Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Tara E. Galovski, PhD


Peterson, Zoe

Williams, Amy

Wilcox, Natalie


Despite advancements in the field of trauma-focused treatment, a close examination of the literature reveals three concerns. First, a significant number of RCT participants either do not respond to treatment or drop out prematurely. Second, despite significant dissemination of evidence-based interventions, fidelity to those interventions beyond trainings is not well understood. And finally, the effectiveness of trauma-focused interventions in the “real-world” community setting remains unclear. Literature suggests that identification of key treatment components could help to address these three concerns. This study focused on one evidence-based treatment in particular, Cognitive Processing Therapy (CPT), and aimed to extend the current literature by first expanding the existing CPT fidelity rating system to assess theorized CPT critical components and second, by examining the influence of treatment fidelity on symptom change and attrition rates. Results showed that overall fidelity to specific treatment components did not predict PTSD symptom change, newly added CPT fidelity rating system items did not add predictive value over the original items, and neither fidelity to individual theorized critical components nor fidelity to nonspecific treatment components predicted symptom change. Additionally, treatment completers and dropouts did not differ significantly on most fidelity scores. Overall fidelity to the CPT protocol was high in this sample. Further exploration of the relationships amongst therapist fidelity, nonspecific factors, and treatment outcome is indicated.

OCLC Number


Included in

Psychology Commons