Innovative service delivery for secondary prevention of PTSD in at-risk OIF–OEF service men and women

Grös, Daniel F.; Strachan, Martha; Ruggiero, Kenneth J.; Knapp, Rebecca G.; Frueh, B. Christopher; Egede, Leonard E.; Lejuez, Carl W.; Tuerk, Peter W.; Acierno, Ron

doi:10.1016/j.cct.2010.10.003

Cited by 33 publications

(26 citation statements)

References 30 publications

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“…In an initial RCT that compared videoconferencing with standard PE treatment, Frueh and colleagues reported that videoconferencing resulted in comparable reductions in symptoms as face-to-face therapy; however, patients in the videoconferencing condition reported less comfort with therapy and poorer adherence to homework exercises than their counterparts who received treatment in person (Frueh et al, 2007). A larger study found that whereas telemedicine-delivered PE resulted in significant symptom reduction, it was not as powerful as treatment delivered face-to-face; it needs to be acknowledged, however, that this study did not randomize patients (Gros, Yoder, Tuerk, Lozano, & Acierno, 2011). Encouraging findings also came from a strongly-powered RCT that found comparable results in treating anger in veterans with PTSD via telemedicine as through in-person therapy (Morland et al, 2010).…”

Section: Future Directionsmentioning

confidence: 91%

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Foa

Gillihan

Bryant

2013

Psychol Sci Public Interest

163

138

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Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions. There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully. Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models. Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped. Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.

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Section: Future Directionsmentioning

confidence: 91%

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Foa

Gillihan

Bryant

2013

Psychol Sci Public Interest

163

138

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“…Participants received eight, 90-min sessions of BA-TE, a trans-diagnostic exposure-based psychotherapy designed specifically to improve treatment outcome in patients with comorbid symptoms of PTSD and depression (Gros et al, 2011; Gros et al, 2012). BA-TE includes behavioral activation, in vivo exposure, and imaginal exposure techniques, the latter of which are consistent with the prolonged exposure model described by Foa, Hembree, and Rothbaum (2007).…”

Section: Methodsmentioning

confidence: 99%

“…For purposes of the primary research question in the larger study (Gros et al, 2011), participants were randomized into either in-person treatment ( n = 117) or treatment that was provided through telehealth technologies ( n = 115). Those in the telehealth group received treatment though an internet based video service (e.g., a “Skype” type program) or a videophone (Viterion 500) was used at the participant’s discretion.…”

Section: Methodsmentioning

confidence: 99%

Differential treatment response trajectories in individuals with subclinical and clinical PTSD

Korte

Grös

Acierno

2016

Journal of Anxiety Disorders

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Subclinical presentations of posttraumatic stress disorder (PTSD), wherein patients are one or two symptom criteria short of the full disorder, are prevalent and associated with levels of distress and impaired functioning approximating that of full PTSD. Nonetheless, research examining treatment efficacy for this group is in the nascent stage. The purpose of the present study was to examine whether the subclinical PTSD group would: (1) show a greater reduction in PTSD symptoms at pre and post treatment in response to an exposure based treatment and (2) show a greater rate of change over the course of treatment, when compared to the full criteria PTSD group. We also examined whether differences would emerge when examining PTSD symptom clusters. Consistent with predictions, the subclinical PTSD group demonstrated a greater reduction in PTSD symptoms at post-treatment (29%) than those with a PTSD diagnosis (14%). Further, the groups had different treatment trajectories, with the subclinical PTSD group showing a marginally greater rate of change during the course of treatment. Findings also varied by symptom cluster with the subclinical group showing a greater rate of change in the intrusions, hyper-vigilance, and avoidance symptom clusters. There was not a significant between group difference in the numbing symptom cluster. This study provides preliminary evidence that treating PTSD symptoms at the subclinical level may result in a larger, and more rapid symptom reduction, and thus has implications supporting treatment earlier in the developmental trajectory of the disorder.

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“…In homebased CVT, the use of Internet-enabled tablets to connect Veterans with providers has eliminated the need for Internet access, which can be problematic for some rural Veterans [19]. Studies examining clinical efficacy indicate that CVT treatment outcomes are comparable with inperson delivery [20][21], including treatment of PTSD [18,22].…”

Section: Clinical Video Teleconferencingmentioning

confidence: 99%

“…Mental health care practice supported by electronic processes and communication, referred to as e-mental health, provides a number of potential solutions to service barriers. The VHA has become a leader in the development and delivery of healthcare services via synchronous (real-time) clinical video teleconferencing (CVT), often referred to as telemental health [17][18]. Additionally, the VHA has developed computer and mobile telephone applications, such as the Prolonged Exposure Coach [12].…”

Section: Introductionmentioning

confidence: 99%

E-mental health preferences of Veterans with and without probable posttraumatic stress disorder

et al. 2015

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Innovative service delivery for secondary prevention of PTSD in at-risk OIF–OEF service men and women

Cited by 33 publications

References 30 publications

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress

Differential treatment response trajectories in individuals with subclinical and clinical PTSD

E-mental health preferences of Veterans with and without probable posttraumatic stress disorder

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