Cognitive Therapy and Research

, Volume 42, Issue 6, pp 735–746 | Cite as

Is Integrated CBT Effective in Reducing PTSD Symptoms and Substance Use in Iraq and Afghanistan Veterans? Results from a Randomized Clinical Trial

  • Christy CaponeEmail author
  • Candice Presseau
  • Elizabeth Saunders
  • Erica Eaton
  • Jessica Hamblen
  • Mark McGovern
Original Article


This study is the first to examine integrated cognitive behavioral therapy (ICBT) in a sample of military veterans with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Generalized linear mixed models were used to examine primary outcomes from a small, randomized clinical trial comparing ICBT plus treatment as usual (TAU) to TAU only in a sample (N = 44) of U.S. veterans who served in Iraq and/or Afghanistan. A significant reduction in PTSD and SUD symptoms over time was detected in both conditions. One significant time-by-condition interaction effect for re-experiencing symptoms was observed, with ICBT showing greater reductions from baseline to post-treatment. Overall, the efficacy of ICBT in this veteran sample was not as robust as outcomes with non-veteran patients. Challenges to engagement and retention in treatment and further intervention adaptations for veterans are discussed.


Posttraumatic stress disorder Substance use Veterans Cognitive behavioral therapy Treatment outcomes 



This study was funded by the National Institute on Drug Abuse (NIDA; Grant R01DA030102).

Compliance with Ethical Standards

Conflict of interest

Christy Capone, Candice Presseau, Elizabeth Saunders, Erica Eaton, Jessica Hamblen and Mark McGovern declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Providence VA Medical CenterProvidenceUSA
  2. 2.Department of Psychiatry and Human BehaviorBrown UniversityProvidenceUSA
  3. 3.Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare SystemBostonUSA
  4. 4.The Dartmouth Institute (TDI) for Health Policy and Clinical PracticeLebanonUSA
  5. 5.National Center for PTSDWhite River JunctionUSA
  6. 6.Stanford University School of MedicinePalo AltoUSA

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