Page 101 - JSOM Spring 2026

Case Context phone, tablet, laptop, or desktop computer). Exclusionary cri-
teria include unstable housing, non-independent activities of
This case report describes treatment completed at an acceler- daily living, suicide attempt within 30 days, untreated psycho-
ated treatment program (ATP) for PTSD in Chicago, IL. This sis or mania, or substance use dependence.
program offers two formats of massed treatments for PTSD: 1)
an in-person format offering individual sessions and a mixture
of groups and adjunctive services or 2) a virtual, stand-alone Case Description and Formulation
treatment format offered via the Interjurisdictional Practice The patient is a 40-year-old married White male SOF Officer
of Psychology compact (PSYPACT). In this case report, the with high religiosity. He sought treatment after experiencing
Servicemember selected the virtual format, which involved 16 an indirect trauma exposure via live-stream drone AV feed
sessions of CPT meeting twice daily for most days, Monday during a combat mission involving an ambush of a unit that he
through Friday for 2 weeks (see Table 1 for schedule of treat- advised and trained 2 years prior to seeking treatment. The pa-
ment). Previous research has demonstrated that virtual and tient was referred by his embedded mental health provider and
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massed CPT is acceptable and effective. The in-person ATP has had no duty restrictions from intake to treatment completion.
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been rigorously studied and described in other publications. 16 After completing an intake process, the patient met criteria for
PTSD (CAPS-5 total score = 49) and recurrent major depres-
Military Servicemembers and Veterans interested in this ATP sive disorder. He had a limited mental health treatment history,
must complete a multi-component intake process, involving noting that he had not completed a trauma-focused EBP and
a biopsychosocial evaluation, an assessment of PTSD using had no history of psychopharmacological interventions.
a structured interview via the Clinician Administered PTSD
Scale for DSM-5 (CAPS-5), and completion of self-reported During his intake, the patient endorsed several cognitions
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measures to determine program eligibility and suitability. consistent with moral injury. For instance, he endorsed blame-
For this study, the Posttraumatic Stress Disorder Checklist-5 related beliefs positing that he failed to adequately prepare the
Checklist (PCL-5) and Patient Health Questionnaire-9 team for the ambush (“If I had done a better job planning
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(PHQ-9) surveys were used to measure PTSD and depres- the mission, they would still be alive”). In this case, he per-
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sion severity before, during, and after treatment. The PCL-5 ceived that he failed to meet a professional standard. He also
is a 20-item measure of PTSD severity in which respondents struggled with faith-based beliefs, such as “Why does God give
rate how much they are bothered by each symptom using a others what they pray for, but still lets these things happen?”
5-point Likert scale (0 = not at all; 4 = extremely). Total scores Given the patient’s strong faith and religious background, spir-
on the PCL-5 range from 0 to 80 with high scores indicating itual counseling was offered as part of the treatment plan. This
higher severity. The PHQ-9 is a 9-item scale assessing depres- session was conducted by a Chaplain staff member who typ-
sion severity, inviting respondents to rate how frequently their ically provides spiritual care for the in-person program. The
symptoms have bothered them within the last 2 weeks using a patient consented to add one counseling session to his treat-
4-point Likert scale (0 = not at all; 3 = every day). ment plan to support the exploration of moral and existential
concerns (week 1, Wednesday; see Table 1).
Acceptance requires a confirmed PTSD diagnosis. For the vir-
tual format, eligibility requires residence/physical present in Course of Treatment
a PSYPACT member state during treatment, access to stable The patient completed all sessions and practice assignments
internet, and a serviceable video-capable device (e.g., mobile between sessions throughout the treatment. During the first

TABLE 1 Schedule and Pacing of Treatment
Week Day Session number Session content
1 1 Overview of PTSD and CPT
Monday
2 Examine impact of trauma
3 Monitoring relationship between thoughts and emotions
Tuesday
4 Examining index event by exploring questions
5 Practice with exploring questions
Wednesday
* Spiritual counseling session
6 Identifying patterns of thinking
Thursday
7 Identifying alternative beliefs and introduction to themes
8 Practice identifying alternative beliefs
Friday
9 Practice identifying alternative beliefs
2 10 Practice identifying alternative beliefs
Monday
11 Practice identifying alternative beliefs
12 Practice focused on safety
Tuesday
13 Practice focused on power/control
Wednesday 14 Practice focused on esteem
15 Practice focused on intimacy
Thursday
16 Review final impact statement
Friday 17 Termination
*Non-CPT session.
CPT = cognitive processing therapy; PTSD = posttraumatic stress disorder.

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