@article{4eb8797919004c008032ecef9109823a,
title = "In-office, in-home, and telehealth cognitive processing therapy for posttraumatic stress disorder in veterans: a randomized clinical trial",
abstract = "Background: Trauma-focused psychotherapies for combat-related posttraumatic stress disorder (PTSD) in military veterans are efficacious, but there are many barriers to receiving treatment. The objective of this study was to determine if cognitive processing therapy (CPT) for PTSD among active duty military personnel and veterans would result in increased acceptability, fewer dropouts, and better outcomes when delivered In-Home or by Telehealth as compared to In-Office treatment. Methods: The trial used an equipoise-stratified randomization design in which participants (N = 120) could decline none or any 1 arm of the study and were then randomized equally to 1 of the remaining arms. Therapists delivered CPT in 12 sessions lasting 60-min each. Self-reported PTSD symptoms on the PTSD Checklist for DSM-5 (PCL-5) served as the primary outcome. Results: Over half of the participants (57%) declined 1 treatment arm. Telehealth was the most acceptable and least often refused delivery format (17%), followed by In-Office (29%), and In-Home (54%); these differences were significant (p = 0.0008). Significant reductions in PTSD symptoms occurred with all treatment formats (p <.0001). Improvement on the PCL-5 was about twice as large in the In-Home (d = 2.1) and Telehealth (d = 2.0) formats than In-Office (d = 1.3); those differences were statistically large and significant (d = 0.8, 0.7 and p = 0.009, 0.014, respectively). There were no significant differences between In-Home and Telehealth outcomes (p = 0.77, d = −.08). Dropout from treatment was numerically lowest when therapy was delivered In-Home (25%) compared to Telehealth (34%) and In-Office (43%), but these differences were not statistically significant. Conclusions: CPT delivered by telehealth is an efficient and effective treatment modality for PTSD, especially considering in-person restrictions resulting from COVID-19. Trial registration: ClinicalTrials.gov ID NCT02290847 (Registered 13/08/2014; First Posted Date 14/11/2014).",
author = "Peterson, {Alan L.} and Jim Mintz and Moring, {John C.} and Straud, {Casey L.} and Stacey Young-McCaughan and McGeary, {Cindy A.} and McGeary, {Donald D.} and Litz, {Brett T.} and Velligan, {Dawn I.} and Alexandra Macdonald and Emma Mata-Galan and Holliday, {Stephen L.} and Dillon, {Kirsten H.} and Roache, {John D.} and Bira, {Lindsay M.} and Nabity, {Paul S.} and Medellin, {Elisa M.} and Hale, {Willie J.} and Resick, {Patricia A.}",
note = "Funding Information: Support for the completion of this project was provided by the STRONG STAR Consortium (www.STRONGSTAR.org ). The authors would like to thank the U.S. military service members and veterans for their participation in this clinical trial. The authors acknowledge Robert Villarreal, F. Alex Carrizales, Antoinette Brundige, Julie Collins, and Joel Williams for their research support on this project. The views expressed herein are solely those of the authors and do not reflect an endorsement by or the official policy or position of the U.S. Army, the Department of Defense, the Department of Veterans Affairs, or the US Government. Funding Information: JM and CS had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study concept and design was completed by AP, JM, SY-M, EM-G, SH, and PR. The acquisition of the data was completed by AP, JM, SY-M, BL, JR, and PR. The analysis and interpretation of the data was conducted by AP, JM, JCM, CS, SY-M, CM, DM, BL, WH, and PR. Initial drafting of the manuscript was completed by AP, JM, JCM, CS, SY-M, DM, and PR. Critical revision of the manuscript for important intellectual content was conducted by AP, JM, JCM, CS, SY-M, CM, DM, BL, DV, AM, EM-G, SH, KD, JR, LB, PN, EM, WH, and PR. Statistical data analyses were conducted by JM, CS, and WH. Research grant funding was obtained by AP and PR. Administrative, technical, and material support was provided by JCM, CM, DM, EM-G, SH, KD, JR, LB, PN, EM, and PR. The author(s) read and approved the final manuscript. Publisher Copyright: {\textcopyright} 2022, The Author(s).",
year = "2022",
month = dec,
doi = "10.1186/s12888-022-03699-4",
language = "English (US)",
volume = "22",
journal = "BMC Psychiatry",
issn = "1471-244X",
publisher = "BioMed Central",
number = "1",
}