson et al.

2006), and with each step the question of whether the CPT protocol should be changed for the new population arose. Chard (2005) did expand the protocol to include an additional number of sessions, a group, and individual therapy for survivors of child sexual assault. We learned that there were no differences between patients with or without child sexual or physical abuse with the 12 session protocol overall (Resick, Suvak & Wells, 2014). Frequency but not severity or duration of sexual abuse predicted drop-out, but not outcomes. In examining the CPT dismantling study, it was found that the version without the written accounts worked best.

Lester et al. (2010) examined drop-out and outcomes across female Caucasian and African-American clients across the Resick et al. (2002 and 2008) studies and found that while African-American clients were more likely to drop-out of treatment, they did equally well in the intent-to-treat analyses and improved more than Caucasians who dropped out of treatment. The authors speculated that cultural messages against receiving therapy may have motivated them to achieve as much as possible in the shortest time possible.

Military Culture As the VA began disseminating CPT across the country, it added information about military culture to its training. As we began conducting CPT research with active military members we found that the military culture was even stronger than anticipated, because they were still living within it and were implicitly or explicitly being taught ‘rules’ that may work in a combat setting but may not prove viable at home or once discharged. The CPT protocol didn’t change, but the content of assumptions and stuck points often varied because of the difference in some of the traumas (e.g., seeing people killed or killing), the expectations that mental health treatment signifies defeat, and ongoing expectations about war. Blogging.