Treatment of Eating Disorder—Posttraumatic Stress Disorder Patients in Residential Care With and Without Cognitive Processing Therapy

OBJECTIVE: Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis for individuals with eating disorders (EDs) admitted to residential treatment (RT). While cognitive processing therapy (CPT) has shown promise for ED-PTSD populations, few large-scale naturalistic studies have evaluated CPT in residential ED treatment settings. This study examined outcomes for ED-PTSD patients who elected to receive CPT compared to those who did not. METHODS: Participants (n = 348) (including 247 who received CPT [CPT+] and 101 who did not [CPT-]) completed standardized self-report measures at admission and discharge: PTSD Checklist for DSM-5 (PCL-5), Eating Disorder Examination Questionnaire (EDE-Q), Eating Disorders Inventory (EDI-2), and Patient Health Questionnaire (PHQ-9). Outcomes included changes in PCL-5, EDE-Q, and PHQ-9 scores, and EDI-2 Ineffectiveness and Interoceptive Awareness subscale scores. RESULTS: Significant Time × Group interactions indicated that symptom change differed by CPT participation for some outcomes. CPT + participants had greater reductions in EDE-Q Global, PCL-5 total, and PHQ-9 total scores than CPT- participants. Changes in ineffectiveness and interoceptive awareness scores did not differ significantly between groups. DISCUSSION: CPT participation during RT was associated with greater reductions in PTSD, depressive, and ED symptoms through discharge-the nonrandomised design and variation in CPT exposure limit causal interpretation.