Is symptom improvement similar during PTSD psychotherapy delivered by video telehealth and in-person in routine veterans health administration care?

Holder N, Batten A, Shiner B, Maguen S. Is symptom improvement similar during PTSD psychotherapy delivered by video telehealth and in-person in routine veterans health administration care? Journal of anxiety disorders. 2026 Feb 19; 119:103132, DOI: 10.1016/j.janxdis.2026.103132.

Related HSR&D Project(s)

• CDA 21-194 – Improving Care for Veterans by Understanding and Facilitating Transition to Recommended PTSD Treatment

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Abstract:

One strategy to boost access to trauma-focused evidence-based psychotherapy (TF-EBP), first-line treatment for posttraumatic stress disorder (PTSD), is through video telehealth. Our goal was to determine if delivery modality (i.e., video telehealth vs. in-person) was associated with the likelihood of experiencing clinically meaningful improvement in PTSD symptoms among veterans receiving TF-EBP in routine care. We identified veterans who participated in TF-EBP with appropriately anchored PTSD symptom measurements in the Veterans Health Administration between 4/2022-4/2023 (n = 17,106). Using Bayesian hierarchical logistic regression, we modeled the probability of experiencing a 15-point reduction in the PTSD Checklist for DSM-5 (PCL-5) from pre- to post-treatment. We were primarily interested in the risk-adjusted differences in clinically meaningful PTSD symptom improvement across delivery modalities, accounting for relevant demographic, military, clinical, and service delivery characteristics. Overall, 38.5 % of veterans in the sample experienced clinically meaningful PTSD symptom improvement. Relative to those receiving primarily in-person TF-EBP, veterans who received primarily video telehealth TF-EBP had lower risk-adjusted odds of experiencing symptom improvement (Median Posterior Odds Ratio = 0.83, Region of Practical Equivalence = 38.3 %). Video telehealth delivery of TF-EBP was associated with a small reduction in the likelihood of experiencing clinically meaningful improvement in PTSD symptoms. While findings suggest the need for future research to understand and close this small gap, video telehealth delivery continues to provide access to care for many VHA-enrolled veterans, and clinicians should continue to engage in shared decision-making during treatment modality selection.