Implementing Cognitive Processing Therapy for Posttraumatic Stress Disorder With Active Duty U.S. Military Personnel: Special Considerations and Case Examples

Numerous studies and reports document the prevalence of combat-related posttraumatic stress disorder (PTSD) in military personnel returning from deployments to Iraq and Afghanistan. The Department of Veterans Affairs and Department of Defense recommend cognitive processing therapy (CPT) as one of two first-line treatment options for patients with PTSD. CPT is an evidence-based, trauma-focused cognitive treatment for PTSD that has been shown to be efficacious in a wide variety of populations, but has just begun to be implemented with active duty military. The purpose of this article is to describe treatment considerations that may be pertinent to active duty populations, including stigma related to mental health treatment and minimization of symptoms, duty obligations, and special factors related to rank and occupational specialties. We provide recommendations for navigating these issues within the CPT protocol. Additionally, we discuss common themes that may be especially relevant when conducting CPT with an active duty military population, including blame/responsibility, the military ethos, erroneous blame of others, just-world beliefs, traumatic loss, fear of harming others, and moral injury. Case examples illustrating the use of CPT to address these themes are provided.