Recruitment consisted primarily of mailings to veterans with a diagnosis of PTSD who received VA care, as identified via VA databases. A telephone screen was followed by a 2-hour in-person baseline assessment. Twelve cohorts of 10 to 21 veterans were randomized every 3 to 4 months from September 24, 2014, to February 5, 2018. Figure 1 illustrates recruitment and retention. Participants completed assessments at posttreatment and 3-month and 6-month follow-ups and received $20 to $50 for each assessment.

CPT indicates cognitive processing therapy; LKM, loving-kindness meditation; MBSR, mindfulness-based stress reduction.

Random permuted block randomization (blocks of 2, 4, or 6 individuals) stratified by symptom severity per the Clinician-Administered PTSD Scale (CAPS-5, score ≥37) with masked allocation using sequentially numbered opaque envelopes was performed. The CAPS-5 score was calculated by summing severity scores for the 20 DSM-5 PTSD symptoms. A symptom was considered present if the severity was 2 (moderate) or higher. A PTSD diagnosis required at least 1 symptom for both criteria B and C, at least 2 symptoms for both criteria D and E, and meeting criteria F and G. A staff member not involved in recruitment constructed randomization lists using the random number generator feature of Excel (Microsoft Corp).27

Loving-kindness meditation groups were co-led by 2 community meditation teachers with experience teaching mindfulness and loving-kindness meditation to veterans. A study team member (D.J.K.) with experience teaching loving-kindness meditation provided supervision. CPT groups were co-led by 2 master’s-level therapists who had completed training and certification in CPT through the VA. They received supervision by an experienced CPT national trainer.

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