In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial

Abstract

Background Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. Methods The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. Results Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p < .0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = −.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. Conclusions CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. Trial registration ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).

The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes

“…Previous research has demonstrated that CPT delivered via telehealth is noninferior to in‐person treatment as assessed using measures of PTSD at posttreatment and 6‐month follow‐up (Germain et al., 2010; Maieritsch et al., 2016; Morland et al., 2014). The parent study (Peterson et al., 2022) also demonstrated that effect sizes for telehealth were large and, in fact, even larger than those observed in the in‐office condition.…”

Impact and efficiency of treatment across two PTSD clinical trials comparing in-person and telehealth service delivery formats.

“…The present study pooled data from 268 participants enrolled in two concurrently funded and conducted randomized clinical trials of cognitive behavioral treatments for PTSD across three different delivery formats (i.e., telehealth, in-home, and office). Trial 1 (Peterson et al, 2018, 2022) employed 12 sessions over 6 weeks of CPT for PTSD using a three-arm equipoise-stratified design (with the choice to opt out of 1 of the 3 treatment formats prior to randomization). Trial 2 (Morland et al, 2020) employed a variable length of PE for PTSD, including 6–15 individual, 90-min sessions delivered approximately once weekly, using a three-arm randomized design across three treatment formats.…”

“…They also noted that these options may be particularly valuable for rural veterans who lacked convenient access to a VA health care facility. Peterson et al (2022) evaluated PTSD symptom improvement, treatment acceptability, treatment retention, and overall estimated cost in dollars and time commitment, finding strong support for the delivery of CPT using telehealth.…”

An open trial of VA CONNECT: Caring for Our Nation's Needs Electronically during the COVID-19 Transition

“…However, there is far less guidance for group-based interventions. Emerging literature supports the feasibility, acceptability, and efficacy of telehealth-adapted VA group interventions for various mental health needs during the COVID-19 pandemic ( Fletcher et al, 2021 ; Fortier et al, 2022 ; Pernicano et al, 2022 ; Peterson et al, 2022 ; Possemato et al, 2022 ). However, to date, investigation into the potential utility of e-mental health interventions targeting COVID-19-specific concerns has been limited.…”