An important question for clinicians is how well do evidence-based PTSD therapies work in the real world? In this article published in Psychological Services, Feingold and colleagues (2018) examined this with respect to both Cognitive Processing Therapy (CPT) and a generic form of Cognitive Behavioural Therapy (CBT).
Does this work for those in the criminal justice system in the presence of serious mental illness?
Well, the short answer is yes! As documented by Feingold, serious mental illness (SMI) such as schizophrenia, severe depression and bipolar is frequently accompanied by prior exposure and risk of trauma, with comorbid PTSD common. The clinical needs of this group of clients is compounded when clients are involved in the criminal justice system. For those with SMI, incarceration can lead to further traumatic exposure and victimization, as well as exacerbation of pre-existing psychiatric difficulties. Jail-diversion programs offers an unique window to address sufferers mental health, however the effectiveness of therapies for PTSD and trauma-related issues is unknown. Feingold et al. addressed this issue.
Clients diagnosed with PTSD received Cognitive Processing Therapy (n = 31), and those with trauma-related distress or problems but not diagnosed with PTSD, received CBT (n = 28). In the latter group, disorders such as depression were the typical focus of therapy. On average clients received 10-12 sessions. As would be expected, the sample had multiple comorbidities, significant trauma histories, and were not always living in stable settings. For example, 30% were either homeless or had transient housing arrangements.
Clinically significant reductions in PTSD and depression were observed. Not surprisingly those who were able to complete treatment had better outcomes. Dropout was 44%, somewhat expected due to the complexity of the sample, but appeared to be more a function of logistical issues and certain comorbidity reasons (e.g., substance relapse requiring focus), not inability to engage in trauma-related therapy. Although the findings are preliminary, and replication could address some of the study limitations (e.g., lack of no-treatment control, lack of follow-up assessment), they do demonstrate the short-term effectiveness of evidence-based approaches, including CPT, for challenging and complex samples.