Study Suggests PTSD Treatment via Video-Teleconferencing as Effective as In-Person Treatment
BACKGROUND:
The prevalence of PTSD is estimated to be 9%-15% among Vietnam Veterans and 10%-20% among Veterans of the Iraq and Afghanistan wars. However, among Veterans in need of treatment for PTSD, 50%-90% attend an insufficient number of visits or do not initiate them at all. One efficacious treatment for PTSD is cognitive processing therapy (CPT) – a trauma-focused psychotherapy that can be delivered in individual or group formats. CPT targets the cognitive symptoms of PTSD, and CPT-cognitive only (CPT-C) therapy is a variant of this therapy. This study is the first randomized controlled trial to compare the efficacy of delivering CPT-C via video-teleconferencing (VTC) to in-person delivery among a sample of rural Veterans. Investigators recruited 125 male Veterans from four VA healthcare facilities across the Hawaiian Islands; of these patients, 64 received in-person treatment and 61 received treatment via VTC. Approximately 77% of Veterans completed treatment by attending at least 10 of the 12 group treatment sessions, which occurred twice weekly over a six-week period. Veterans were assessed at baseline, mid-treatment, immediately post-treatment, and 3 and 6 months post-treatment. Measures included attrition, treatment adherence, patient satisfaction, treatment expectancy, and group therapeutic alliance.
FINDINGS:
- The use of clinical video-conferencing services to provide CPT-C therapy to Veterans with PTSD who lived in rural settings was found to be as effective as face-to-face treatment. Significant reductions in PTSD symptoms were identified at post-treatment and 3- and 6-month follow-ups.
- High levels of therapeutic alliance, treatment compliance, and satisfaction, and moderate levels of treatment expectancies were reported, with no differences between groups. For example, at post-treatment, Veterans reported high levels of satisfaction with both in-person and VTC therapies, rating 11 of 14 items on the satisfaction scale as "very good" or "excellent."
- VTC technology evidenced very few disruptions, and no sessions were canceled due to technological difficulties. There were no adverse events associated with delivering CPT-C through videoconferencing.
LIMITATIONS:
- For Veterans living in rural areas, their local mental health facilities may not have the technological equipment necessary for VTC.
- Veterans with acute safety concerns (homicidal or suicidal) or current substance dependence were excluded.
- This study did not include female Veterans. However, a complementary female Veteran study was just completed by Dr. Morland and her team and will be published this summer.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (DHI 07-259). Dr. Morland is part of the National Center for PTSD-Pacific Island Division, VA Pacific Islands Health Care System.
Morland L, Mackintosh M, Greene C, et al. Cognitive Processing Therapy for Post-traumatic Stress Disorder Delivered to Rural Veterans via Telemental Health: A Randomized Non-Inferiority Clinical Trial. Journal of Clinical Psychiatry. May 2014;75(5):470-76.
