Helping Veterans Using Cognitive Processing Therapy (CPT) and Research on Linguistic Themes in the DSM and Artificial Intelligence’s Accuracy in Diagnosis

In this episode, I speak with Matt about his work with veterans, PTSD and his research on AI's ability to diagnose mental health disorders. Matt explained that he got into the field of psychotherapy after being a patient, working through his own issues after being in the Marines. He found the process very helpful and went on to become a therapist and initially worked with unhoused populations, psychosis and gang young, but wanted to go into working with veterans and first responders, treating PTSD. He shared that he never intended to go into research, but after doing his dissertation, he thought he might as well publish it, and then was invited to be part of a research group. Matt shared that most of the treatment for veterans is provided by the Veteran’s Administration, although they did not hire clinicians with his licensure. He explained that he was fortunate to get connected with an organization called the Head Strong Project that provides services to active duty military and veterans addressing PTSD and suicide prevention. He said that many of his clients often have a history of trauma, in addition to their experience in the military, as well as around 50% of his clients also have comorbid ADHD. Matt discusses the three major evidence based approaches to treating trauma: Prolonged Exposure (PE), Cognitive Processing Therapy, & Eye Movement Desensitization Reprocessing. He shares how the dropout rate for PE is 40% and EMDR is not always successful, which might be due to the eye movements and that not being as effective with those in the military, although he doesn’t know any research backing that up. Matt explained that he uses CPT and in the approach, the focus is on beliefs or what they refer to as “stuck points”. There may be assimilated “stuck points" that the person has taken from the traumatic experience and over accommodated "stuck points”< which are things that the person now believes and has adjusted their thinking patters as a result of the trauma. He explains the treatment starts off with psycheducation and teaching coping skills, then addressing the “stuck points”. He explained that they help the clients break down thinking patterns from events, then usechallenging questions, identify cognitive distortions, use cognitive reframing, and put this all together into a challenging questions worksheet. He shared that once you have that framework in place, then you follow up on five themes which include: Safety, Trust, Power & Control, Esteem, and Intimacy, then work through stuck points in each of those areas. Finally, you work through the traumatic narrative and what you believed before and what you believe now. We discussed the five themes and how particularly discussed an intervention called the Trust Star, where the person picks aspects of someone’s personality, and rates how that leads them to be more trusting of them or less. The breaks out of the all or none thinking around trust. Lastly, we discuss Matt’s research into linguistic patterns in different DMS disorders throughout the various editions of the DSM. He also discusses his work group’s research into having AI review vignettes and try to arrive at a diagnosis. He reported that Chat GPT did worse than chance, Claude was about as good as chance, and Gemini had a 97% rate of accuracy. We discuss AI and its use related to therapy.
Matt Rensi, Ph.D., LPCC, is a licensed counselor in California, Oregon, and Idaho. He holds a Ph.D. in counselor education and supervision, often teaching at various universities. He currently works primarily with law enforcement, veterans, firefighters, and active duty military personnel. His primary focuses are PTSD, substance use, ADHD, marital or couples issues, and anything that may be associated with that cluster of struggles. Matt conducts research on various topics as part of an independent research team. He is a clinical partner with The Headstrong Project and the SOF Network. Matt is also a clinician at the Institute for the Advancement of Psychotherapy and its specialty center, the Bay Area Center for ADHD.