Enhancing Memory in CPT for PTSD

NCT ID: NCT06000475

Last Updated: 2025-10-14

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-10-15
• Study Completion Date: 2026-06-30

Brief Summary

Several psychotherapies for posttraumatic stress disorder (PTSD) have a strong evidence base for their efficacy, but nonresponse rates are high, particularly among older Veterans. Accumulating evidence indicates that memory deficits and poor learning of therapy contents adversely affect psychotherapy treatment response in PTSD. However, limited research has examined methods for increasing learning of therapy contents in psychotherapy for PTSD. The proposed study aims to examine the feasibility of integrating an intervention to increase learning and memory of psychotherapy content into the provision of a widely used psychotherapy, cognitive processing therapy (CPT), for older adults with PTSD. The ultimate goal of this line of research is to develop novel rehabilitation interventions to increase functioning for individuals with PTSD.

Detailed Description

Posttraumatic stress disorder (PTSD) is prevalent among Veterans and is a substantial public health burden. Several psychotherapies, including cognitive processing therapy (CPT), have a strong evidence base for their efficacy in PTSD. However, many individuals show limited benefit from such treatments, particularly older Veterans. One factor likely affecting treatment response is poor encoding, storage, and retrieval of the skills and treatment points that are learned in psychotherapy. Individuals with PTSD display deficits in learning and memory, and aging is independently associated with declines in memory and executive functioning. Thus, older adults with PTSD may be at heightened risk of cognitive dysfunction that could impact their ability to benefit from frontline PTSD treatments. To this end, pre-treatment memory functioning has been shown to consistently predict treatment response in psychotherapy for PTSD. Inefficient learning and memory for psychotherapy content may be one mechanism explaining this relationship, as poor learning of therapy content is linked with worse treatment adherence and outcomes. The primary aim of this proposal is to examine the feasibility and acceptability of integrating a novel Memory Support intervention into the provision of CPT for older adults with PTSD. The Memory Support intervention was developed such that specific strategies to enhance encoding and retrieval of therapy content and skills can be integrated into manualized psychotherapy. However, no prior studies have integrated this intervention into treatments for PTSD. The proposed project will be guided by a user-centered design framework for treatment development and be conducted in three phases. In the first phase, the investigators will develop a modified CPT treatment manual that systematically integrates Memory Support, with clinician (n=3) and Veteran (n=3) feedback to provide guidance on process and techniques. In the next phase, the investigators will conduct iterative refinement of the modified treatment through a case series in older Veterans (n=3) with an experienced CPT therapist. Finally, the investigators will conduct a small feasibility randomized controlled trial (n=20) in which the investigators will examine accrual, retention, completion, acceptability, and variability in symptom and functional outcomes, as well as all procedures for a larger trial. The proposed project offers substantial conceptual innovations by bridging foundational work from rehabilitation neuropsychology and psychotherapy mechanisms research and will provide valuable pilot data to inform a novel intervention for older Veterans with PTSD that can be tested in future large-scale studies. Such approaches may be especially relevant for Veterans with neurocognitive deficits (e.g., memory), potentially suggesting a target for a personalized approach to mental health care.

Conditions

Stress Disorders, Post-Traumatic

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Cognitive Processing Therapy (CPT)

Standard CPT as described in the treatment manual

Group Type: ACTIVE_COMPARATOR

Cognitive Processing Therapy

Intervention Type: BEHAVIORAL

CPT as described in the treatment manual

Cognitive Processing Therapy (CPT) + Memory Support

CPT+Memory support will also incorporate frequent and intentional use of strategies to enhance learning and memory of this content.

Group Type: EXPERIMENTAL

Cognitive Processing Therapy

Intervention Type: BEHAVIORAL

CPT as described in the treatment manual

Cognitive Processing Therapy (CPT) + Memory Support

Intervention Type: BEHAVIORAL

CPT+Memory support will also incorporate frequent and intentional use of strategies to enhance learning and memory of this content.

Interventions

Cognitive Processing Therapy

CPT as described in the treatment manual

Intervention Type: BEHAVIORAL

Cognitive Processing Therapy (CPT) + Memory Support

CPT+Memory support will also incorporate frequent and intentional use of strategies to enhance learning and memory of this content.

Intervention Type: BEHAVIORAL

Other Intervention Names

CPT

Eligibility Criteria

Inclusion Criteria

• Veterans with DSM-5 diagnoses of PTSD via the Clinician Administered PTSD Scale (CAPS-5)
• Age >59

Exclusion Criteria

• daily benzodiazepine use (due to memory impairing effects)
• bipolar or psychotic disorders
• current suicidal ideation with plan or intent
• current moderate or severe substance use disorder not in remission for >1 mo.
• severe traumatic brain injury
• a Montreal Cognitive Assessment (MoCA) indicative of dementia
• or other disorders that would severely limit study participation

• Minimum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

VA Office of Research and Development

FED

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

James C. Scott, PhD

Role: PRINCIPAL_INVESTIGATOR

Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA

Locations

Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA

Philadelphia, Pennsylvania, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

James C Scott, PhD

Role: CONTACT

James.Scott2de50a@va.gov

(215) 823-5800 ext. 7138

Richard A Moore

Role: CONTACT

richard.moore7@va.gov

(215) 823-5800 ext. 7916

Facility Contacts

Kyong-Mi Chang, MD

Role: primary

Kyong-Mi.Chang@va.gov

215-823-5893

Richard A Moore

Role: backup

richard.moore7@va.gov

(215) 823-5800 ext. 7916

Other Identifiers

1I21RX004627

Identifier Type: NIH

Identifier Source: secondary_id

View Link

D4627-P

Identifier Type: -

Identifier Source: org_study_id