Home-based delivery of variable length prolonged exposure therapy: A comparison of clinical efficacy between service modalities - PubMed (original) (raw)

Randomized Controlled Trial

. 2020 Apr;37(4):346-355.

doi: 10.1002/da.22979. Epub 2019 Dec 24.

Margaret-Anne Mackintosh 1, Lisa H Glassman 1, Stephanie Y Wells 1, Steven R Thorp 1, Sheila A M Rauch 1, Phillippe B Cunningham 1, Peter W Tuerk 1, Kathleen M Grubbs 1, Shahrokh Golshan 1, Min Ji Sohn 1, Ron Acierno 1

Affiliations

Randomized Controlled Trial

Home-based delivery of variable length prolonged exposure therapy: A comparison of clinical efficacy between service modalities

Leslie A Morland et al. Depress Anxiety. 2020 Apr.

Abstract

Objective: This study examined clinical and retention outcomes following variable length prolonged exposure (PE) for posttraumatic stress disorder (PTSD) delivered by one of three treatment modalities (i.e., home-based telehealth [HBT], office-based telehealth [OBT], or in-home-in-person [IHIP]).

Method: A randomized clinical trial design was used to compare variable-length PE delivered through HBT, OBT, or IHIP. Treatment duration (i.e., number of sessions) was determined by either achievement of a criterion score on the PTSD Checklist for Diagnostic and Statistical Manual-5 (DSM-5; PTSD Checklist for DSM-5) for two consecutive sessions or completion of 15 sessions. Participants received PE via HBT (n = 58), OBT (n = 59) or IHIP (n = 58). Data were collected between 2012 and 2018, and PTSD was diagnosed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), administered at baseline, posttreatment, and 6 months following treatment completion. The primary clinical outcome was CAPS-5 PTSD severity. Secondary outcomes included self-reported PTSD and depression symptoms, as well as treatment dropout.

Results: The clinical effectiveness of PE did not differ by treatment modality across any time point; however, there was a significant difference in treatment dropout. Veterans in the HBT (odds ratio [OR] = 2.67; 95% confidence interval [CI] = 1.10, 6.52; p = .031) and OBT (OR = 5.08; 95% CI = 2.10; 12.26; p < .001) conditions were significantly more likely than veterans in IHIP to drop out of treatment.

Conclusions: Providers can effectively deliver PE through telehealth and in-home, in-person modalities although the rate of treatment completion was higher in IHIP care.

Trial registration: ClinicalTrials.gov NCT03110302.

Keywords: PTSD; clinical trials; empirical supported treatments; health services; trauma.

Published 2019. This article is a U.S. Government work and is in the public domain in the USA.

PubMed Disclaimer

References

REFERENCES

    1. Acierno, R., Gros, D. F., Ruggiero, K. J., Hernandez-Tejada, B. M., Knapp, R. G., Lejuez, C. W., … Tuerk, P. W. (2016). Behavioral activation and therapeutic exposure for posttraumatic stress disorder: A noninferiority trial of treatment delivered in person versus home-based telehealth. Depression and Anxiety, 33(5), 415-423. https://doi.org/10.1002/da.22476
    1. Acierno, R., Knapp, R., Tuerk, P., Gilmore, A. K., Lejuez, C., Ruggiero, K., … Foa, E. B. (2017). A noninferiority trial of prolonged exposure for posttraumatic stress disorder: In person versus home-based telehealth. Behaviour Research and Therapy, 89, 57-65. https://doi.org/10.1016/j.brat.2016.11.009
    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 ed.). Arlington, VA: American Psychiatric Publishing.
    1. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. (2001). AUDIT: The alcohol use disorders identification test: Guidelines for use in primary health care. Geneva, Switzerland: World Health Organization.
    1. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. https://doi.org/10.1037/0022-006X.56.6.893

Publication types

MeSH terms

LinkOut - more resources