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A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder
Open accessAbstract
Numerous studies have demonstrated the efficacy of cognitive processing therapy (CPT) for treating posttraumatic stress disorder (PTSD). Two prior meta-analyses of studies are available but used approaches that limit conclusions that can be drawn regarding the impact of CPT on PTSD outcomes. The current meta-analysis reviewed outcomes of trials that tested the efficacy of CPT for PTSD in adults and evaluated potential moderators of outcomes. All published trials comparing CPT against an inactive control condition (i.e. psychological placebo or wait-list) or other active treatment for PTSD in adults were included, resulting in 11 studies with a total of 1130 participants. CPT outperformed inactive control conditions on PTSD outcome measures at posttreatment (mean Hedges' g = 1.24) and follow-up (mean Hedges' g = 0.90). The average CPT-treated participant fared better than 89% of those in inactive control conditions at posttreatment and 82% at follow-up. Results also showed that CPT outperformed inactive control conditions on non-PTSD outcome measures at posttreatment and follow-up and that CPT outperformed other active treatments at posttreatment but not at follow-up. Effect sizes of CPT on PTSD symptoms were not significantly moderated by participant age, number of treatment sessions, total sample size, length of follow-up, or group versus individual treatment; but, older studies had larger effect sizes and percent female sex moderated the effect of CPT on non-PTSD outcomes. These meta-analytic findings indicate that CPT is an effective PTSD treatment with lasting benefits across a range of outcomes.
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“Overall, meta-analyses show large effect sizes for cognitive interventions [34, 35], yet, they are rarely tested in adolescents [36].”
From Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. (2021) · cites this paper as [35]
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“Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Processing Therapy (CPT) are widely used as psychotherapeutic treatment for PTSD regardless of the traumatic event (see, Asmundson et al., 2019; Powers et al., 2010, for meta-analytic reviews).”
BackgroundKoweszko, T., de Barbaro, B., Izydorczyk, B., Mastalerz–Migas, A., Samochowiec, J., Szulc, A., Kowalska, A., Wachowska, K., & Gałecki, P. (2023) · Psychiatria Polska · doi:10.12740/pp/166172 · Cited by 7
“These efforts may allow the patient to use adaptive strategies to cope with daily life [36].”
BackgroundRimane, E., Steil, R., Renneberg, B., & Rosner, R. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01637-x · Cited by 9
Sheffler, J., Meng, Z., Sachs‐Ericsson, N., Caimary, V. G., Patel, J., & Pickett, S. M. (2024) · Journal of Aging and Health · doi:10.1177/08982643241237832 · Cited by 8
“These CBT based treatments that focus on trauma-focused meaning and involve the processing of traumatic material have been found to be ef fi cacious in older adult populations (Asmundson et al., 2019).”
Melani, M., Paiva, J. M., Mendlowicz, M. V., Vilete, L. M. P., Luz, M. P., Ventura, P. R., Passos, R. B. F., & Berger, W. L. (2024) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001769 · Cited by 7
The neuroscientific basis of post-traumatic stress disorder (PTSD): From brain to treatment
Agbaria, L., Mirzaei, F., A'amar, N. O., Raba, F. T., Papazian, G., Bhatnagar, K., Sirimanne, N., Ayoubkhan, A. A., Thilagendra, A. G., & Gupta, A. (2025) · Progress in brain research · doi:10.1016/bs.pbr.2025.01.009 · Cited by 7
The Hero’s Journey to Resilience and Thriving in the Context of Disaster
Smith, B. W. (2020) · Springer eBooks · doi:10.1007/978-3-030-32007-2_6 · Cited by 6
‘Undoing a knot’: a qualitative study of massed 1-week Cognitive Processing Therapy
Kovacevic, M., Tharaud, J. B., Montes, M., Mundle, R. S., Splaine, C. C., Silverberg, J. T., Pridgen, S., Werner, B., & Held, P. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2205126 · Cited by 6
Shi, Y., Yu, H., Miao, J., & Wang, L. (2021) · Journal of Oncology · doi:10.1155/2021/8142155 · Cited by 5
“542 Cognitive processing therapy [43] 86 79 15.”
Trauma and Posttraumatic Stress Disorder Among First Responders
Zegel, M., Leonard, S. J., Healy, N. A., & Vujanovic, A. A. (2023) · Springer eBooks · doi:10.1007/978-3-031-38149-2_21 · Cited by 7
Su, Y., & Liang, S. H. (2024) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2024.08.012 · Cited by 6
Psychological intervention with adult victims of sexual abuse: A comprehensive review
Fávero, M., Moreira, D. S., Abreu, B. M. V., Sánchez, A. D. C., Moreira, D. S., & Sousa‐Gomes, V. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2598 · Cited by 5
Thorisdottir, A. S., & Asmundson, G. J. G. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1938663 · Cited by 5
“…to simultaneous remissions in symptoms of comorbid conditions (e.g. depression), which suggests that focusing treatment on the source of the psychological difficulties leads to generalized benefits in mental health functioning (Asmundson et al., 2019; Resick et al., 2014; Van Minnen et al., 2015).”
BackgroundResultInfluentialSelf-citationPinciotti, C. M., Ponzini, G. T., Hundt, N. E., Fletcher, T. L., Wells, S. Y., Wadsworth, L. P., Kirk, N. P. V., Abramowitz, J. S., Quinlan, K., Goodman, W. K., et al. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100877 · Cited by 5
Muñoz, M. D. L. F. R., Chrzan‐Dętkoś, M., Uka, A., García-López, H. S., Bina, R., & Le, H. (2024) · Archives of Women s Mental Health · doi:10.1007/s00737-024-01537-y · Cited by 8
Steil, R., Görg, N., Kümmerle, S., Lechner‐Meichsner, F., Gutermann, J., & Müller‐Engelmann, M. (2021) · Verhaltenstherapie · doi:10.1159/000514724 · Cited by 5
“Die CPT erwies sich des Weiteren als vielversprechender Ansatz in der Behandlung von Patient*innen mit komplexer PTBS [Müller-Engelmann et al., 2016; Bohus et al., 2020], unter der auch viele Geflüchtete leiden [Barbieri et al., 2019].”
BackgroundSandanapitchai, P., & Nixon, R. D. V. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.03.003 · Cited by 4
Seidel-Koulaxis, L. J., Daniels, J. K., & Ostafin, B. D. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2429334 · Cited by 4
“CPT resulted in lower PTSD symptoms compared to inactive control or alternative treatments post-treatment and at follow-up with large effect sizes (for a meta-analysis, see Asmundson et al., 2019).”
Held, P., Splaine, C. C., Smith, D. L., & Kaysen, D. L. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2237361 · Cited by 4
Reed, D. E., Lehinger, E. A., Cobos, B. A., Williams, R. M., McGeary, C. A., & McGeary, D. D. (2024) · Military Psychology · doi:10.1080/08995605.2024.2309897 · Cited by 4
de Vogel, V., Depla, J., & Vos, M. K. (2025) · Social Sciences · doi:10.3390/socsci14030124 · Cited by 4
Long-Term Clinical and Neuronuclear Imaging Sequelae of Cancer Therapy, Trauma, and Brain Injury
Alcantara, A., Berenji, G. R., Scherling, C., Durcanova, B., Diaz‐Aguilar, D., & Silverman, D. H. S. (2019) · Journal of Nuclear Medicine · doi:10.2967/jnumed.119.237578 · Cited by 4
“Department of Defense and Department of Veterans Affairs, cognitive processing therapy has been successful in reducing feelings of fear and culpability in PTSD (40).”
BackgroundYahalom, J., Hamilton, A. B., Lang, A. J., Holliday, R. P., & Monteith, L. L. (2023) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-023-00283-9 · Cited by 6
“, Present-Centered Therapy [PCT]) [52].”
Fitzpatrick, S., Liebman, R. E., Monson, C. M., & Resick, P. A. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102681 · Cited by 4
Wachen, J. S. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23632 · Cited by 4
Narrative Self‐Transcendence: Decreased Regret and Increased Acceptance Over Late Midlife
Reischer, H. N., Couch, N. G., Wright, M. N., Duarte, A. J., & McAdams, D. P. (2025) · Journal of Personality · doi:10.1111/jopy.13022 · Cited by 3
Metadata
- Authors
- Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J., & Powers, M. B.
- Affiliations
- University of Regina (CA)
- Baylor University Medical Center (US)
- The University of Texas at Austin (US)
- University of Mississippi (US)
- Corresponding author
- Asmundson, Gordon J. G.
- ORCID
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2018-10-18
- Volume
- 48
- Issue
- 1
- Pages
- 1-14
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- OpenAlex
- W2897437472
- Cited by
- 207
- References
- 48
- Citations by year
- 2026: 30 · 2025: 44 · 2024: 35 · 2023: 27 · 2022: 18 · 2021: 31 · 2020: 10 · 2019: 11 · 2018: 1
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- PubMed (publishedVersion)
- QSpace (Queen's University Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- cognitive processing therapy, post-traumatic stress disorder, treatment moderators, sex differences in treatment response
- MeSH terms
- Humans, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome
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