Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial

Abstract

Background: Peer-supported mobile health (mhealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement into care, there is limited investigation about the impact of peers on symptom outcome. Trauma-exposed populations frequently suffer from co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported transdiagnostic mhealth program on symptom outcomes and functioning.Objective: This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) webSTAIR, an abbreviated transdiagnostic online program derived from Skills Training in Affective and Interpersonal Regulation (STAIR) compared to waitlist control in a community sample of Veterans who screened positive for either post-traumatic stress disorder (PTSD) and/or depression.Methods: A total of 178 eligible Veterans were enrolled in the study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to the waitlist control. PTSD and depressive symptoms as well as emotion regulation, and psychosocial functioning were assessed via phone at pretreatment, posttreatment, and 8-week follow-up. Mixed-effects models were used to assess change in outcome measures across timepoints and evaluate the impact of module completion on outcomes. Exploratory analyses were conducted to determine whether number and type of peer interactions influenced outcomes.Results: Participants randomized to BPS webSTAIR reported significantly greater improvement on all outcome measures at posttreatment compared to the waitlist control (d=-0.48 to -0.64), and gains were maintained at 8-week follow-up. Those who completed more modules reported greater improvement on all outcomes (d=-0.64 to -0.83). An initial cohort of participants who were required to chat with a peer coach to progress exchanged more messages per module but were less likely to complete the program, compared to a later cohort for whom chatting was optional.Conclusions: BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in Veterans. Peer-supported transdiagnostic mhealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Future research should evaluate how best to deliver peer support, how much to deliver, and for whom the support benefits most. Clinical Trial: ClinicalTrials.gov NCT04286165