Augmenting Cognitive Processing Therapy with a peer-led support intervention to improve well-being: A sustainable and scalable model for enhancing PTSD recovery in vulnerable populations

In the absence of treatment, posttraumatic stress disorder (PTSD) is chronic and enduring with significant impact on patients’ quality of life and well-being. While robust, evidence-based psychotherapies (EBPs) exist for treating PTSD, the primary focus of clinical trials has been on core symptom reduction with less attention to their impact on mental well-being (MWB). There is a growing recognition of the importance of improvement in MWB in achieving holistic recovery from mental health conditions. Augmenting EBPs for PTSD with interventions designed to target critical aspects of mental well-being may move the needle further toward recovery from PTSD. Developing models of care delivery that are accessible, feasible, and tolerable for the most vulnerable populations, such as those experiencing health disparities, is critical. Women veterans, a racially and ethnically diverse subgroup of the military population, are at high risk for poor mental health (including PTSD) and for declines in well-being after separation from service. These declines are due, in part, to low base rates in civilian communities, lack of recognition for service by the general population, and limited access to resources designed to meet their unique needs. Women veterans, especially those with additional marginalized identities, report difficulty establishing connections and belongingness with both veteran and civilian populations resulting in loneliness and isolation, known risk factors for negative mental health outcomes. Cognitive Processing Therapy (CPT) is a first-line treatment that has been shown to result in large decreases in PTSD symptoms, as well as moderate improvement in aspects of mental well-being. However, like most EBPs, CPT is not universally accessible as evident in significant healthcare disparities across populations including those living in rural locales and/or below the poverty line, those with disabilities, and members of minoritized populations (e.g. racial, ethnic). Novel, scalable, and sustainable methods for increasing trauma survivors’ access to and engagement in care are needed. Self-guided CPT may be a viable alternative to traditional psychotherapy. Combining a self-help version of the robust, demonstrably effective CPT protocol with an intervention designed to target critical aspects of well-being and with the added benefit of peer support may move the needle further toward holistic recovery. This intervention -the Women Veterans Network’s (WoVeN)- is a peer-led, manualized, 8 session, group-based intervention designed to increase belongingness and improve well-being. This project seeks to assess the feasibility, acceptability and tolerability of a self-help version of CPT augmented by WoVeN and evaluate its impact on PTSD, well-being, and depression.