Exploring Structural Adaptations to Cognitive Processing Therapy: A Systematic Review and Meta-Analysis

In the evolving field of psychological interventions for posttraumatic stress disorder (PTSD), Cognitive Processing Therapy (CPT) has emerged as a first-line treatment, backed by robust empirical evidence. Despite the proven efficacy of CPT in improving PTSD symptoms, individuals face significant barriers when seeking treatment. To overcome these challenges, CPT has undergone testing in diverse settings, accompanied by structural modifications deviating from its commonly delivered format of weekly (or bi-weekly) face-to-face contact, including changes in delivery method, length or intensity of sessions, or format (e.g., group). We conducted a systematic review and meta-analysis to assess the effectiveness of these structural adaptations within CPT for treating PTSD. Fifteen randomized controlled trials (RCTs) and 12 non-RCTs were included for the review. The meta-analysis of the 15 RCTs revealed significant improvements in PTSD and depression outcomes with structural adaptations of CPT. Generally, no significant differences were found when comparing these adaptations with standard CPT or non-CPT treatments, although this is accompanied by the caveat of likely modest power for subanalyses involving different comparator types. The findings suggest that adapting the delivery of CPT typically yields similar outcomes in PTSD symptom improvement as standard CPT and confirms its flexibility in addressing barriers to PTSD treatment access. Limitations and future directions are discussed.