Feasibility of an intensive outpatient treatment program for posttraumatic stress disorder within the veterans health care administration.

Abstract

Trauma-focused treatments for posttraumatic stress disorder (PTSD), such as Prolonged Exposure (PE) therapy and Cognitive Processing Therapy (CPT), are effective and supported by various Clinical Practice Guidelines; however, drop-out rates for the treatments are as high as 40% within clinical programs. One promising solution is delivering the evidence-based psychotherapies (EBPs) three or more times per week within an intensive outpatient program (IOP) for PTSD. The present study examined the feasibility and effectiveness of a relatively low-resourced PTSD IOP within a larger PTSD program at the Veterans Healthcare Administration. The intensive program offers two tracks (2 week or 4 week) grounded in the massed delivery of PE and CPT. Over a 12-month period, 351 veterans completed an assessment for PTSD and 172 started within one of the local PTSD programs (e.g., weekly, IOP, or residential). Results of the study demonstrated that the IOP is an acceptable (i.e., 87.3% completion rate) and effective (e.g., PTSD Checklist for Diagnostic and Statistical Manual [DSM-5] [PCL-5] decrease effect size d = 1.80) treatment option. There was also adequate demand for the program (e.g., 37.2% of patients engaged in care with the PTSD programs started the IOP), and the program was implemented with fidelity to the design. Taken together, the results of this study demonstrate that this low-resource IOP model is a promising approach to improve completion rates within the continuum of care for the treatment of PTSD. Impact StatementPTSD IOPs based on more frequent delivery of EBPs are feasible and effective options to improve retention and can be implemented within VHA using low staffing resources.

Support for Policy Changes for Therapy Related to Homefront Missions

“…The most recent clinical research has demonstrated that PTSD recovery can be expedited and there are lower patient dropout rates when sessions are massed or compressed so that multiple sessions are administered over 1 week. [8][9][10][11][12] Providing these therapies in a massed format has shown to be as effective as when these therapies are provided weekly.…”

Addressing Attrition from Psychotherapy for PTSD in the U.S. Department of Veterans Affairs

“…IOPs are intensive treatment programs which offer adjunctive interventions such as yoga and mindfulness classes, in addition to the primary EBPs [51,53,54]. Yamokoski et al [55] describe a clinic in which two intensive protocols were offered. The shorter option held five treatment days per week and took around two weeks to complete in total.…”

“…Group sessions were used primarily to support individual therapies, such as clarifying treatment rationales, progress reviews, or addressing any difficulties patients might be experiencing. Outside therapy sessions, patients also worked on homework assignments and/or presented to psychiatry appointments [55].…”

“…However, these do not detract from the efficacy of the treatment. Studies examining the efficacy of intensive PE and CPT protocols have found that they achieved the same results as standard treatments, yet with the added benefit of lower attrition rates [51,55,56]. In a controlled experimental study testing the efficacy of intensive PE, Foa and colleagues [56] reported an attrition rate of just 13.6%.…”

“…In a controlled experimental study testing the efficacy of intensive PE, Foa and colleagues [56] reported an attrition rate of just 13.6%. The IOP that Yamokoski and colleagues [55] examined reported an attrition rate of 12.7%. Both figures demonstrate the potential for intensive protocols to lower dropout rates.…”