Peer support during in vivo exposure homework to reverse attrition from prolonged exposure therapy for posttraumatic stress disorder (PTSD): description of a randomized controlled trial

Abstract

Background Effective treatments for posttraumatic stress disorder (PTSD) (e.g., prolonged exposure (PE); cognitive processing therapy (CPT)) exist and are widely adopted by the Departments of Veterans Affairs (VA) and Defense (DoD). Unfortunately, dropout from these treatments regularly exceeds 30%. However, in a recent survey of patients who dropped out of PE, approximately half indicated a greater likelihood of completion if a peer who had completed treatment were available to help with the in vivo exposure homework. Methods We will use a between-groups randomized controlled design with repeated assessment at baseline, post treatment, and 3- and 6-month follow-up across measures of PTSD, depression, and functioning with 150 veterans who have indicated that they intend to drop out of treatment. Participants will be randomly assigned to one of two PE + Peer Support conditions: (1) a peer will offer support directly during in vivo exposure homework for 3–4 weeks; vs (2) a peer will call weekly for 3–4 weeks to offer general support and to check in on treatment progress. Discussion The present study was designed to test the hypothesis that dropout from exposure-based PTSD treatment may be mitigated by using peers as support agents directly during PE in vivo homework experiences. Specifically, we intend to determine: whether patients who have dropped out of PE and are offered the “in vivo peer” adjunctive component to PE therapy will (1) return and complete treatment and (2) evince reduced PTSD symptomatology, compared to the same PE treatment, but with general peer support more reflective of current VA practices. Trial registration This study protocol is approved and information is available at ClinicalTrials.gov, ID: NCT03485391. Registered on 2 April 2018.

Associations between Predictors of PTSD and Psychosocial Functioning in Veterans: Results from a Longitudinal Assessment Study

“…Social support is an established risk factor for the emergence and exacerbation of mental health symptoms, and attempts have been made to intervene at the level of social functioning for an array of mental health disorders [59]. Importantly, there is evidence that social support could be an effective addition to the treatment for PTSD [60], and trials including peer support into EBTs for PTSD are underway [61]. Similarly, there have been calls for a greater emphasis on depressive symptoms in the treatment of PTSD, along with a growing recognition that depressive symptoms exist partly independent of trauma symptoms [62,63].…”

Exploring trajectories in transdiagnostic behavior therapy

“…Mobile applications have been designed for similar behavioral psychotherapies in efforts to improve homework compliance, such as the PE Coach app for prolonged exposure for PTSD (Reger et al., 2013). Similarly, innovative research is investigating whether the incorporation of a peer who has successfully completed exposure‐based psychotherapy improves treatment adherence and completion (Hernandez‐Tejada et al., 2020). Although motivation and treatment goals are assessed early in TBT (Gros et al., 2023), another approach could be to more fully incorporate motivational interviewing into TBT to better manage patient resistance (Westra & Norouzian, 2018).…”

Effect of patient characteristics on posttraumatic stress disorder treatment retention among veterans: A systematic review

“…The results of an RCT that included a sample of mostly female patients with opioid use disorder demonstrated a highly beneficial effect of financial incentives on attendance at PE sessions (Schacht et al., 2017); we suggest trying such incentives for individuals with service‐connected disabilities. Pairing a PE patient with a “buddy” who has successfully completed treatment is currently being studied as a way to improve retention (Hernandez‐Tejada et al., 2020), as is promoting family involvement (Meis et al., 2019).…”