BACKGROUND/RATIONALE:
PTSD occurs in as many as 1 in 5 combat Veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Evidence-based psychotherapies, such as Prolonged Exposure (PE), result in clinically significant symptom relief for many. Yet, adherence to these treatments (i.e., session attendance and homework compliance), which is vital to ensuring recovery, can be poor. Engaging families in Veterans' treatment may provide a powerful method for promoting EBP adherence. Our data indicate that 70% of Veterans express some interest in involving their family in their care for PTSD; yet, only 17% of providers have had any contact with Veterans' families. The objective of the proposed study is to evaluate the effectiveness of improving family support as a tool to improve Veterans' EBP adherence. This research agenda directly addresses two VA HSR&D priorities: 1) innovative mental health care and 2) improving the quality of life for Veterans and their caregivers. This work aligns with the VHA Blueprint for Excellence and Strategic Plan through meeting the unique needs of military-service disabled Veterans (i.e., PTSD), providing a novel approach to treatment for Veterans, and emphasizing patient- and family-centered care.

OBJECTIVE(S):
Our Primary Aim is to improve Veterans' adherence to PE through engaging families in care. We hypothesize that when families attend PE's initial educational sessions, Veterans' attendance to PE and homework compliance will improve, compared to PE as typically delivered. As secondary outcomes, we will examine group differences in treatment satisfaction, relationship functioning, quality of life, and PTSD symptom severity. Our secondary aims are to: 1) To determine if the key social influences (family support for PE; helping Veterans avoid trauma-reminders), targeted by our strategies of engaging families in PE, improve Veterans' PE adherence; 2) to examine barriers/facilitators of engaging families in PE to improve family support.

METHODS:
We are proposing a practical randomized controlled trial to compare Veteran adherence to PE with and without family attendance at PE's educational sessions. To achieve aim 2, we will use a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in PE within VA. Participants will include Veterans with clinically significant symptoms of PTSD across three sites, plus a family member or friend of the Veteran. Primary outcome variables will include session attendance and therapist ratings of homework compliance. Secondary outcomes will include treatment satisfaction, relationship functioning, quality of life, and PTSD severity measured before and after treatment. Key social influences, targeted by family-involvement strategies, will be assessed through brief weekly self-reports.

FINDINGS/RESULTS:
None to date.

IMPACT:
This study aims to improve Veterans' adherence to evidence-based treatment for PTSD, through increasing family support for treatment. Improving retention rates in evidence-based PTSD treatment will positively impact Veterans' health and well-being, lower the cost of treating PTSD, and decrease long-term demand for PTSD services. If effective, this approach could help resolve national calls for routine inclusion of family involvement in PTSD treatment. Once demonstrated for PTSD, these strategies could be utilized for other conditions and problems relevant to Veteran populations (e.g., suicide prevention, TBI rehabilitation) and stimulate shifts across practice and policy to better routine and evidence-based involvement of families in care.

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External Links for this Project

NIH Reporter

Grant Number: I01HX002086-01A2
Link: https://reporter.nih.gov/project-details/9291804

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PUBLICATIONS:

Journal Articles

1. Meis LA, Glynn SM, Spoont MR, Kehle-Forbes SM, Nelson D, Isenhart CE, Eftekhari A, Ackland PE, Linden EB, Orazem RJ, Cutting A, Hagel Campbell EM, Astin MC, Porter KE, Smith E, Chuick CD, Lamp KE, Vuper TC, Oakley TA, Khan LB, Keckeisen SK, Polusny MA. Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement. Trials. 2022 Mar 30; 23(1):243. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial, Treatment - Implementation, TRL - Applied/Translational
Keywords: Cognitive Therapy, Family, PTSD
MeSH Terms: none