Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches

Abstract

Introduction Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. Methods Data were drawn from veterans ( N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. Results FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. Discussion Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review

“…A number of facilitators were identified regarding the virtual delivery of trauma therapies to military members, veterans, and PSP ( Table 2 ). These included (1) the convenience of accessing teletherapy, particularly for clients in rural and remote areas [ 79 , 85 , 87 ], (2) the comfort of participating in therapy from the client’s home [ 57 , 59 , 85 , 87 ] resulting in less stress [ 55 , 58 ] and stigma, [ 86 , 87 ], (3) the efficaciousness of several different evidence-based PTSD treatment modalities delivered using digital health, including PE, CPT, CBT, and BA-TE [ 25 , 53 , 56 , 77 ], and (4) the ability to see a therapist from a central health clinic or the location of their choosing reduced travel time and transportation and missed work costs [ 25 , 55 , 82 ]. Many clients found that participating in teletherapy provided the same opportunities for relationship building with the therapist as in-person treatment [ 52 , 81 ].…”

“…Multiple barriers were also identified ( Table 3 ), including (1) issues with technology related to connectivity, inconsistent access to a secure, high-quality internet connection, and hardware that disrupts and limits the high quality and secure service delivery [ 25 , 52 , 53 , 55 , 64 , 79 , 81 , 85 , 89 ], (2) client openness to digital health services [ 59 ], (3) challenges to client privacy and comfort, including lack of a quiet, private space, experiences of isolation or disruption in the home environment, and client discomfort with communication over video conferencing [ 56 , 59 , 79 , 84 , 85 ], (4) limits to the therapeutic alliance and therapist comfort with intervention activities that may impact clinical utility and effectiveness [ 57 , 58 , 65 , 66 , 79 ], (5) the ease of abrupt disengagement from treatment and engagement in social avoidant behaviors [ 55 - 57 , 59 , 79 ], and (6) safety concerns and risk management [ 52 , 59 , 81 ].…”

“…“... treatment-interfering cognitions, such as negative treatment expectancies, may need to be addressed with cognitive restructuring in the early stages of treatment.” [ 57 ]…”

“…“Veterans engaged in [Clinical Video Technology] CVT-delivered PE or [Cognitive Processing Therapy] may need additional education about the role of avoidance in symptom maintenance and frank discussion about. How the CVT modality may be reinforcing avoidance.” [ 57 ]…”

“…This can positively impact the well-being, operational readiness, and pandemic response. It can also potentially better serve those who might not otherwise seek treatment such as disadvantaged or minority groups, or those who have experienced sexual trauma or operational stress injuries, for example [ 55 , 57 , 59 , 62 , 81 ].…”