Behavioral Activation + Cognitive Processing Therapy for PTSD and Comorbid MDD

Major depressive disorder (MDD) is the psychological condition most commonly comorbid with
posttraumatic stress disorder (PTSD). PTSD and MDD comorbidity is associated with greater
symptom severity, lower levels of functioning, greater disability, and increased suicide
potential relative to PTSD or MDD alone. Unfortunately, no psychological treatment
intervention specifically addresses this comorbidity. Individuals with comorbid PTSD and MDD
often receive evidence-based treatments for PTSD, such as cognitive processing therapy (CPT);
although such treatments typically reduce both PTSD and depression symptoms, few studies have
specifically examined these outcomes in individuals with PTSD and comorbid MDD. The primary
goal of this randomized controlled trial is to evaluate whether greater improvement in
depression symptoms can be achieved by augmenting CPT with behavioral activation (BA), a
standard depression treatment, for active-duty service members with PTSD and comorbid MDD.
Participants will be evaluated at three assessment time-points (pre-treatment,
post-treatment, and three-month follow-up), as well as complete self-report measures of PTSD
and MDD symptoms at each therapy session.

Inclusion Criteria:

- Active-duty service member seeking mental health treatment at Naval Medical Center San
Diego (NMCSD), branch clinics, or Naval Hospital Camp Pendleton (NHCP)

- Meet current diagnostic criteria for PTSD based on the DSM-5 as a consequence of any
index traumatic event (e.g., combat, military sexual trauma, child abuse, accidents,
etc.)

- Meet current diagnostic criteria for MDD based on DSM-5 criteria.

Exclusion Criteria:

- Unmanaged psychosis or manic episode in the past year

- Substance use disorder warranting primary substance use treatment or detoxification

- Participation in concurrent psychotherapies directly targeting PTSD

- Participation in concurrent psychotherapies directly targeting depression