Evaluating an Internet-based video cognitive processing therapy intervention for veterans with PTSD: A pilot study

Abstract

Introduction There remain a number of UK military veterans who are not able to access psychological therapies for post-traumatic stress disorder (PTSD). Some of these barriers are practical, including the need to balance work and other life commitments with attendance at residential or outpatient appointments. There is a need to investigate more accessible and flexible methods of delivering psychological therapies to veterans. One such alternative is to use remote-access video technology, often referred to as tele-therapy. The aims of the present study were to explore the feasibility of using tele-therapy in this population, whilst also reporting mental health outcomes for those who accessed the intervention. Methods Participants were recruited from a UK veterans mental health charity. The intervention consisted of 12 sessions of cognitive processing therapy delivered via Skype. Participants completed various measures of mental health, including PTSD at three time points: pre-treatment, post-treatment and at three months follow-up. A measure of therapeutic alliance was also completed by participants and the clinician. Results A total of 27 participants engaged in tele-therapy, with a treatment completion rate of 79% and a ‘did not attend’ rate of 12%, which compared well against similar outpatient services. All mental health outcomes showed maintained improvement at three months follow-up, with the highest effect size recorded for PTSD. Therapeutic alliance was also rated highly by both participants and the clinician. Discussion The findings suggest that tele-therapy could provide a viable alternative format for delivering trauma-focused psychological therapies to veterans. Limitations and recommendations for future research are also presented.

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 ].…”

“…digital health engagement was not rated by clients as inferior to in-person therapy when it came to building a relationship with their clinician [ 81 ]. Interestingly, within the included studies, baseline variables such as age, gender, education level, employment status, and relationship status did not appear to correlate with the effectiveness of the psychotherapeutic intervention or the modality of which it was delivered [ 63 , 82 , 84 ]. Although results regarding adherence to therapy and dropout varied throughout the studies, the modality of therapy delivery (digital health or in-person) did not appear to be a predictor of adherence or dropout.…”

Evidence of Phone vs Video-Conferencing for Mental Health Treatments: A Review of the Literature

“…Whether remote care can provide sustained effects for PTSD is inconclusive. A pre-post comparison of patients receiving care through video (with no modality comparison group), showed large effect size between PTSD symptoms at three-month follow-up [32]. However, another study that compared video and in-person care found that patients and providers disagreed on whether treatments had lasting effects: provider-assessments found continuing reduction in symptoms only for in person groups, but patient-reports on symptom reduction at follow-up were comparable across both video and in person [30].…”

Practice implications and clinical observations: Virtual care for a military/Veteran population during the COVID-19 pandemic

“…Personally, the ability to provide continued care to my patients, and make a meaningful contribution to their well-being during a time when the world turned upside down, helped me mitigate my own stress and anxiety. Importantly, it's becoming clear to me that most evidence-based treatments for PTSD, depression and anxiety are robust and effective in virtual administration, as has been widely reported in research literature 3,4,5,6,7,8,9 . Yet, I quickly learned one hour of virtual care was not equivalent to an hour of face-to-face care, due to the emotional and cognitive demands.…”