Therapy via Video-Teleconference as Effective as In-Person Treatment in Reducing Anger Problems in Veterans with PTSD
FINDINGS:
- Cognitive behavioral therapy (CBT) anger management conducted via video-teleconference was as effective as in-person delivery of the same treatment in reducing anger problems among Veterans with PTSD who live in rural settings. Moreover, mean improvements in the video-teleconferencing group were actually slightly larger than in the in-person treatment group.
- Veterans in both treatment groups benefited from anger management therapy (AMT), making this one of the few large randomized controlled trials to show meaningful benefits for reducing anger problems in Veterans with PTSD.
- Veterans in both treatment groups reported high rates of treatment credibility, satisfaction with care, homework adherence, and high alliance with the therapist. However, Veterans in the in-person condition reported significantly higher group therapy alliance.
- A total of 13 Veterans (10.4%) dropped out of treatment, but there were no significant differences between in-person and video-teleconferencing on frequency of dropout (12.5% vs. 8.2%).
BACKGROUND:
Recent research on returning OEF/OIF Veterans indicates high rates of combat-related PTSD (4%-17%) and other post-traumatic psychiatric conditions, particularly disregulated anger. One challenge in reaching this population is that 40% of service members return home to live in rural or remote areas, where access to healthcare may be problematic. Pilot studies suggest the feasibility of providing psychotherapy via teleconferencing, but they have not compared this to in-person treatment. This study compared the effectiveness of group AMT via video-teleconferencing provided at local VA clinics with in-person group therapy conducted at a VA medical center. Male combat Veterans with PTSD living in a rural setting and attending three VA outpatient clinics across the Hawaiian Islands were randomly assigned to two treatment groups: traditional in-person treatment (n=64), and CBT via video-teleconferencing (n=61). Investigators assessed demographics, psychiatric comorbidity, severity of PTSD, and severity of anger at baseline, mid-treatment (3 weeks), post-treatment (6 weeks), and at 3 and 6 months post-treatment.
LIMITATIONS:
- It is unknown how patients who are accustomed to in-person group therapy would accept the transition to video-teleconferencing treatment.
- This study focused on alleviating anger problems in Veterans with PTSD rather than treating PTSD symptoms, per se.
- The videoconferencing was provided through the local clinic. It is not known whether services could be delivered as effectively through Web-based videoconferencing from the Veteran's home.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (TEL 03-080). Drs. Morland and Greene are part of VA's National Center for PTSD, Pacific Island Division.
Morland L, Greene C, Rosen C, et al. Telemedicine for Anger Management Therapy in a Rural Population of Combat Veterans with Post-Traumatic Stress Disorder: A Randomized Non-inferiority Trial. Journal of Clinical Psychiatry January 26, 2010; E-pub ahead of print.
