A Comparison of Cognitive Processing Therapy (CPT) Versus Accelerated Resolution Therapy (ART) Versus Wait List (WL)
Phase: NA
Conditions: Posttraumatic Stress Disorder
Sponsor: University of Cincinnati

Page 1 
Protocol 
A Comparison of Cognitive Processing Therapy (CPT) versus Accelerated 
Resolution Therapy (ART) versus Wait List (WL) 
(CPT vs. ART vs. WL) 
Principal Investigator: Kathleen M. Chard, PhD 
Lead Research Coordinator: Laura Gilliam, PhD 
UC Site Coordinator: Erica Birkley, PhD 
Version 2.0 
Revised 7-20-17 

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CPT vs. ART vs. WL Research Protocol Table of Contents 
 
SECTION I: STUDY PURPOSE (pg. 4) 
SECTION II: STUDY OBJECTIVES (pg.4-5) 
A. PRIMARY 
B. SECONDARY 
C. TERTIARY 
D. EXPLORATORY ANALYSES 
SECTION III: STUDY DESIGN (pg.5-12) 
A. STUDY POPULATION 
1. Rationale for Inclusion of Non-Veteran Participants 
B. STUDY TREATMENT CONDITIONS 
1. Treatment Conditions 
2. Rationale for WL Condition 
3. Procedure for Determining # of Sessions for CPT & ART 
C. STUDY SITES (Table 1.0) 
D. OUTCOME MEASURES 
E. PLANNED STATISTICAL ANALYSES & SAMPLE SIZE 
F. RANDOM ASSIGNMENT 
SECTION IV: PARTICIPANT CHARACTERISTICS & RECRUITMENT (pg. 12-16) 
A. INCLUSION CRITERIA 
B. EXCLUSION CRITERIA 
C. CONCURRENT TREATMENT 
D. RECRUITMENT 
E. SCREENING & INFORMED CONSENT 
1. Phone Screen & Study Site Determination 
2. Informed Consent 
SECTION V: ASSESSMENTS (pg. 16-18) 
A. ASSESSORS 
B. SELF-REPORT ASSESSMENTS (Table 2.0) 
SECTION VI: PARTICIPANT PAYMENT (Table 3.0) (pg. 18-19) 
SECTION VII: DELIVERY OF THERAPY (pg. 19-20) 
A. THERAPIST 

Page 3  
 
B. TRAINING 
C. CONSULTATION 
D. DIGITAL AUDIO RECORDINGS 
E. ADHERENCE & COMPETENCE RATINGS 
SECTION VIII: DATA & SAFETY MONITORING (pg. 20-21) 
A. DATA ENTRY & STORAGE 
B. CERTIFICATION OF CONFIDENTIALITY 
SECTION IX: REFERENCES (pg. 22-23) 
APPENDICES (pg. 24-43) 
Appendix A. Telephone Script for WL Participants 
Appendix B. Study Measures 
Appendix C. Randomization Tables 
 
 

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I. 
Study Purpose 
The purpose of this research study is to compare two psychotherapy treatments for the 
symptoms of Posttraumatic Stress Disorder (PTSD) with a no therapy, wait-list control 
condition. The two treatments are Cognitive Processing Therapy (CPT) and Accelerated 
Resolution Therapy (ART). CPT looks at the impact the traumatic event has had on 
your life and helps you to examine and change unhelpful thoughts and feelings related 
to the event, yourself, others and the world. CPT is a gold-standard treatment for PTSD. 
Prior randomized control trials of CPT have demonstrated efficacy of the intervention in 
reducing PTSD symptom severity with samples of victims of childhood sexual abuse, 
interpersonal violence, and military-related trauma (e.g., Chard, 2005; Monson et al., 
2006; Resick et al., 2008). CPT is widely disseminated within the Veterans Affairs 
Healthcare System (VA), where CPT is one of two empirically-supported PTSD-focused 
treatments offered to veterans (Chard, Ricksecker, Healy, Karlin, & Resick, 2012), and 
across community treatment and academic medical centers.  
Accelerated Resolution Therapy (ART) also involves processing thoughts and feelings 
related to the event, but does this in a different way than CPT by relying more on 
visualization or imagination rather than talking. There has only been one randomized 
clinical trial of ART for the treatment of PTSD (Kip et al., 2013), and the effectiveness of 
ART in comparison to a gold-standard PTSD psychotherapy is unknown. In order to 
prove efficacy, ART must to be compared to a gold standard treatment for PTSD, such 
as CPT. 
The purpose of this research study is to compare the effectiveness of these two 
therapies on PTSD symptoms, along with related symptoms such as depression, sleep 
and physical health to see which treatment is better. The study will also try to determine 
if there are people who respond better to one treatment or the other.  
II. 
Specific Objectives 
This study is designed to provide clinicians, researchers, administrators, and patients 
with information on the comparative effectiveness of PTSD psychotherapy treatments. 

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A. Primary Objective 
The primary objective is to compare the effectiveness of Cognitive Processing Therapy 
and Accelerated Resolution Therapy in reducing PTSD symptom severity for Veteran 
and civilian patients with PTSD.  
B. Secondary Objective 
The secondary objective is to compare the effectiveness of Cognitive Processing 
Therapy and Accelerated Resolution Therapy in reducing depression symptom severity.  
C. Tertiary Objective 
The tertiary objective is to examine whether treatment effectiveness is reduced when 
patient preference for treatment is incongruent with their random assignment. 
D. Exploratory Analyses 
Exploratory analyses will be performed to examine whether demographic (e.g., sex, 
age, Veteran/Non-Veteran status) and other clinically-relevant variables (e.g., sleep 
quality, anger, pain, health care utilization) predict differential response and/or drop-out 
across treatment condition.  
III. Study Design 
This study will examine the effectiveness of Cognitive Processing Therapy (CPT) as 
compared to Accelerated Resolution Therapy (ART) and a Wait list (WL) control using a 
Randomized, Cross-Over Design with blinded assessment.  280 participants will be 
randomly assigned to receive ART, CPT or WL condition. Upon completion of the WL 
condition after 7 weeks, participants will be re-randomized to ART or CPT.   
The primary outcome is improvement in PTSD symptom severity as measured by 
change on the Clinician-Administered PTSD Scale for DSM-IV or DSM-5 (CAPS-IV/ 
CAPS-5) after treatment. This primary outcome measure will be administered by post-
doctoral fellows in psychology who will remain blinded to treatment condition. The 

Page 6  
 
CAPS-IV and CAPS-5 will be administered at pre- and post-treatment, and 3-month and 
1-year follow-up visits.  
A. Study Population 
Participants will be 280 male and female Veterans and civilians who meet criteria for 
PTSD, or subthreshold PTSD, due to any Criterion A traumatic event. Subthreshold 
PTSD occurs when a patient has a Criterion A traumatic event, and endorses symptoms 
in each of the PTSD Diagnostic Criterions (B-E), but falls below the number and/or 
severity of total Criterion requirements to meet criteria for a PTSD diagnosis. Inclusion 
and exclusion criteria and recruitment are described in Section IV. 
1. Rationale for Inclusion of Non-Veteran participants 
Civilians will be included in this study as they have different Criterion A traumatic events 
(e.g., non-combat). It is imperative to the primary study objective to assess the 
comparative effectiveness of CPT and ART across a variety of trauma(s).   
B. Study Treatment Conditions 
1. Treatment Conditions 
Cognitive Processing Therapy (CPT). CPT looks at the impact the traumatic event has 
had on your life and helps you to examine and change unhelpful thoughts and feelings 
related to the event, yourself, others and the world. CPT will be conducted in 5-15, 60 
minute sessions held once or twice a week.  CPT will be implemented using the 
Cognitive-Only version, excluding the trauma account.  
Acceleration Resolution Therapy (ART). ART, like CPT also involves processing 
thoughts and feelings related to the event, but does this in a different way relying more 
on visualization or imagination rather than talking. ART will be conducted in 5-15, 60 
minute sessions held once or twice a week. 
Wait List (WL). WL will include a 7 week minimal attention control period with weekly 
check-in calls (see Appendix A for telephone script) to ensure that the participant has 

Page 7  
 
not experienced any significant worsening in their symptoms that might require 
interventions, (e.g. suicidal intent). 
2. Rationale for Wait List Condition 
The 7 week timeline for the Wait List condition is commensurate with the average length 
of psychotherapy. Many of the clinics within the Department of Veterans Affairs have a 
wait time to start psychotherapy. In the national Cooperative Studies Program research 
study CSP-591, VAMC sites such as Cincinnati, have averaged 38 days from initial 
participant screening to entry into treatment. Furthermore, patients with PTSD have 
symptoms of avoidance and may prefer not to start therapy immediately.  
3. Procedure for Determining the Number of Sessions for CPT and ART 
Early completers: After a minimum of five sessions, individuals with two successive 
sessions (i.e., sessions 4 and 5) with a PCL-5 of 18 or under and with agreement of 
both therapist and participant, will be considered early completers and will be given their 
post-test assessment.  They will be reassessed at 3-months and 1 year follow ups from 
their last treatment session. 
Drop Outs:  Participants in any of the three conditions (CPT, ART, or WL) who drop out 
of treatment will be asked to remain in the study for participation in the assessment 
portion of the study only. Treatment discontinuation will be based on a discussion 
between the participant, the study therapist, and the research team to determine the 
vest clinical care plan for ongoing treatment. Participants will be discontinued from 
treatment if they show substantial worsening of PTSD, other symptoms, or functioning 
requiring lengthy hospitalization if the worsening is due to treatment.  If participants 
decide to discontinue treatment early, they will be asked by their clinician for a reason 
and if they consent to be contacted for post-treatment assessments. If they agree to be 
contacted, study staff will contact the participant to schedule their post-treatment 
assessment immediately following their last treatment session. Participants will also be 
contacted to participate in the 3 and 12 month follow up assessments. Participants will 
be reminded of the voluntary nature of this study and their option to withdraw 
participation at any time.  

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C. Study Sites 
The study will be conducted at the Cincinnati VA Medical Center, Trauma Recovery 
Center, in Fort Thomas, Kentucky, and at the UC Health Stress Center located in 
Cincinnati, Ohio.  
Table 1.0 Participant Flow Through the Randomized Clinical Trial 
Study Phase 
(timeline) 
Site 
Event 
 
 
 
Enrollment  
(2-3 weeks) 
VA only 
Telephone Screening Phase: Inclusion and 
Exclusion Criteria assessed & Site Determination 
for participant* 
VA or UC Informed Consent, Pre-Treatment Assessment, & 
Randomization Assigned by sealed envelope 
opened by participant after site visit 
VA or UC Phone scheduling of initial session with therapist  
Waitlist 
(if assigned) 
VA or UC Waitlist Condition participants will wait 7 weeks, 
will receive weekly Phone Check-In calls by study 
staff (see Appendix A), then will be randomized to 
CPT or ART 
Treatment 
(5-15 weekly or 
biweekly sessions) 
VA or UC Treatment begins (session 1) 
VA or UC Mid-Treatment Assessment (session 2 – 7) 
VA or UC Treatment Ends (session 5 – 15) 
Post-Treatment 
(1 year) 
VA or UC Post-treatment Assessment 
VA or UC 3-month follow-up Assessment 
VA or UC 1-year follow-up Assessment 
* Prior to the phone screen, participants will be asked to identify how they learned about 
the study and which site (UC or VA) they were referred from. Veteran participants may 
be seen at the Cincinnati VAMC or the UC Health Stress Center depending on their 
associated site. All civilian participants will be seen at the UC Health Stress Center. 
D. Outcome Measures 

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The primary outcome is improvement in PTSD symptom severity as measured by 
clinically significant change on the Clinician-Administered PTSD Scale for DSM-IV or 
DSM-5 (CAPS-IV/CAPS-5). 
A complete description of all of the outcome measures is in Appendix B. 
E. Sample Size and Planned Statistical Analyses 
1. Planned Statistical Analyses 
The primary objective is to compare the effectiveness of CPT and ART in reducing the 
primary outcome -- PTSD symptom severity -- for Veteran and civilian patients with 
PTSD. We predict that CPT will be significantly superior to WL (and potentially superior 
to ART) in reducing PTSD symptoms post-treatment.  To test this hypothesis we will 
use a 3 (Group: CPT, ART, WL) x 4 (Time: Baseline, Post-treatment) mixed-model 
ANCOVA covarying for baseline PTSD ratings.  A significant omnibus interaction, and 
lower-order interactions, in the hypothesized direction will confirm this hypothesis. 
The secondary objective is to compare the effectiveness of CPT and ART in reducing 
depression symptom severity.  We predict that CPT will be superior to WL (and 
potentially ART) in reducing depression symptoms post-treatment.  We will test this 
hypothesis with a mixed-model ANCOVA following the same analysis plan as for the 
primary objective. 
The tertiary objective is to examine whether treatment effectiveness is reduced when 
patient preference for treatment is incongruent with their random assignment as we 
predict.  To test this hypothesis, we will first categorize participants to a dichotomized 
preference group based on self-report.  We will then perform a 2 (Group: Preferred 
Therapy, Non-preferred Therapy) x 4 (Time: Baseline, Post-Treatment, 3 Month, 1 
Year) mixed-model ANCOVA covarying for baseline PTSD for both the primary (PTSD) 
and secondary (depression) outcome variables. A significant omnibus interaction, and 
lower-order interactions, in the hypothesized direction will confirm this hypothesis.  
Additionally, the primary and secondary analyses will be rerun covarying for preference 
to examine this variable’s differential influence on CPT and ART outcomes. 

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Exploratory analyses will be performed to examine whether demographic and clinical 
variables differentially predict response and drop-out across treatment condition. 
Considering the exploratory nature of these analyses we make no predictions.  
However, we will use hierarchical multiple regression to examine the influence of 
demographics independent of the influence of clinical factors in predicting response 
(i.e., 50% symptom reduction) and drop out for each treatment.  Based on the sample 
size estimate below, we will recruit a sample sufficient to include up to 24 predictors 
within these analyses – a more than sufficient number. 
2. Sample Size Estimates 
In order to estimate sample size, we used means and SDs from pilot data, prior studies 
from other groups (Frost et al., 2014; Kip et al., 2012; 2014) and a previously published 
study from our group (Suris et al., 2013) to determine the expected effect size (ES) for 
differences in PTSD symptoms across pre- and post-treatment (i.e. time).  We also 
calculated treatment differences at the post-treatment time point only.  We employed 
the ES metric delta (Δ) for mean time differences and Cohen's d for mean treatment 
differences.  According to Cohen (1990), an ES d = 0.2 is considered small, 0.5 
medium, and 0.8 large for behavioral research.  Effect sizes within the large range are 
clinically relevant for behavioral research and even medium effect sizes should be 
“visible to the naked eye of a careful observer (Cohen, 1990).”  Sample size estimates 
were then made using G*Power version 3.1 (Franz Faul, University of Keil, Germany).  
Using G*Power, we also estimated the a priori sample size required to identify the 
repeated-measures ANOVA interaction terms to be tested in the primary and secondary 
analyses. 
ESs were large for active treatment differences across pre- and post-treatment times (d 
= 1.04 for CAPS reduction with CPT; d = 2.02 for PCL reduction in civilians with ART; d 
= 1.28 for PCL reduction in military with ART).  To detect similarly large differences (ds 
> 0.8) in PTSD severity means over time at α = 0.05, power = 0.95 (to be conservative 
since there should be considerable power for these analyses), two-tailed in the 
proposed study would require at least a total N = 32 (n = 16 for each active treatment).  
A total sample size of N = 152 (n = 76 per active treatment condition) would be required 

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to identify PTSD symptom reductions over pre-and post-treatment in the WL condition 
considering the medium ES. 
ES was small for active treatment difference between CPT and PCT symptoms post-
treatment (d = 0.16).  No data directly comparing CPT and ART are available in the 
extant literature.  To detect a similarly small difference (ds < 0.2) in PTSD severity 
means post-treatment with α = 0.05, power = 0.80, two-tailed in the proposed study 
would require at least a total N = 706 (n = 353 for each active treatment).  Therefore, 
the proposed N = 240 would be insufficient to identify statistically significant differences 
between CPT and ACT post-treatment if we assume a similarly small effect size.  The 
extant literature does not provide ES estimates between CPT vs. WL and ART vs. WL, 
but these ESs would be expected to be considerably larger than the CPT vs. PCT 
estimate. 
In the absence of prior WL data with which to estimate ES, and considering that we 
intend to test interaction effects primarily, we estimate the necessary sample size to 
detect statistically significant Time x Treatment interactions across the entire power and 
ES range.  Results indicate that for the primary analysis we will have sufficient power to 
detect even small effects with a total sample size = 246 (n = 123 per active treatment 
condition).  For the secondary analysis we will have sufficient power to detect even 
small effects with a total sample size = 138 (n = 69 per active treatment condition). 
It should be noted that the above calculations are based on simple contrasts between 
means and hypothetical power functions for the interaction term in repeated measures 
ANOVA, none of which include covariates. These estimates are conservative in that 
inclusion of covariates, as expected in the final analysis, generally increases 
power and we intend to over-sample minimally to accommodate participant 
attrition, further assuring adequate power. The total sample, then, will be N = 240, 
split equally between the two active treatments.  This estimate, based primarily on 
repeated measure ANOVA, is very conservative as it provides a sufficient sample size 
to detect even small interaction effects. If needed, we propose oversampling by up to 40 
participants to account for drop-outs from assessment or to bolster marginal effects. 

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F. Random Assignment:  
David Fleck, PhD, our statistician, has created a randomization table for all participants 
using a randomized, cross-over design. For participants who are randomized to the 
Wait List condition, following the completion of this seven week condition, they will be 
randomized into one of the two active treatment conditions, CPT or ART, using the 
randomization table (see Appendix C).  
IV. 
Participant Characteristics and Recruitment 
A. Inclusion Criteria 
Participants will include 280 males and females ages 18 and older who meet criteria for 
PTSD (or subthreshold PTSD).  Individuals will be included regardless of gender, 
ethnicity, military/civilian status, or type of trauma(s).  
Participants must also agree to participate in either treatment, agree to allow IRB-
approved study staff to access their medical record to review the extent to which they 
use UC or VA services before or during the study, have access to a telephone or agree 
to come into the Cincinnati VAMC, Trauma Recovery Center for the initial set of 
questions to determine whether they are eligible to participate, and agree to have their 
assessment and treatment sessions digitally audio recorded.  
B. Exclusion Criteria 
Participants who 1) meet criteria for unmedicated bipolar, mania, or unmedicated 
psychotic disorders; 2) meet criteria for a substance use disorder requiring detoxification 
treatment; 3) have active suicidal or homicidal intent with (a) plan(s) and (a) means; 4) 
have a medical condition that will interfere with twice weekly therapy sessions will be 
excluded from the research study; 5) show severe problems with memory or other 
problems with thinking and reasoning (defined as 1 SD below age-graded norms on the 
Montreal Cognitive Assessment [MoCA], Nasreddine et al. 2005).  

Page 13  
 
Individuals with a psychotropic medication change within the last 30 days will be asked 
to stay consistent with their current dose for a minimum of 30 days before admission to 
the study.  
C. Concurrent Treatment 
Participants will be asked to refrain from any concurrent psychotherapy that focuses on 
treating the symptoms of PTSD or related mental health disorders.  Exceptions will be 
made for those active in substance use treatment programs, including 12 step programs 
and relapse prevention.  
D. Recruitment 
Participant recruitment will take place both at the University of Cincinnati, and at the 
Cincinnati VA Medical Center. The Trauma Recovery Center hosts a weekly orientation 
group for patients seeking PTSD-specific treatment which enrolls approximately 10 new 
Veterans per week. Historically, sharing research study information in this orientation 
group, in addition to soliciting UC and Cincinnati VAMC clinician and physician primary 
care referrals, have been successful methods of recruitment (See Recruitment Material: 
VA Orientation Group Recruitment Slide). Participants will indicate interest in this study 
through completion of a confidential questionnaire, given to the orientation group leader 
(See Recruitment Material: VA Orientation Group Questionnaire_ART Question). 
Participants in the group will also sign a permission to contact form during the 
orientation group, granting permission for the clinician leading the group to discuss the 
potential participant’s eligibility in the research study with study staff (See Recruitment 
Material: Contact Permission Form). Participant recruitment will also take place at the 
UC Health Stress Center. This clinic currently treats an average of 40 patients per 
week, and receives approximately 10-15 weekly referrals for PTSD-specific treatment. 
IRB-approved study fliers will be posted in approved areas to aid in recruitment, in 
addition to distributing IRB-approved mailings to providers within the Cincinnati VAMC, 
UC Stress Center, local primary care centers, hospitals, and community mental health 
treatment centers within the greater Cincinnati area (See Recruitment Material: 
Recruitment Flyer). We will also use Study KIK and radio advertisements as additional 

Page 14  
 
recruitment tools, and the Study KIK and radio advertisements will only use study 
descriptive information that has been IRB approved from the study flier. The contact 
number on all study recruitment tools will be 513-233-1620. This telephone number is 
associated with the VA site, so all interested participants for the study from both UC 
Stress Center and Cincinnati VAMC will contact study staff at the VA site. 
E. Screening and Informed Consent 
1. Phone Screen and Study Site Determination 
All phone screens will occur at the VA site. Study staff will contact potential participants, 
and prior to any screening data being collected participants will be asked to identify how 
they learned about the study and which site (UC or VA) they were referred from. Civilian 
participants can only be seen at the UC Health Stress Center. Once the participant’s 
associated site is known, study staff will inform the participant that all study 
appointments will be held at their associated site and changing study sites during their 
involvement in the study will be prohibited.  If the participant agrees with staying with 
their associated site, the phone screen will continue. If the participant does not agree, 
study personnel will explain the requirements for the study and refer the participant back 
to their original provider. All data collected during the phone screen will be stored on the 
appropriate secure network. Study staff will be equipped with access to both sites 
network, despite being housed at the VA site (e.g. UC laptop will be provided to store all 
UC participant’s phone screen data). All data collected during the phone screen, 
including PHI, will be stored electronically on the appropriate site’s secure network (e.g. 
PHI of VA participants will be kept on the secure VA Network; PHI of UC participants 
will be stored on the secure UC Network).  
The phone screen will be used to determine if the participant might be eligible for the 
study by assessing inclusionary and exclusionary criteria, including patient current 
mood, behaviors, treatment, and medications (See Forms: 01-Phone Screen, 02-
Concomitant Medications, 03-Demographic Information, 04-Suicidal & Homicidal 
Screen). All forms during the phone screen will be completed electronically in a 
database on the participant’s designated site’s secure network. If participants do not 

Page 15  
 
have access to a phone they must agree to come to the Trauma Recovery Center in 
Fort Thomas, KY to complete the screening in person with study staff. If a participant is 
initially eligible for this study, staff and the participant will schedule all future study 
appointments at the participants designated site, either the Cincinnati VA Medical 
Center--Trauma Recovery Center or the University of Cincinnati Health Stress Center. 
Study staff will remind the participant that all future study appointments will be held at 
that location (including assessments and treatment sessions), and changing study sites 
during the duration of their involvement in the study will be prohibited.  
2. Informed Consent 
Each site has a site-specific Informed Consent Form (ICF, See VA ICF and UC ICF). 
Research study staff will review and discuss the ICF and HIPAA Authorization forms at 
the Pre-treatment Assessment with the potential participant. The documents must be 
completed and signed before any study procedures are performed. The person 
obtaining the consent will review the documents with the potential participant in a 
location providing privacy to discuss all elements of the document and study 
procedures. The person obtaining the consent will give the potential participant time to 
read the ICF and ask questions. A copy of the ICF will be given to interested 
participants to review and discuss with study personnel. The following elements will be 
discussed with the potential participants: 
 The purpose and objectives of the study 
 The length of the study 
 Any potential risks, discomfort, inconvenience 
 The importance of following study procedures 
 The importance of compliance with all assessments and study visits 
 Randomization 
 Participation is voluntary and the participant may withdraw from the study 
at any time without loss of benefits to which he/she may otherwise be 
entitled 
 Alternative treatments 
 Reimbursement schedule for visits 

Page 16  
 
 The participant’s SSN is required 
 Consent to be audio recorded during assessments and treatment sessions 
 Provisions for keeping study data confidential and exceptions of 
confidentiality  
 AEs are treated at no cost to the participant 
 
The participant must sign the ICF and the HIPAA Authorization (Cincinnati VAMC site 
only) before any study procedures are performed. A copy of the signed ICF will be given 
to the participant. The original signed forms will be filed in the Participant Consent Form 
Master File, which will be retained at each individual study site. For participant’s at the 
UC Health Stress Center site, a copy of the signed ICF will be scanned into their 
medical records. 
 
V. Assessments 
A. Assessors:  Clinical psychology post-doctoral fellows will perform all pre-, post-, and 
follow-up assessment interviews, and will be trained and supervised by licensed clinical 
psychologists.  The assessors will remain blind to treatment condition throughout the 
study. Assessors will administer the: Clinician Administered PTSD Scale for DSM-IV 
and DSM-5 (CAPS-IV/CAPS-5), the Structured Clinical Interview for DSM-5 (SCID-5), 
the Montreal Cognitive Assessment (MOCA), and the Creative Imagination Scale. 
Participants in the two active treatment conditions will complete a self-report  
assessment battery at pre-treatment, post-treatment, 3 month, and 1-year follow- up.  
B. Self-Report Assessments: The self-report assessment forms will be completed by 
either paper-and-pencil questionnaires or the survey feature in RedCap. For 
assessments completed in RedCap survey, participants will complete the RedCap 
survey on a secure laptop computer or tablet at their designated location (connected to 
VA patient wifi at the Cincinnati VA or UC Health patient wifi at the UC Health Stress 
Center). Once a self-report survey has been completed by a participant, the RedCap 
system will not allow a participant access to change their responses. Participants will 
not have access to any data within RedCap, and will only be able to view their self-

Page 17  
 
report assessment forms in RedCap Survey mode. Table 2.0 indicates which self-report 
assessments can be completed by RedCap Survey and which assessments will be 
conducted by Assessor interview. 
All potential participants will complete a pre-treatment assessment. Following their 7 
week wait list period, participants in the WL condition undergo their first post-
assessment. Their first post-assessment will be entered as their pre-treatment data 
when they are randomized to the active treatment condition. All participants will be 
reassessed in-person or by phone following treatment completion (post-treatment) and 
for their 3-month and 1 year follow-up. 
Participants in the two active treatment conditions will complete additional assessments 
at post-treatment, 3 month, and 1-year follow-up. The measures in those assessments 
will be counter-balanced, and will include: the Structured Clinical Interview for DSM-5 
(SCID5), Clinician Administered PTSD Scale for DSM-IV and DSM-5 (CAPS-IV/CAPS-
5), PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionaire-9 and -15 (PHQ-9, 
PHQ-15), Brief Pain Inventory (BPI), State-Trait Anger Expression Inventory -2 (STAXI-
2), Pittsburgh Sleep Quality Index (PSQI), Posttraumatic Cognitions Inventory (PTCI), 
Perth Emotional Reactivity Scale (PERS), The Future Scale (HOPE), Suicide/Homicide 
Screen (SI/HI Screen), and the Health Care Utilization (HCU).  
At the pre-assessment only will the following forms be included: a locator information 
form, a treatment preference questionnaire, the Montreal Cognitive Assessment 
(MOCA), and the Creative Imagination Scale (CIS). 
Participants in the two active treatment conditions will also be assessed by their 
clinician at each session with the PCL-5 and PHQ-9. Participant will complete the 
Expectancy of Therapeutic Outcome form at session #1. Participants will complete the 
Working Alliance Inventory (WAI-SR) at Session #2 and the Post-treatment 
assessment. Participants will also complete the HOPE and PSQI assessments at 
sessions #3 and #6.  
 

Page 18  
 
Table 2.0 Research Visit Schedule Grid 
 
Pre 
Session 
Post 
3 month 
1 year 
RedCap 
Survey 
Assessor 
Interview 
Locator 
Information Form 
X 
 
 
 
 
X 
 
Treatment 
Preference 
X 
 
 
 
 
X 
 
CIS 
X 
 
 
 
 
 
X 
MOCA 
X 
 
 
 
 
 
X 
Therapy 
Expectancy 
 
X (#1) 
 
 
 
X 
 
SI/HI Screen 
X 
 
X 
X 
X 
 
X 
HOPE 
X 
X (#3/6) 
X 
X 
X 
X 
 
CAPS-IV 
X 
 
X 
X 
X 
 
X 
CAPS-5 
X 
 
X 
X 
X 
 
X 
SCID-5 
X 
 
X 
X 
X 
 
X 
PCL-5 
X 
X 
X 
X 
X 
X 
 
PHQ-9 
X 
X 
X 
X 
X 
X 
 
PHQ-15 
X 
 
X 
X 
X 
X 
 
PERS 
X 
 
X 
X 
X 
X 
 
BPI 
X 
 
X 
X 
X 
 
X 
PSQI 
X 
X (#3/6) 
X 
X 
X 
X 
 
STAXI-2 
X 
 
X 
X 
X 
 
X 
PTCI 
X 
 
X 
X 
X 
X 
 
HCU 
X 
 
X 
X 
X 
X 
 
WAI-SR 
 
X (#2) 
 
 
 
X 
 
*Participants in the two active treatment conditions will also be assessed by their study 
therapist at each session, or the session number(s) indicated. 
 
VI. Participant Payment 
Participants may find the continued assessment burdensome, thus their reimbursement 
will increase for the 3-month and 1-year follow-up assessments by modest amounts in 
relation to the additional burden. The questionnaire assessments during treatment are 
brief, and are a standard part of clinical care, so participants will not be compensated.  
Table 3.0 Reimbursement Schedule for Study Participants 
Assessment 
Participant Payment ($) 
Baseline 
70 

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Posttreatment* 
75 
3-month follow-up 
85 
1 year follow-up 
100 
*Individuals in the WL condition will receive two post-treatment assessments (one after 
WL period and one after completion of either CPT or ART following WL period), and will 
thus receive an additional $75.00 for completion of the 2nd post-treatment assessment. 
 
Participants randomly assigned to CPT or ART will receive up to $330 in total 
compensation for their participation in this study. Participants randomly assigned to WL 
will receive up to $405 in total compensation for their participation in the study. 
Participants will be issued a debit card by the Greenphire ClinCard System. When a 
visit is completed funds will be approved and loaded onto the participants’ card. 
Participants will be issued one card for the duration of their participation. If a participant 
card is lost or stolen, they are instructed to call (866) 952-3795. An instruction sheet will 
be provided for further information. Greenphire and its Customer Support members will 
not have access to participant name or contact information; they will have a participant 
study ID number that will be provided to you by the study coordinator. Participants are 
able to use this study ID number to check the balance on their Greenphire debit card. 
 
VII. 
Delivery of Therapy 
A. Therapists: Two therapists at the UC Stress Center and 8 therapists at the 
Cincinnati VAMC, Trauma Recovery Center will perform all of the therapy. Therapists 
will be licensed clinical psychologists or licensed independent clinical social workers. 
Participants will be randomly assigned to therapist and then condition at both locations. 
Thus, all therapists will provide both therapies.  
B. Training:  Laney Rosenzweig and three ART trainers will come to the Cincinnati 
VAMC for a 3-day ART training of the 10 therapists. Dr. Chard will ensure that 
therapists are appropriately trained in CPT.  
C. Consultation: Laney Rosenzweig and her team will provide weekly phone 
consultation in ART. All study therapists have already achieved CPT Provider status. 

Page 20  
 
Dr. Chard will provide CPT consultation. Therapists will be approved as study therapists 
after Ms. Rosenzweig signs off on their abilities.  
D. Digital Audio Recordings: All therapy sessions will be digitally audio recorded for 
later adherence review. See Data and Safety Monitoring section for more information.  
E. Adherence and Competence Ratings: Dr. Kevin Kip and his team, (who are 
otherwise unaffiliated with the conduct or outcome of this study), at the University of 
South Florida will provide Adherence and Competence Ratings for ART on 10% of the 
total number of treatment cases.  
VIII. Data and Safety Monitoring 
Every effort will be made to maintain the confidentiality of participant study records. The 
University of Cincinnati will be allowed to inspect sections of participant medical and 
research records related to this study. The data from the study may be published; 
however, individual participants will not be identified by name. Participant identity will 
remain confidential unless disclosure is required by law.  
There are times when we may have to show participant records to people from the Food 
and Drug Administration, the Office of Human Research Protections, The General 
Accounting Office, the Office of the Inspector General, and the study monitors may look 
at or copy portions of records about participants. This information will not be shared 
unless requested via official channels from the offices with an appropriate rational for 
the request. 
A. Data Entry and Storage: A paid study coordinator and/or post-doctoral fellow will 
screen all potential participants over the phone. A paid research associate will enter 
assessment interview data for the study into RedCap. Each individual site for the study 
will maintain its own site-specific electronic database through REDCap.  All data will be 
identified by code number. The written interview assessment data will be stored in 
locked file cabinets that will be accessible only to study staff, located in room 3268.02 at 
UC and in room 204 for data collected at the Cincinnati VAMC, Trauma Recovery 
Center. At the end of the research study, data from both sites will be de-identified and 

Page 21  
 
combined into one large data set held by the Cincinnati VA Medical Center at the end of 
the research study. This combined data set will not include any identifying information. 
The key listing participant names and code numbers will be kept in an electronic file at 
each respective site on the S drive that is password protected and only accessible by 
study staff. During the study, records will be released to appropriate professionals only 
upon written consent by the participant. Destruction of all research records pertaining to 
this study will be in accordance with the Department of Veterans Affairs and University 
of Cincinnati record retention schedule. The electronic recordings of the assessments 
and sessions will be stored on the S drive in the University of Cincinnati system, or 
Cincinnati VA system depending on participant location assignment, with password 
protection accessible by study staff only. The electronic recordings will be uploaded to a 
secure DMZ sharepoint server that will be accessed by Dr. Kevin Kip and his team for 
adherence review. 
B. Certification of Confidentiality: To further protect participant privacy, the 
researchers will apply to obtain a Certificate of Confidentiality from the Department of 
Health and Human Services (DHHS), immediately following IRB approval. With this 
certificate, the researchers may not disclose information (for example by court order or 
subpoena) that may identify a participant in any federal, state, or local civil, criminal, 
administrative, legislative, or other proceedings. Disclosure will be necessary, however, 
upon request of DHHS for audit or program evaluation purposes. 
 
 

Page 22  
 
IX. References 
Barber, T. X., Wilson, S. C. (1978). The Barber Suggestibility Scale and the Creative 
Imagination Scale: Experimental and Clinical Applications. American Journal of 
Clinical Hypnosis, 21: 84-108. 
Becerra, R., Preece, D., Campitelli, G., & Scott-Pillow, G. (2017). The assessment of 
emotional reactivity across negative and positive emotions: Development and 
validation of the Perth Emotional Reactivity Scale (PERS). Assessment. doi: 
10.1177/1073191117694455 
Chard, K. M. (2005). An evaluation of cognitive therapy for the treatment of 
posttraumatic stress disorder related to childhood sexual abuse. Journal of  
Consulting and Clinical Psychology, 73, 965-971 
Chard,K. M., Ricksecker, E. G., Healy, E. T., Karlin, B E., & Resick, P. A. (2012). 
Dissemination and experience with cognitive processing therapy. Journal of 
Rehabilitation Research and Development, 49(5), 667-678 
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2015). Structured Clinical 
Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV). Arlington, VA, 
American Psychiatric Association. 
Foa, E. B., Ehlers, A., Clark, D. M., Tolin, D. F., and Orsillo, S. M. (1999). The 
Posttraumatic Cognitions Inventory (PTCI): Development and validation. 
Psychological Assessment, 11, 303-314. 
Hatcher, R. L. & Gillaspy, J. A. (2006) Development and validation of a 
revised short version of the working alliance inventory, Psychotherapy Research, 
16:1, 12-25, DOI:10.1080/10503300500352500 
Kip, K. E., Rosenzweig, L., Hernandez, D. F., et al., (2013). Randomized controlled trial 
of Accelerated Resolution Therapy (ART) for symptoms of posttraumatic stress 
disorder (PTSD). Military Medicine, 178, 1298-1309. 
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002). The PHQ-15: Validity of a new 
measure for evaluating the severity of somatic symptoms. Psychosomatic 
Medicine, 64(2), 258-266. DOI: 10.1097/00006842-200203000-00008 
Monson, C.M., Schnurr, P.P., Resick, P.A., Friedman, M.J., Young-Xu, Y., Stevens, S. 

Page 23  
 
P. (2006). Cognitive processing therapy for veterans with military-related 
posttraumatic stress disorder. Journal of consulting and clinical psychology, 
74(5), 898. 
Nasreddine, Z. S., Bedirian, V., Whitehead, V., & Cummings, J. L. (2005). The Montreal 
Cognitive Assessment MoCA: A brief screening tool for mild cognitive  
impairment. Journal of the American Geriatrics Society, 53, 695-699. DOI:  
10.1111/j.1532-5415.2005.53221.x 
Resick, P., Galovski, T., Uhlmansiek, M., Scher, C., Clum, G., & Young-Xu, Y. (2008). 
A randomized clinical trial to dismantle components of cognitive processing 
therapy for posttraumatic stress disorder in female victims of interpersonal 
violence. Journal of Consulting and Clinical Psychology, 76(2), 243-258. 
Snyder, C.R., Harris, C., et al. (1991).The will and the ways: Development and 
validation of an individual differences measure of hope. Journal of Personality 
and Social Psychology, 60, 585. 
Spielberger, C. D. (1999). STAXI-2: The State Trait Anger Expression Inventory 
professional manual. Odessa, FL: Psychological Assessment Resources. 
Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M. 
(2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). 
 
 
 
 
 
 
 
 
 

Page 24  
 
Appendix A. Script for weekly phone check-in calls by study staff for participants in the 
wait-list condition.  
CPT vs ART vs WL Study 
Weekly Check-in for WL Participants 
 
PARTICIPANT # __  __  __  __  __  __  
 
Week Number: 1   2   3   4   5   6   7 
 
 
 
Caller Initials: __________ 
Date/Time of call:________ 
Reached: Yes  No Rescheduled______________ Notes: 
___________________________ 
 
Caller Initials: __________ 
Date/Time of call:________ 
Reached: Yes  No Rescheduled______________ Notes: 
___________________________ 
 
Caller Initials: __________ 
Date/Time of call:________ 
Reached: Yes  No Rescheduled______________ Notes: 
___________________________ 
 
Caller Initials: __________ 
Date/Time of call:________ 
Reached: Yes  No Rescheduled______________ Notes:_______________________ 
 

Page 25  
 
 
[If machine] 
Good morning/afternoon. I am calling from the [Cincinnati VA Medical 
Center/University of Cincinnati] for Mr./Mrs. __________. Please give us a call 
back at your earliest convenience at (859) 572-6226 and leave us a message as to 
the best time and phone number to reach you. Thank you.  
[If a person]  
Hello. My name is _____________________ with the [Cincinnati VA Medical 
Center/University of Cincinnati]. May I please speak with Mr/Mrs/___________? 
[If No] 
May I leave a message for them? Please have him/her call back at this 
number  
(859) 572-6226 and leave a message as to the best time and phone number 
to reach them. Thank you. 
 
[If Yes] 
Hello Mr/Ms. __________________. I am calling from the CPT vs. ART vs. 
WL research study. We are scheduled to do our [first, second, etc.] of our 7 
weekly check-ins. As a reminder, the call usually takes about 15 minutes.  
Would you like to check-in now?  
 
[If no] 
What day/time later today or tomorrow would work well for you? 
[Schedule new call]. 
[If Yes]  
Ok, great. There are no right or wrong answers and we appreciate 
your taking the time to let us know how you are doing [complete 
check-in below] 
 
 
[General Check In]:  

Page 26  
 
Overall, have there been any changes in your PTSD symptoms compared to [your 
initial assessment/your last weekly check-in call]? 
 No, I feel about the same 
 Yes, my symptoms have improved 
 No, my symptoms have gotten worse 
 
[If worse]. Tell me more about that. What’s been different? [Obtain enough detail 
to inform research team whether an event might need to be reported as an AE and 
SAE, including dates/times of any incidents].  
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
________________________________ 
______________________________________________________________________
______________________________________________________________________
________________ 
[Medication Check]: 
Have there been any changes in your medications since [your initial 
assessment/your last weekly check-in call], including new medications, 
discontinued medications, and any dosing changes. 
 No  
 Yes [If yes, note changed medication(s), dosing, and date changed below, and 
inform research team] 
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________ 
[SI/HI Screen]: 
We’d like to ask you a few questions to check-in about your safety. Keep in mind 
that if we are concerned for your immediate safety or that of someone else, we 
may take steps to make sure you or that other person are safe.  
1. [Ideation] Do you have any thoughts of harming yourself right now?   
 

Page 27  
 
 No [Skip next two questions] 
 Yes  [What kind of thoughts have you had?]  
 
[Provide the following examples only if needed]. For example, some people have 
thoughts that they wish they were dead, and other people have thoughts of 
doing things to hurt themselves or end their lives. What thoughts like that 
have you had?  
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
_______________________. 
2. [Plan] Have you been thinking about how you might do this?  
 No  
 Yes  [Describe. Have you worked out any plan or details of how to kill 
yourself?] 
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
_______________________. 
3. [Intent] Do you intend to kill yourself?  
 No  
 Yes  [Describe] 
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
_______________________. 
4. Since the last assessment, have you made a suicide attempt or done anything 
to harm yourself?  
 No  
 Yes  [Describe] 
___________________________________________________________________
___________________________________________________________________

Page 28  
 
___________________________________________________________________
_______________________. 
********IF PARTICIPANT REPORTS YES TO QUESTIONS 2, 3, or 4 Conduct full 
Suicide Risk Assessment (SRA; included below). Document full SRA in 
participant electronic medical record.  
Is there anything else that you think it would be important for us to know?  
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________. 
What additional questions do you have? [Document any questions and answers 
provided]  
______________________________________________________________________
______________________________________________________________________
_______________. 
Is the best way to reach you still [confirm Phone number, Best Time to Reach, 
Address]. [Note any changes below and update participant contact] 
______________________________________________________________________
______________________________________________________________________
_______________. 
 [Weeks 1-6].  
Thank you so much. We really appreciate your taking the time to complete the 
weekly check-ins. If at any time, your symptoms get worse, you may contact our 
clinic staff at 859-572-6226. What day/time works for you to complete our next 
weekly check-in? 
[schedule next call]. Thank you and have a wonderful day/afternoon.  
[Week 7 only].  

Page 29  
 
We really appreciate your taking the time to complete the weekly check-ins. Since 
this is your last week, we’d like to schedule a time for you to come back to [The 
Cincinnati VA/The University of Cincinnati] to schedule your second pre-
treatment assessment. As a reminder, you will be compensated $75.00 for this 
assessment and, if you still qualify, you will be assigned to one of the two study 
treatments for PTSD. What day/time works for you to come in for the visit? 
[schedule assessment].  
______________________________________________________________________ 
SUICIDE RISK ASSESSMENT (SRA) [V7.0] 
The following questions are a guide to engaging a patient in an empathetic  
conversation about a difficult subject. Although there are items to check,  
suicide risk is best evaluated through a trusting relationship rather than  
simply relying on a checklist.  
 
1) Socio-demographic risk factors (check those that apply) 
  -Elderly      [  ]      -Unmarried [  ] 
  -White        [  ]      -Male      [  ] 
  -Living alone   [  ]  
  -Other: 
 
2) Stressors (check areas of stress) 
  -Poor Health (including chronic pain)      [  ]       
  -Financial  [  ] 
  -Family       [   ]      -Legal     [  ] 
  -Occupational [  ]      -Marital/sig. other [  ] 
  -Other: 
 
3) Other risk factors (check those that apply) 
  -Depression   [  ]      -ETOH or drug use   [  ] 
  -Anxiety or agitation [   ]    -Serious Mental Illness [  ] 
  -Other: 
  
4)  List Protective Factors, e.g. pt. has family support, wants to live to see his/her 
children to grow up, etc.   
- Family/friend support  [   ] 
- Sense of Belonging [  ] 
- Religious beliefs against suicide [  ] 
- Future oriented  [  ] 
- Provides reason to continue living [  ] 
- Other: 
 
5) Has the patient had thoughts about death or about killing him/herself? Yes [  ] No [  ] 
   (If yes, ask the following): 

Page 30  
 
  -Do you have a plan for how you would do this?  Yes [  ] No [  ] 
  -Are there means available? (e.g. a gun, pills) Yes [  ] No [  ] 
  -Explain:  
  -Have you actually rehearsed or practiced how you would like to kill yourself?    Yes [  ] 
No [  ] 
  -Do you tend to be impulsive?    Yes [  ] No [  ] 
  -How strong is your intent to do this?  
  -Have you heard voices telling you to hurt or kill yourself?    Yes [  ] No [  ] 
  -What kinds of things would increase a desire to end you life? 
  -What kinds of things would decrease a desire to end your life? 
 
6) Is there a history of previous suicide attempts by: 
   Yourself           Yes [  ] No [  ] 
   Family members     Yes [  ] No [  ] 
 
SUICIDE RISK ASSSESSMENT SUMMARY/CONCLUSION: 
The answers to the above questions can not be totaled for a score. Rather, they  
are a guide for formulating a clinical judgment. Based on your clinical  
judgment, using the information currently available, please check below as  
applicable) 
  A) There is no current risk of suicide           [  ] 
  B) There is less than imminent risk of suicide    [  ] 
  C) There is imminent risk of suicide           [  ] 
  
 Narrative explaining conclusion:  
 
SUICIDE PREVENTION PLAN  
  (A, B, and C are suggestions. Describe actual plan below) 
 Example A:  No current risk, no plan needed. 
 Example  B:  If there is less than imminent risk of suicide, develop a 
  treatment plan which may include some or all of these elements: 
    -Inform and involve someone close to the patient. 
    -Limit access to means of suicide. 
    -Arrange for increased contact with the patient. 
    -Make a commitment to help the patient through the crisis. 
    -Provide the patient/family with crisis telephone numbers, 
     e.g. 911 or the (SAMHSA) Veterans Crisis Line 1-800-273-TALK and "pressing 1". 
      Document that these numbers were given.  
Example C:  If there is an imminent risk of suicide, do not leave the patient alone.  
Arrange for psychiatric consultation or transfer to a hospital emergency room by escort, 
ambulance or police.  
   Note: patients who are hospitalized are given an additional assessment by the 
admitting physician to determine whether special precautions are indicated and level of 
observation needed. 
 
DESCRIBE suicide prevention plan (if indicated):  ______________________________ 

Page 31  
 
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Page 32  
 
Appendix B. Study Measures. 
Adult Hope Scale (HOPE; Snyder et al., 1991). This 12-item self-report measure 
when administered is labeled the “Future Scale”. Each item is assessed on an 8-point 
Likert scale. It is designed to measure cognitive strategies to meet a goal and 
motivation to achieve the goal.  
Brief Pain Inventory (BPI). This is a 14-item self-report measure of physical pain. 
Current, average, and worst pain is captured on a 10-point Likert scale. This measure 
also assess pain management and pain-related functional impairment.  
Clinician Administered PTSD Scale for DSM-IV and DSM-5 (CAPS-IV/CAPS-5; 
Weathers et al., 2013). PTSD diagnosis will be determined pre- and post- intervention 
by a trained clinician using the CAPS-IV/CAPS-5, in which the 20-item DSM-5 PTSD 
symptoms will be assessed. The CAPS-5 is considered the “gold standard” for PTSD 
assessment. Preliminary analyses from a Veteran sample at the Cincinnati VAMC 
Trauma Recovery Center suggest that this measure has demonstrated good internal 
consistency (α = .79). 
Creative Imagination Scale (CIS; Barber & Wilson, 1978). This is a measure of 
imaginative suggestibility that will be administered pre-treatment by the post-doctoral 
fellow in psychology. It is a widely used and accepted valid measure of suggestibility 
within the field of hypnosis research.  
Health Care Utilization (HCU). This is a 14-item self-report measure documenting to 
what extent a patient has utilized care, including participation in treatment including 
psychotherapy, medication management, and hospitalization.  
Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005). This is a brief, 10-
minute cognitive screening tool to assist clinicians in the detection of mild cognitive 
impairment. This measure has demonstrated good internal consistency (α = .83).  
Patient Health Questionaire-15 (PHQ-15). This is a 15-item self-report assessment of 
somatic symptoms designed for use in clinical practice and research. This measures 
demonstrated good internal reliability (α = .80) in primary care samples.  

Page 33  
 
Perth Emotional Reactivity Scale (PERS; Becerra et al., 2017). This is a 30-item self-
report questionnaire designed to measure emotional reactivity. Activation, intensity, and 
duration of a person’s emotional responses are measured separately for positive (e.g., 
happiness) and negative emotions (e.g., sadness). Internal reliability for general 
negative reactivity scale (α = .94) and general positive reactivity scale (α = .83) were 
excellent, with good fit indices for the subscales (α = .81-.89). 
Pittsburgh Sleep Quality Index (PSQI). This is a self-report measure designed to 
assess the quality and patterns of sleep in seven areas: subjective sleep quality, sleep 
latency, duration, habitual sleep efficiency, sleep disturbances, use of sleeping 
medications, and daytime dysfunction over the past month.  
Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999). This self-report 
measure is designed to assess cognitions following trauma(s). There are three factors 
within the PTCI, Negative Cognitions about the Self, Negative Cognitions about the 
World, and Self-Blame. This measure has demonstrated good internal consistency (α = 
.86 - .97) and test-retest reliability (P = .74 - .89). 
PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013). Participants will complete 
the PCL-5, a self-reported PTSD symptom severity measure, pre-, mid-, and post- 
intervention. The PCL-5 is comprised of 20 items on a four-point Likert scale that 
assess all DSM-5 PTSD symptoms. Preliminary analyses from a Veteran sample at the 
Cincinnati VAMC Trauma Recovery Center suggest that this measure has 
demonstrated good internal consistency (α = .88). 
State-Trait Anger Expression Inventory 2nd Edition (STAXI-2; Spielberger, 1999). 
The STAXI-2 is a 57-item assessment designed to measure anger from a state-trait 
personality perspective. The STAXI-2 is comprised of six scales and five subscales and 
each item is rated on a 4-point scale of anger intensity or frequency. Participants will 
complete this full measure pre-, mid-, and post- intervention.  The STAXI-2 has 
demonstrated good internal reliability (.81 to .91) and validity (α = .73-.84; Spielberger, 
Krasner, & Solomon, 1988; reviewed in Deffenbacher et al., 1996) and is one of the 
most commonly used measures of anger. 

Page 34  
 
Structured Clinical Interview for DSM-5 (SCID-5; First et al., 2015).  Diagnoses for 
any co-occurring mental disorders will be made pre- and post- intervention by a trained 
post-doctoral fellow in psychology using the SCID-5, a structured clinician interview 
designed to assess for the presence of DSM-5 disorders and aid in differential 
diagnoses.  
Expectancy of Therapeutic Outcome (Therapy Expectancy). This self-report 
assessment is completed a pre-treatment only, and assesses 4 participant expectancy-
related thoughts about the treatment program they have been assigned (e.g., “how 
logical does this type of treatment seem to you”?). This measure has been used in prior 
PTSD clinical trials.  
Treatment Preference. During the pre-treatment assessment, participants are given a 
brief overview of CPT and ART and are asked to indicate which treatment they prefer 
and how confident they are in their treatment preference on a 4-point Likert scale. This 
measure has been used in prior PTSD clinical trials. 
Twenty-Item Toronto Alexithymia Scale (TAS-20; Bagby, Parker, and Taylor, 1994). 
This 20-item self-report measure assesses difficulty identifying feelings, difficulty 
describing feelings, and externally-oriented thinking. This measure has demonstrated 
good internal reliability (α = .81) among a psychiatric sample.  
Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006). This 
12-item revised and shortened version of the Working Alliance Inventory (WAI) is a 
measure of working alliance between therapist and patient in three areas: goal, task, 
and bond. This measure has demonstrated excellent total score internal reliability (α = 
.91 - .92) and subscale internal reliability (α = .85 - .90). 
 
 
 
 

Page 35  
 
Appendix C. Randomization Tables. 
1. University of Cincinnati, UC Health Stress Center Site 
CPT/ART/WL Randomization Schedule 
University of Cincinnati Site 
Initial Randomization 1:1:1 
block 
identifier 
 block 
size 
 sequence  
within block 
 
treatment 
provider 
code 
Participant ID (02-####) 
5 
48 
1 WL 
VJ8 
5 
48 
2 CPT 
Honda 
QD7 
5 
48 
3 CPT 
Birkley 
XY8 
5 
48 
4 CPT 
Honda 
VN2 
5 
48 
5 CPT 
Birkley 
AA2 
5 
48 
6 CPT 
Honda 
HH2 
5 
48 
7 ART 
Honda 
BR1 
5 
48 
8 ART 
Birkley 
JC1 
5 
48 
9 ART 
Honda 
NB1 
5 
48 
10 ART 
Birkley 
QT5 
5 
48 
11 WL 
RG0 
5 
48 
12 CPT 
Birkley 
MO9 
5 
48 
13 WL 
AM0 
5 
48 
14 CPT 
Honda 
KX8 
5 
48 
15 WL 
CC0 
5 
48 
16 ART 
Honda 
CU6 
5 
48 
17 ART 
Birkley 
XX9 
5 
48 
18 CPT 
Birkley 
PW2 
5 
48 
19 CPT 
Honda 
EK9 
5 
48 
20 WL 
KQ3 
5 
48 
21 WL 
PH6 
5 
48 
22 ART 
Honda 
EM1 
5 
48 
23 WL 
DV2 
5 
48 
24 WL 
EP0 
5 
48 
25 WL 
SN1 
5 
48 
26 CPT 
Birkley 
LY3 
5 
48 
27 CPT 
Honda 
GA9 
5 
48 
28 CPT 
Birkley 
FN5 
5 
48 
29 WL 
DP9 
5 
48 
30 CPT 
Honda 
GD7 
5 
48 
31 ART 
Birkley 
EN6 
5 
48 
32 WL 
ZF6 
5 
48 
33 ART 
Honda 
GF7 

Page 36  
 
5 
48 
34 WL 
RF9 
5 
48 
35 ART 
Birkley 
HW4 
5 
48 
36 ART 
Honda 
KU9 
5 
48 
37 WL 
NK4 
5 
48 
38 CPT 
Birkley 
RD5 
5 
48 
39 WL 
JM6 
5 
48 
40 WL 
EM0 
5 
48 
41 ART 
Birkley 
XZ3 
5 
48 
42 CPT 
Honda 
YN8 
5 
48 
43 ART 
Honda 
OX8 
5 
48 
44 CPT 
Birkley 
WU4 
5 
48 
45 ART 
Birkley 
EE5 
5 
48 
46 WL 
KG0 
5 
48 
47 ART 
Honda 
NN5 
5 
48 
48 ART 
Birkley 
RJ2 
Wait-List Randomization 1:1 
block identifier 
 block size 
 sequence  
within block 
 
treatment 
provider 
 code 
Participant ID (02-####) 
6 
16 
1 CPT 
Honda 
VJ8-2 
6 
16 
2 ART 
Honda 
RG0-2 
6 
16 
3 CPT 
Birkley 
AM0-2 
6 
16 
4 CPT 
Honda 
CC0-2 
6 
16 
5 CPT 
Birkley 
KQ3-2 
6 
16 
6 CPT 
Honda 
PH6-2 
6 
16 
7 ART 
Birkley 
DV2-2 
6 
16 
8 CPT 
Birkley 
EP0-2 
6 
16 
9 ART 
Honda 
SN1-2 
6 
16 
10 ART 
Birkley 
DP9-2 
6 
16 
11 ART 
Honda 
ZF6-2 
6 
16 
12 CPT 
Honda 
RF9-2 
6 
16 
13 ART 
Birkley 
NK4-2 
6 
16 
14 CPT 
Birkley 
JM6-2 
6 
16 
15 ART 
Honda 
EM0-2 
6 
16 
16 ART 
Birkley 
KG0-2 
 
1. Cincinnati VA Medical Center, Trauma Recovery Center Site 
CPT/ART/WL Randomization 
Schedule 
Cincinnati VAMC Site 
Initial Randomization 1:1:1 

Page 37  
 
 block size 
 sequence within 
block 
 treatment 
provider 
 code 
Participant ID (01-
####) 
192 
1 WL 
RL7 
192 
2 CPT 
Bailey 
QL9 
192 
3 ART 
Bailey 
YU4 
192 
4 WL 
YJ1 
192 
5 WL 
OS5 
192 
6 CPT 
Dickstein 
UB6 
192 
7 CPT 
Klump 
ZR3 
192 
8 CPT 
McIlvain 
SC9 
192 
9 ART 
Dickstein 
AR3 
192 
10 CPT 
Mesa 
CP5 
192 
11 ART 
Klump 
CH6 
192 
12 ART 
McIlvain 
KY7 
192 
13 CPT 
Monroe 
WC7 
192 
14 WL 
JE6 
192 
15 ART 
Mesa 
AL2 
192 
16 CPT 
Pukay-
Martin 
LK7 
192 
17 ART 
Monroe 
SS5 
192 
18 CPT 
Simpson 
YR1 
192 
19 ART 
Pukay-
Martin 
OO3 
192 
20 CPT 
Bailey 
PD5 
192 
21 WL 
YH1 
192 
22 ART 
Simpson 
XA2 
192 
23 CPT 
Dickstein 
AT6 
192 
24 ART 
Bailey 
KA2 
192 
25 WL 
RW8 
192 
26 CPT 
Klump 
XV3 
192 
27 CPT 
McIlvain 
JA0 
192 
28 ART 
Dickstein 
ZZ0 
192 
29 WL 
KK2 
192 
30 WL 
GA9 
192 
31 WL 
ZE5 
192 
32 WL 
GA1 
192 
33 WL 
EY5 
192 
34 ART 
Klump 
FS9 
192 
35 CPT 
Mesa 
GM6 
192 
36 ART 
McIlvain 
SL6 
192 
37 ART 
Mesa 
VN7 
192 
38 ART 
Monroe 
MY6 
192 
39 CPT 
Monroe 
LY1 

Page 38  
 
192 
40 ART 
Pukay-
Martin 
CC7 
192 
41 ART 
Simpson 
UT0 
192 
42 CPT 
Pukay-
Martin 
RE4 
192 
43 CPT 
Simpson 
UW4 
192 
44 ART 
Bailey 
ZY6 
192 
45 WL 
YU5 
192 
46 ART 
Dickstein 
GC6 
192 
47 CPT 
Bailey 
OO6 
192 
48 CPT 
Dickstein 
AA0 
192 
49 ART 
Klump 
IF7 
192 
50 CPT 
Klump 
HQ1 
192 
51 CPT 
McIlvain 
OT2 
192 
52 ART 
McIlvain 
QI3 
192 
53 CPT 
Mesa 
AU7 
192 
54 ART 
Mesa 
VK8 
192 
55 ART 
Monroe 
BC7 
192 
56 WL 
SK9 
192 
57 WL 
ML1 
192 
58 WL 
LL9 
192 
59 WL 
SX5 
192 
60 ART 
Pukay-
Martin 
VK9 
192 
61 WL 
NG7 
192 
62 ART 
Simpson 
WC5 
192 
63 ART 
Bailey 
RI0 
192 
64 CPT 
Monroe 
DH0 
192 
65 ART 
Dickstein 
PF7 
192 
66 CPT 
Pukay-
Martin 
QI0 
192 
67 CPT 
Simpson 
DX3 
192 
68 WL 
NN5 
192 
69 CPT 
Bailey 
BJ1 
192 
70 WL 
AL4 
192 
71 WL 
QS8 
192 
72 WL 
KU7 
192 
73 ART 
Klump 
OP6 
192 
74 ART 
McIlvain 
PK6 
192 
75 CPT 
Dickstein 
UU9 
192 
76 CPT 
Klump 
ZU1 
192 
77 CPT 
McIlvain 
DI3 
192 
78 CPT 
Mesa 
ST9 
192 
79 CPT 
Monroe 
BD2 

Page 39  
 
192 
80 CPT 
Pukay-
Martin 
GF7 
192 
81 ART 
Mesa 
YJ0 
192 
82 CPT 
Simpson 
QN4 
192 
83 WL 
BR0 
192 
84 WL 
OS7 
192 
85 ART 
Monroe 
MY3 
192 
86 WL 
WY7 
192 
87 CPT 
Bailey 
SM0 
192 
88 WL 
RI3 
192 
89 WL 
KM5 
192 
90 WL 
MW9 
192 
91 ART 
Pukay-
Martin 
KQ0 
192 
92 WL 
BJ8 
192 
93 WL 
HA2 
192 
94 WL 
BY7 
192 
95 WL 
CD2 
192 
96 ART 
Simpson 
PM4 
192 
97 ART 
Bailey 
UO3 
192 
98 ART 
Dickstein 
XC0 
192 
99 CPT 
Dickstein 
TQ0 
192 
100 CPT 
Klump 
EW8 
192 
101 WL 
QI8 
192 
102 WL 
CN8 
192 
103 WL 
CC5 
192 
104 WL 
RT3 
192 
105 ART 
Klump 
KE9 
192 
106 CPT 
McIlvain 
OK4 
192 
107 ART 
McIlvain 
FO6 
192 
108 WL 
DQ4 
192 
109 WL 
OP1 
192 
110 ART 
Mesa 
OY4 
192 
111 ART 
Monroe 
DK3 
192 
112 CPT 
Mesa 
UB5 
192 
113 CPT 
Monroe 
US0 
192 
114 CPT 
Pukay-
Martin 
NX6 
192 
115 WL 
VS6 
192 
116 ART 
Pukay-
Martin 
NA6 
192 
117 CPT 
Simpson 
KZ5 
192 
118 ART 
Simpson 
ZE2 
192 
119 CPT 
Bailey 
WG0 

Page 40  
 
192 
120 CPT 
Dickstein 
XZ8 
192 
121 WL 
IF9 
192 
122 WL 
HO4 
192 
123 ART 
Bailey 
RE2 
192 
124 CPT 
Klump 
MR3 
192 
125 WL 
JA7 
192 
126 WL 
ZG0 
192 
127 ART 
Dickstein 
TI8 
192 
128 CPT 
McIlvain 
HN6 
192 
129 CPT 
Mesa 
WW2 
192 
130 CPT 
Monroe 
WL6 
192 
131 WL 
WL8 
192 
132 ART 
Klump 
QQ1 
192 
133 WL 
EW9 
192 
134 CPT 
Pukay-
Martin 
MC4 
192 
135 CPT 
Simpson 
WF0 
192 
136 WL 
HO6 
192 
137 WL 
WT1 
192 
138 ART 
McIlvain 
BI4 
192 
139 CPT 
Bailey 
KU2 
192 
140 WL 
JE8 
192 
141 ART 
Mesa 
CC9 
192 
142 WL 
SM9 
192 
143 CPT 
Dickstein 
RX7 
192 
144 WL 
WL0 
192 
145 WL 
BB2 
192 
146 WL 
VE0 
192 
147 ART 
Monroe 
LO2 
192 
148 WL 
IK7 
192 
149 CPT 
Klump 
PN3 
192 
150 ART 
Pukay-
Martin 
LD4 
192 
151 ART 
Simpson 
OA5 
192 
152 WL 
PN4 
192 
153 CPT 
McIlvain 
KY5 
192 
154 WL 
KW6 
192 
155 WL 
WO2 
192 
156 WL 
IP0 
192 
157 ART 
Bailey 
CJ0 
192 
158 CPT 
Mesa 
BV2 
192 
159 CPT 
Monroe 
GH7 
192 
160 WL 
PW4 

Page 41  
 
192 
161 WL 
SK5 
192 
162 ART 
Dickstein 
RT4 
192 
163 ART 
Klump 
BT7 
192 
164 CPT 
Pukay-
Martin 
RQ3 
192 
165 WL 
FX7 
192 
166 WL 
JQ3 
192 
167 CPT 
Simpson 
QU5 
192 
168 CPT 
Bailey 
DU1 
192 
169 ART 
McIlvain 
LL1 
192 
170 WL 
HT1 
192 
171 CPT 
Dickstein 
DM6 
192 
172 CPT 
Klump 
VL1 
192 
173 ART 
Mesa 
GF4 
192 
174 ART 
Monroe 
XG0 
192 
175 CPT 
McIlvain 
BV8 
192 
176 WL 
VE1 
192 
177 ART 
Pukay-
Martin 
PD2 
192 
178 ART 
Simpson 
GH1 
192 
179 CPT 
Mesa 
NY2 
192 
180 WL 
NR3 
192 
181 ART 
Bailey 
BW2 
192 
182 ART 
Dickstein 
XW9 
192 
183 WL 
DS8 
192 
184 ART 
Klump 
BY1 
192 
185 ART 
McIlvain 
ZC4 
192 
186 CPT 
Monroe 
KE6 
192 
187 CPT 
Pukay-
Martin 
VS9 
192 
188 ART 
Mesa 
JI8 
192 
189 ART 
Monroe 
YY5 
192 
190 ART 
Pukay-
Martin 
EB5 
192 
191 CPT 
Simpson 
FM0 
192 
192 ART 
Simpson 
RG5 
Wait-List Randomization 1:1 
block 
identifier 
 block 
size 
 sequence within 
block 
 
treatment provider 
 code 
Participant ID (01-
####) 
4 
64 
1 ART 
Bailey 
RL7-2 
4 
64 
2 CPT 
Bailey 
YJ1-2 
4 
64 
3 ART 
Dickstein 
OS5-2 
4 
64 
4 ART 
Klump 
JE6-2 
4 
64 
5 ART 
McIlvain 
YH1-2 

Page 42  
 
4 
64 
6 CPT 
Dickstein 
RW8-2 
4 
64 
7 CPT 
Klump 
KK2-2 
4 
64 
8 CPT 
McIlvain 
GA9-2 
4 
64 
9 CPT 
Mesa 
ZE5-2 
4 
64 
10 CPT 
Monroe 
GA1-2 
4 
64 
11 CPT 
Pukay-
Martin 
EY5-2 
4 
64 
12 ART 
Mesa 
YU5-2 
4 
64 
13 CPT 
Simpson 
SK9-2 
4 
64 
14 ART 
Monroe 
ML1-2 
4 
64 
15 ART 
Pukay-
Martin 
LL9-2 
4 
64 
16 CPT 
Bailey 
SX5-2 
4 
64 
17 ART 
Simpson 
NG7-2 
4 
64 
18 CPT 
Dickstein 
NN5-2 
4 
64 
19 CPT 
Klump 
AL4-2 
4 
64 
20 CPT 
McIlvain 
QS8-2 
4 
64 
21 ART 
Bailey 
KU7-2 
4 
64 
22 CPT 
Mesa 
BR0-2 
4 
64 
23 CPT 
Monroe 
OS7-2 
4 
64 
24 ART 
Dickstein 
WY7-2 
4 
64 
25 ART 
Klump 
RI3-2 
4 
64 
26 CPT 
Pukay-
Martin 
KM5-2 
4 
64 
27 CPT 
Simpson 
MW9-
2 
4 
64 
28 CPT 
Bailey 
BJ8-2 
4 
64 
29 ART 
McIlvain 
HA2-2 
4 
64 
30 ART 
Mesa 
BY7-2 
4 
64 
31 ART 
Monroe 
CD2-2 
4 
64 
32 ART 
Pukay-
Martin 
QI8-2 
4 
64 
33 ART 
Simpson 
CN8-2 
4 
64 
34 CPT 
Dickstein 
CC5-2 
4 
64 
35 CPT 
Klump 
RT3-2 
4 
64 
36 ART 
Bailey 
DQ4-2 
4 
64 
37 ART 
Dickstein 
OP1-2 
4 
64 
38 CPT 
McIlvain 
VS6-2 
4 
64 
39 CPT 
Mesa 
IF9-2 
4 
64 
40 CPT 
Monroe 
HO4-2 
4 
64 
41 ART 
Klump 
JA7-2 
4 
64 
42 CPT 
Pukay-
Martin 
ZG0-2 
4 
64 
43 CPT 
Simpson 
WL8-2 

Page 43  
 
4 
64 
44 ART 
McIlvain 
EW9-2 
4 
64 
45 ART 
Mesa 
HO6-2 
4 
64 
46 ART 
Monroe 
WT1-2 
4 
64 
47 CPT 
Bailey 
JE8-2 
4 
64 
48 CPT 
Dickstein 
SM9-2 
4 
64 
49 ART 
Pukay-
Martin 
WL0-2 
4 
64 
50 CPT 
Klump 
BB2-2 
4 
64 
51 CPT 
McIlvain 
VE0-2 
4 
64 
52 ART 
Simpson 
IK7-2 
4 
64 
53 CPT 
Mesa 
PN4-2 
4 
64 
54 ART 
Bailey 
KW6-2 
4 
64 
55 ART 
Dickstein 
WO2-2 
4 
64 
56 ART 
Klump 
IP0-2 
4 
64 
57 ART 
McIlvain 
PW4-2 
4 
64 
58 ART 
Mesa 
SK5-2 
4 
64 
59 ART 
Monroe 
FX7-2 
4 
64 
60 CPT 
Monroe 
JQ3-2 
4 
64 
61 ART 
Pukay-
Martin 
HT1-2 
4 
64 
62 CPT 
Pukay-
Martin 
VE1-2 
4 
64 
63 ART 
Simpson 
NR3-2 
4 
64 
64 CPT 
Simpson 
DS8-2