PE is an efficacious treatment for active-duty Army soldiers with PTSD from deployments to Iraq or Afghanistan. Results extend previous evidence supporting the efficacy of PE to active-duty military personnel and raise important questions for future research on VRE. (PsycINFO Database Record

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High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma‐focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study‐level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence‐based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta‐analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma‐focused treatments, 16.1% for non–trauma‐focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study‐level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma‐focused treatment groups had a higher risk of dropout compared to non–trauma‐focused treatments, RR = 1.60. The statistical heterogeneity of within‐treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma‐focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study‐level covariates.

This article describes the development and evaluation of a training program for behavioral health providers on the integration of mobile health applications (health apps) in clinical care. The purpose was to train military and Department of Veterans Affairs (VA) providers in the use and current research of various behavioral health apps. The training focused on 5 core competencies: gaining knowledge on the evidence base for using mobile apps in behavioral health practice, effective integration of mobile technologies into traditional treatment settings, security and privacy issues involved with digital data, ethical issues, and cultural considerations. During a 3-year span (October 2014 -September 2017), the training program delivered 20 one-day workshops at 15 military or VA locations, reaching 760 Department of Defense and VA clinicians (psychologists, social workers, physicians, and nurses) on best practices for health apps in clinical care. Prior to the training, less than half of the providers who attended the workshop (41.1%) reported that they were using health apps during treatment. Just following the training, 93.7% of the trainees indicated their intent to use health apps during patient care. At the 3-month posttraining interval, provider-reported use of health apps in treatment was 90.8%. Results demonstrated the impact of a mobile apps provider training program to deliver a relevant, feasible, and impactful approach to educating providers regarding mobile health best practices. Data collected also provided valuable insight into military provider technology use over a 3-year period. Public Significance StatementIn order for clinicians to leverage mobile health technology to best serve their patients, training on best practices is necessary. This article describes the results of an education and training program that successfully trained 760 clinicians over the course of a 3-year period on best practices for mobile health in clinical care.

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Objective: A key symptom of posttraumatic stress disorder (PTSD) is hyperreactivity to trauma-relevant stimuli. Though physiological arousal is reliably elevated in PTSD, the question remains whether this arousal responds to treatment. Virtual reality (VR) has been posited to increase emotional engagement during prolonged exposure therapy (PE) for PTSD by augmenting imaginal exposures with trauma-relevant sensory information. However, the comparative effects of VR exposure therapy (VRE) have received limited empirical inquiry. Method: Ninety active-duty soldiers with combat-related PTSD participating in a randomized-controlled trial to receive PE, VRE, or a waitlist-control (WL) condition had their physiological reactivity, indexed by galvanic skin response (GSR), to their trauma memories assessed at pre-, mid-, and posttreatment. Results: Although both VRE and PE conditions showed reduced GSR reactivity to trauma memories from pre- to posttreatment, only the VRE group differed significantly from WL. Across the sample, reductions in GSR were significantly correlated with reductions in self-reported PTSD and anxiety symptoms. Conclusions: This was the first study comparing effects of VRE and PE on psychophysiological variables. Given previous research finding limited differences between VRE and PE in PTSD symptom reduction, these findings lend support to the rationale for including VR in exposure therapy protocols while raising important questions about the potential benefits of VRE.

Caring Contacts (CC), a low-cost intervention originally designed and tested by Jerome Motto in 1976, remains one of the few strategies to demonstrate efficacy in the prevention of suicide deaths. Interest in CC has increased steadily over the last several years in tandem with rising U.S. suicide rates and the acceleration of suicide prevention initiatives. There have been several efforts to design interventions modeled after Motto’s strategy, and the recent publication of additional large-scale randomized controlled trials (RCTs) in alignment with the intent of Motto’s original model afford an opportunity to systematically review efficacy findings. The current systematic review provides an updated and focused analysis of the evidence supporting the efficacy of CC. A systematic literature search of MEDLINE, EMBASE, PsycINFO, Cochrane Library, and ClinicalTrials.gov was conducted, and PRISMA, Cochrane, and GRADE guidelines were followed. Of 2,746 abstracts reviewed, 13 publications, comprising six randomized controlled trials (RCTs) met inclusion criteria. The studies encompassed 6,218 participants across four countries and military, veteran, and civilian health care systems. The primary outcome was suicide mortality; secondary outcomes were suicide attempts and emergency department (ED) presentations/hospitalizations. The DerSimonian–Laird random-effects univariate meta-analysis was used to estimate summary effect sizes and evaluate statistical heterogeneity. Summary risk ratio estimates ranged from 0.57 to 1.29 across outcomes and time points; most estimates indicated a protective effect. For suicide deaths and ED presentations/hospitalization, interval estimates at 1-year postrandomization were consistent with either an increase or a decrease in risk. A protective effect was observed for suicide attempts at 1-year postrandomization. Implications and methodological recommendations for future work in this area reviewed and discussed.

Personal technology use is ubiquitous in the United States today and technology, in general, continues to change the face of health care. However, little is known about the personal technology use of military service members and the behavioral health care providers that treat them. This study reports the technology use of 1,101 active duty service members and 45 behavioral health care providers at a large military installation. Participants reported Internet usage; ownership of smartphones, tablets, and e-readers; usage of mobile applications (apps); and basic demographic information. Compared with providers, service members reported higher rates of smartphone ownership, were more likely to own Android smartphones than iPhones, and spent more time gaming. Both groups spent a comparable amount of time using social media. With the exception of gaming, however, differences between service members and providers were not statistically significant when demographics were matched and controlled. Among service members, younger respondents (18-34) were statistically more likely than older respondents (35-58) to own smartphones, spend time gaming, and engage in social media. Our findings can help inform provider's technology-based education and intervention of their patients and guide the development of new technologies to support the psychological health of service members.