Cognitive Processing Therapy or CPT for PTSD is an effective evidence based therapy that like many therapies has been delivered in a weekly or twice weekly format. Now there is evidence that it can be delivered more intensively.
2018
Craig Bryan and colleagues (2018) examined Military Servicemembers and Veterans with PTSD or subthreshold PTSD (N = 20). They engaged in 12 sessions of individual CPT over 2 weeks along with recreation and psychoeducational sleep classes.
Bryan’s team reported that the number of participants meeting full diagnostic criteria for PTSD significantly declined from 85.0% at pre-treatment to 43.4% at the 6-month follow-up.
Unfortunately, Depression symptoms did not improve, but the severity of suicidal ideation declined from pre-treatment to 6-month follow-up, with the percentage of participants reporting any suicidal ideation falling from 65.5% to 41%
2020
Philip Held and team (2020) took 209 veterans through a 3-week, CPT based intensive treatment programme for PTSD. Participants’ PTSD (PCL-5) and depression (PHQ-9) symptoms were assessed at pre-treatment, post-treatment, and at 3-, 6-, and 12-month follow-up timepoints.
There were small symptom increases from post-treatment to 3-month follow-up. However, significant and clinically meaningful reductions in PTSD and depression symptoms were reported from intake to 12 months follow-up. On average participants had a reduction of greater than 18 points on the PCL-5 (d = 1.28) and greater than 6 points on the PHQ-9 (d = 1.18).
2021
Elizabeth Goetter and team (2021) examined 296 veterans with posttraumatic stress disorder (PTSD). They received either PE (N= 186) or CPT (N= 90), alongside other trauma-informed interventions, in a 2-week intensive clinical program. Treatment selection was determined collaboratively between patient and therapist. Both PTSD and depression were examined. Both PE and CPT groups changed from baseline through to the 6-month follow-up. Results were similar for depression outcomes. Goetter and team concluded both PE and CPT were associated with comparable improvements when delivered as part of a 2-week intensive outpatient program.
2022
Study One
Tara Galovski and colleagues (2022) conducted a small pilot study (N=12) with survivors of intimate partner violence (IPV). They tested the relative effectiveness of individual massed (or intensive) CPT delivered over 5 days compared with standard CPT delivery. That is once per week for 12 weeks. They found that both intensive and standard CPT were associated with large effect improvements from pre-treatment to post-treatment and from pre-treatment to 3-month follow-up. Similarly, both treatment forms also showed significant improvements in depressive, anxiety, and stress symptoms. In summary, there were no differences in the treatment modality on any outcome. In other words both were just as good as each other.
Study Two
Cynthia Yamokoski’s team (2022) investigated the feasibility of an intensive outpatient treatment program for posttraumatic stress disorder within the American veterans health care administration. They reported that their intensive program offered two tracks (2 week or 4 week) of massed delivery of PE or CPT. Over a 12-month period, 351 veterans completed an assessment for PTSD and 172 started within one of the local PTSD programs (e.g., weekly, Intensive Outpatient Program, or residential program). They described that the intensive outpatient program had a high completion rate at 87.3% with an effect size of d = 1.80 on the PCL-5.
Study Three
In another study Craig Bryan and fellow investigators (2022) examined intensive CPT against Standard delivery (i.e., daily vs. weekly sessions). They also assessed the effect of setting (i.e., clinic vs. recreational) on PTSD treatment outcomes.
Their study involved forty-five military personnel and veterans diagnosed with PTSD who chose to receive CPT. They received therapy in one of the following ways.
(a) daily at a recreational facility with recreational programming,
(b) daily on a university campus without recreational programming, and
(c) weekly on a university campus without recreational programming.
PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). Reductions in CAPS-5 and PCL-5 scores were large and statistically significant across all three settings.
They had some very interesting findings, such as that reductions in CAPS-5 and PCL-5 scores were significantly larger in daily therapy on campus, compared to at a recreational facility with recreational programming. Daily therapy on campus compared to weekly on a university campus was not statistically different.
They stated that their results support the effectiveness of CPT across multiple treatment settings and formats. However, they also outlined that their data suggest that daily CPT may be less effective when delivered in combination with recreational activities.
2023
Harrison Weinstein and Colleagues (2023) published an article titled: Intensive Cognitive Processing Therapy (CPT) Associated with Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans.
They examined participants who chose to receive intensive CPT (n = 27) with archival records of individuals who received standard CPT (n = 27). Participants were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5).
Findings
Fifty-four treatment-seeking veterans were offered intensive CPT as routine option. Twenty-Seven selected to do intensive CPT.
Their findings included the following:
Those who did intensive CPT were twice as likely to complete the course of intensive CPT (88.9%) versus those who chose standard CPT (44.4%).
Intensive CPT participants completed treatment in 34 versus 126 days for standard CPT.
Intensive CPT participants were more likely to achieve clinically significant improvement (10+ PCL-5 pre-post reduction). A large percentage, 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in the standard CPT treatment group.
Overall, 66.7% of participants (n = 36) reported clinically significant reductions in PCL-5 scores and 46.3% (n = 25) screened negative for PTSD at their last session.
However, participants who engaged in intensive CPT not more likely to screen negative for PTSD (PCL-5 < 33) at the end of CPT.
Weinstein and team also reported that a positive linear relationship between the number of CPT sessions attended per week, and PCL-5 change was observed. This indicated that more frequent sessions were associated with better treatment response.
Does it matter who and how it is done?
Weinstein and Team reported there were no differences in treatment outcomes based on the accreditation (e.g. psychologist or social worker) of the provider nor whether treatment was delivered in person or virtually.
Cavet Emptor
Because the design of this study was non-random there is a limit to the conclusions that can be drawn. For example, those who choose intensive CPT, may be the participants that are more likely to complete CPT. Unfortunately, no longer term follow up data was collected.
Summary
Weinstein and Team summarised their findings, “Participants who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their participants to participate in treatment as frequently as they are able.”
2025
Erika Roberge and colleagues (2025) examined the psychometric properties of using a Past Day PCL-5 to assess PTSD symptoms over the past day at each treatment appointment. This was in contrast to the commonly used Past Week PCL-5.
They examined data from four intensive PTSD treatment sites (N = 222) that used the Past Day PCL-5 to assess PTSD symptoms. Psychometric properties of the Past Day PCL-5 were analysed by comparing the Past Day PCL-5 to Past Week and Past Month versions of the PCL-5, as well as the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
Psychometric properties examined included internal consistency, test-retest reliability, sensitivity to change, and convergent validity.
They reported that there was consistent psychometric support for the Past Day PCL-5 across sites.
Cavet Emptor
The authors reported that current metrics of reliable and clinically significant change are based on past month symptom assessment and that others (Schuler et al., 2021) have noted that significant day-to-day fluctuations in PTSD symptoms are normal.
They went on to state that future research should identify markers of clinically significant change and good end-state functioning when using the Past Day PCL-5, as these metrics may be different than those established for the Past Month PCL-5.
2026
Lara Baez and team (2026) evaluated changes in PTSD, anxiety, and depressive symptoms over the course of virtual intensive CPT delivered by a commercial virtual trauma clinic.
They studied adult participants with PTSD who completed 3 or more telehealth CPT sessions per week. PTSD, anxiety, and depressive symptoms were assessed at intake, discharge, and 30 and 90 days post discharge.
Their analyses included 148 participants. They found large effect sizes for improvements in PTSD d = 2.94; anxiety d = 1.79; and depressive symptoms d = 1.49, from intake to discharge.
Symptom improvements for PTSD and depression were maintained at 30 and 90 days. Anxiety remained significantly improved from baseline at both time points but showed modest rebound between 30 and 90 days.
Cavet Emptor
The sample from this group were primarily white, highly educated, and had access to technology. Similarly, there was no control group, hence conclusions about generalizability should be cautious.
Summary
Baez and team concluded that virtual intensive CPT produced rapid, very large, and durable reductions in PTSD, depression, and anxiety.
Conclusion
There continues to be increasing evidence of the effectiveness of CPT (And other trauma focussed therapies) delivered in intensive or massed format. This offers clients flexibility in the way they can receive treatment.
References
Baez, L., Huberty, J., Yourell, J., Jewell, C., Lin, E., Kaysen, D., Cutts, L., Noori, S., Rosenthal, I., & Chard, K. (2026). Effectiveness of massed cognitive processing therapy for posttraumatic stress disorder: A retrospective analysis. Journal of Traumatic Stress, 1–12. https://doi.org/10.1002/jts.70045
Bryan, C. J., Leifker, F. R., Rozek, D. C., Bryan, A. O., Reynolds, M. L., Oakey, D. N., & Roberge, E. (2018). Examining the effectiveness of an intensive, 2-week treatment program for military personnel and veterans with PTSD: Results of a pilot, open-label, prospective cohort trial. Journal of Clinical Psychology, 74(12), 2070–2081. https://doi.org/10.1002/jclp.22651
Bryan, C. J., Russell, H. A., Bryan, A. O., Rozek, D. C., Leifker, F. R., Rugo, K. F., Baker, J. C., Khazem, L. R., Roberge, E. M., Shirley, D. M., & Asnaani, A. (2022). Impact of Treatment Setting and Format on Symptom Severity Following Cognitive Processing Therapy for Posttraumatic Stress Disorder. Behavior Therapy, 53(4), 673–685. https://doi.org/10.1016/j.beth.2022.01.014
Galovski, T. E., Werner, K. B., Weaver, T. L., Morris, K. L., Dondanville, K. A., Nanney, J., Wamser-Nanney, R., McGlinchey, G., Fortier, C. B., & Iverson, K. M. (2022). Massed cognitive processing therapy for posttraumatic stress disorder in women survivors of intimate partner violence. Psychological Trauma: Theory, Research, Practice, and Policy, 14(5), 769–779. https://doi.org/10.1037/tra0001100
Goetter, E. M., Blackburn, A. M., Stasko, C., Han, Y., Brenner, L. H., Lejeune, S., Tanev, K. S., Spencer, T. J., & Wright, E. C. (2021). Comparative effectiveness of prolonged exposure and cognitive processing therapy for military service members in an intensive treatment program. Psychological Trauma: Theory, Research, Practice, and Policy, 13(6), 632–640. https://doi.org/10.1037/tra0000956
Held, P., Zalta, A. K., Smith, D. L., Bagley, J. M., Steigerwald, V. L., Boley, R. A., Miller, M., Brennan, M. B., Van Horn, R., & Pollack, M. H. (2020). Maintenance of treatment gains up to 12-months following a three-week cognitive processing therapy-based intensive PTSD treatment programme for veterans. European journal of psychotraumatology, 11(1), 1789324. https://doi.org/10.1080/20008198.2020.1789324
Roberge, E. M., Wachen, J. S., Bryan, C. J., Held, P., Rauch, S. A. M., & Rothbaum, B. O. (2025). Assessing symptom change in massed PTSD treatments: Psychometric evaluation of the past day posttraumatic stress disorder checklist for DSM-5. Psychological Trauma: Theory, Research, Practice, and Policy. https://doi.org/10.1037/tra0001864
Schuler, K., Ruggero, C. J., Mahaffey, B., Gonzalez, A., Callahan, J. L., Boals, A., Waszczuk, M. A., Luft, B. J., & Kotov, R. (2021). When hindsight is not 20/20: Ecological momentary assessment of PTSD symptoms versus retrospective report. Assessment, 28(1), 238–247. https://doi.org/10.1177/ 1073191119869826
Weinstein, H. R., Roberge, E. M., & Parker, S. C. (2023). Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans. Cognitive and Behavioral Practice, 30(3), 314–325. https://doi.org/10.1016/j.cbpra.2022.05.004
Yamokoski, C., Flores, H., Facemire, V., Maieritsch, K., Perez, S., & Fedynich, A. (2022). Feasibility of an intensive outpatient treatment program for posttraumatic stress disorder within the veterans health care administration. Psychological Services. Advance online publication. https://doi.org/10.1037/ser0000628
