Zoe Brier, Isobel Rosenthal, & Kathleen Chard
March 17, 2026
About 90% of people in the United States experience a traumatic event in their lifetime, and a significant number of those exposed to trauma go on to develop PTSD (Kilpatrick et al., 2013). Cognitive Processing Therapy (CPT; Resick et al., 2024), an evidence-based PTSD treatment, is considered a gold standard treatment for PTSD and has decades of research to support its effectiveness in multiple trauma-exposed populations. CPT works to target the changes in beliefs about themselves, other people, and the world that people often experience after a traumatic event. CPT helps patients identify and think differently about these beliefs. Treatment consists of 7-15 sessions, typically delivered once per week. However, this format often leads to patient dropout due to therapy-related and practical barriers (Hundt et al., 2020).
What is Massed Treatment?
Massed treatment is a form of accelerated psychotherapy in which sessions are delivered multiple times per week, rather than a traditional once per week format. Massed PTSD treatments have multiple benefits over traditional treatments, including lower dropout rates and faster patient recovery times. However, massed PTSD treatment has been studied in limited settings, including with Veterans and active-duty service members and in residential treatment centers (Goetter et al., 2021; Held et al., 2020, 2021). CPT when delivered in a massed format has demonstrated lower dropout rates than traditionally delivered CPT, in which massed CPT has dropout rates of 10% and traditional CPT has a dropout rate of 34% (Varker et al., 2021). However, studies evaluating massed CPT on a larger scale have not been conducted in civilian populations.
Nema Health
This study examines data from a commercial telehealth platform, Nema Health (Branford, CT). Nema Health is a virtual telehealth platform which offers massed CPT for PTSD for individuals with all types of trauma exposure. Nema is currently available in 10+ states, and services are reimbursed by major insurance carriers, workers' compensation, or self-pay options. Patients are referred by providers or can self-refer to Nema services. This study examined PTSD, depression, and anxiety symptoms over the course of massed CPT and over 3 months following completion of intensive treatment. Patients in the study engaged in treatment sessions at least 3 times per week. Patients had significant decreases in PTSD symptoms from their initial intake appointment to discharge with a large effect size, and almost all patients were below the clinical cutoff for probable PTSD symptoms. Patients also experienced significant decreases in depression and anxiety symptoms post-treatment. These symptom improvements were maintained over the course of 3 months following completion of massed CPT. Additionally, approximately 14% of patients did not complete massed treatment.
What Does This Mean for the Future of Massed PTSD Treatment?
Massed CPT for PTSD can be delivered effectively at a large scale with civilian patients who have experienced all different trauma types. Patients can receive beneficial and evidence-based treatment over an accelerated time period, thereby allowing patients to experience relief from their symptoms faster. Further, dropout rates were lower than those of traditional CPT at 14%, compared to 34%.
Commercially available telehealth platforms like Nema can deliver safe and effective massed treatment while still adhering to a treatment protocol and potentially reduce some of the barriers that in-person clinics may encounter when offering accelerated treatment options. Patients can engage in treatment all over the US and reduce their time to recovery from PTSD.
Discussion Questions
- What barriers to treatment may still exist for patients to engage in massed treatments that may be unique from traditionally delivered PTSD treatments?
- Which patients may respond better to or be more likely to pursue a massed treatment option?
- What are ways that providers can educate insurance companies about massed treatment that may increase access to accelerated treatment options?
About the Authors
Zoe Brier, PhD is a Staff and Research Psychologist at Nema Health and licensed clinical psychologist. Her research focuses on increasing availability of and access to evidence-based PTSD treatments.
Adrienne (Isobel) Rosenthal, MD, MBA is an adult, child, and adolescent psychiatrist. She is the co-founder and Chief Medical Officer at Nema Health, a virtual clinic that offers intensive PTSD treatment. She is a Clinical Instructor in the Department of Psychiatry at Yale School of Medicine. She has contributed to numerous publications including the Washington Post, Vogue, and Scientific American.
Kathleen Chard, PhD is the Associate Chief of Staff for Research and Director of Trauma Recovery Center at the Cincinnati VA Medical Center and a Professor of Clinical Psychiatry and Director of the UC Health Stress Center at the University of Cincinnati. Dr. Chard is an international expert on the assessment and treatment of stress-related disorders including PTSD. She is co-author of the Cognitive Processing Therapy PTSD treatment manual.
Nema Health Social Media:
LinkedIn: https://www.linkedin.com/company/nema-health/
Instagram: @nemahealth
Website: https://nemahealth.com
Reference Article
Baez L, Huberty J, Yourell J, Jewell C, Lin E, Kaysen D, Cutts L, Noori S, Rosenthal I, Chard K. Effectiveness of massed cognitive processing therapy for posttraumatic stress disorder: A retrospective analysis. J Trauma Stress. 2026 Jan 19. doi: 10.1002/jts.70045. Epub ahead of print. PMID: 41555687.
References
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Hundt, N. E., Ecker, A. H., Thompson, K., Helm, A., Smith, T. L., Stanley, M. A., & Cully, J. A. (2020). “It didn’t fit for me:” A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans. Psychological Services, 17(4), 414–421. https://doi.org/10.1037/ser0000316
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Resick, P. A., Monson, C. M., & Chard, K. M. (2024). Cognitive Processing Therapy for PTSD: A Comprehensive Therapist Manual. Guilford Publications.
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