The effects of web-prolonged exposure among military personnel and veterans with posttraumatic stress disorder.

Abstract

Web-based treatments address many of the logistical and stigma-related barriers to in-person behavioral health care. Prior studies of web-based treatments for posttraumatic stress disorder (PTSD) did not employ gold-standard treatments and have not compared to in-person therapy. Method: We compared a web version of Prolonged Exposure Therapy, "Web-PE," to in-person Present-Centered Therapy (PCT) in a randomized controlled trial (RCT) with 40 military personnel with PTSD seeking treatment at Fort Hood, Texas. Due to recruitment challenges, we terminated the RCT and subsequently examined the effects of Web-PE in an uncontrolled open trial with 34 service members and veterans recruited nationwide. Both studies assessed PTSD, depressive symptoms, and health functioning at baseline and 1 and 3 months posttreatment; the RCT also included a 6-month assessment. Results: Results of the RCT showed no differential impact for Web-PE and PCT, although more PCT participants achieved clinically significant change at one of the follow-up assessments. Both treatment conditions significantly reduced self-reported and blind independent interviewer-assessed symptoms of PTSD. Results of the open trial showed that Web-PE was associated with significant reductions in self-reported PTSD symptoms, with a much larger effect size than in the RCT. Conclusions: Web-PE significantly reduced PTSD symptoms in both studies, although the reductions in PTSD symptoms were greater among open trial participants, who were specifically seeking a web-based treatment. Future research should evaluate Web-PE relative to another web-based treatment.

Perceptions and experiences of web-prolonged exposure for posttraumatic stress disorder: A mixed-methods study.

“…This study used a mixed approach integrating quantitative data on perceptions and experiences of Web-PE with qualitative narrative accounts that provide greater depth of understanding about the meaning of and processes underlying those perceptions and experiences. While the results of two small studies support the initial efficacy of Web-PE in reducing symptoms of PTSD (McLean et al, 2021), this is the first study to examine participants’ perceptions and experiences of the program.…”

“…Web-PE sessions included interactive content covering breathing retraining, common reactions to trauma, in vivo exposure, imaginal exposure followed by processing, and homework review. See McLean et al (2021) for more details.…”

“…Department of Veterans Affairs and U.S. Department of Defense, 2017). A recent report on the effects of Web-PE in an randomized controlled trial (RCT) and open-trial provided preliminary evidence in support of Web-PE in reducing PTSD symptoms among active-duty military personnel and veterans (McLean et al, 2021). Specifically, in the RCT, Web-PE and in-person present-centered therapy both reduced self-reported PTSD symptoms from pre- to posttreatment, with no differential impact between conditions.…”

Assessment and Treatment of Combat-Related Posttraumatic Stress Disorder: Results from STRONG STAR and the Consortium to Alleviate PTSD

“…Several studies presented above successfully adapted PE for military populations in various ways to improve access, reduce dropout, and enhance outcomes. These include shortening the time between sessions [39,40], reducing the number of sessions [42][43][44], providing web-based treatment [46], reducing the length of sessions [47], and conducting intensive weekend retreats for couples [61]. Similarly, a variable length CPT protocol successfully treated active duty military with improved outcomes [51] and demonstrated efficacy in multiple in-person or telehealth settings [54].…”

“…Due to recruitment challenges in the RCT, the efficacy of the Web-PE treatment was then evaluated in an open trial with 34 service members and veterans recruited nationwide. The results of the RCT showed that both Web-PE and PCT significantly reduced interviewer-assessed and self-reported symptoms of PTSD, with no significant differences between the groups and a medium effect size for Web-PE [46]. The open trial of Web-PE showed significant reductions in self-reported PTSD symptoms with a large effect size.…”