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2009 HSR&D National Meeting Abstract

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National Meeting 2009

1072 — Open Trial of Prolonged Exposure for PTSD Delivered via Telepsychiatry vs. In Person

Tuerk P (Charleston VA TREP), Acierno RE (Charleston VA TREP), Ruggiero KJ (Charleston VA TREP), Gros D (Charleston VA TREP), Yoder M (Charleston VA TREP)

Objectives:
To collect pilot data examining the efficacy of Prolonged Exposure (PE) delivered via telepsychiatry (i.e., videoconferencing) vs. in-person format in treatment of veterans with posttraumatic stress disorder (PTSD). PE is an efficacious intervention for PTSD; however, little is known about the use of PE delivered via telepsychiatry.

Methods:
This ongoing open-trial study includes 28 combat veterans of Operations Enduring Freedom or Iraqi Freedom diagnosed with PTSD at a Southeastern Veterans Administration Medical Center. All veterans are given traditional PE and optional access to PE via telepsychiatry is available for patients living in rural areas. Baseline and ongoing assessments include the military version of the PTSD Checklist (PCL) and the Beck Depression inventory (BDI). Drop-out, number of sessions, and symptom patterns are monitored at pre- and post-treatment for the two self-selecting groups (traditional PE, n = 22; PE via telepsychiatry, n = 6).

Results:
For in-person PE, mean pre- and post-treatment PCL scores are 56.86 (sd = 11.11) and 26.71 (sd = 7.95); t = 10.55, df = 13, p < .000, d = 3.17. For tele-psychiatry-based PE, mean pre- and post-treatment PCL scores are 62.00 (sd = 5.35) and 31.50 (sd = 8.58); t = 9.30, df = 3, p = .003, d = 6.96. The treatment completion rate for the in-person PE group is 68.2% as compared to 66.7% for the PE via telepsychiatry group. The average number of sessions to treatment termination is 10 versus 12, respectively. A similar pattern was evidenced in BDI depression scores, with patients in both groups dropping an average of 14 points. No clinically or statistically significant differences in PCL or BDI scores have been found between groups.

Implications:
Pilot data are promising and suggest that the delivery of PE via telepsychiatry is feasible and potentially efficacious. Both mediums evidenced large drops in self-reported PTSD symptoms and depression over the course of treatment. These data are preliminary and a large-scale randomized controlled trial is needed.

Impacts:
These preliminary data provide insight into an innovative and potentially cost-effective alternative to traditional PE for PTSD. Decisions regarding the use of PE via telepsychiatry should be informed by rigorous studies of effectiveness versus traditional PE.


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