The Use of a Brief Family Intervention to Reduce Dropout Among Veterans in Individual Trauma‐Focused Treatment: A Randomized Controlled Trial

Abstract

Dropout from trauma‐focused treatment for posttraumatic stress disorder (PTSD) represents a daunting challenge for the field, particularly among military and veteran samples. Family involvement may help to increase the effectiveness of PTSD treatment while also improving retention. We tested a two‐session brief family intervention (BFI) protocol delivered as an adjunct to individual trauma‐focused treatment among a sample of 20 veteran–family member dyads (N = 40). Willingness to participate in the family‐inclusive protocol was high, with over 85% of veterans and family members who were screened agreeing to take part. All enrolled veterans were beginning a course of either cognitive processing therapy (CPT) or prolonged exposure (PE), delivered in outpatient Veterans Affairs clinics. Family members were randomized to either receive or not receive the BFI from study clinicians. In the BFI condition, 20.0% of veterans dropped out of CPT/PE before the 16‐week study end; the remainder were either still attending on‐protocol sessions or had completed the full protocol. In the control condition, 40.0% of veterans dropped out of CPT/PE before the end of the study. Observed significant, large‐magnitude decreases in PTSD symptoms over time did not differ by condition, ESsg range = −1.12 to −2.04. Accommodation did not significantly decrease over time in either condition, ESsg range = 0.18 to −0.98. The BFI represents a promising option for veterans, family members, and clinicians who are seeking a brief, feasible, narrowly focused method for incorporating families into veterans’ individual trauma‐focused therapy and potentially reducing the rate of dropout.

Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement

“…Observational research shows close relationships play a critical role in stimulating veterans’ treatment-seeking behavior [ 66 , 67 ] and family encouragement reduces PTSD treatment dropout [ 15 ]. Lastly, Thompson-Hollands and colleagues [ 14 ] reduced treatment dropout by 20% when family members were randomized to participate in a two-session adjunctive intervention versus when veterans participated in standard TFT [ 14 ].…”

“…Treatment adherence is infrequently a target of family-involved interventions. However, in a recently completed small RCT ( n = 40), Thompson-Hollands and colleagues [ 14 ] found that a two-session adjunctive intervention with family members, as veterans began PE or Cognitive Processing Therapy (CPT), reduced treatment dropout by 20%, compared to standard PE or Cognitive Processing Therapy. Additionally, Meis and colleagues [ 15 ] found that when veterans entering either PE or CPT were encouraged by a close loved one to face things that made them anxious and uncomfortable, they were more than twice as likely to finish one of these TFTs.…”

Family Involvement in PTSD Treatment: Perspectives from a Nationwide Sample of Veterans Health Administration Clinicians

“…Families remain an underutilized resource within VHA, despite clear indications that veterans desire family involvement (e.g., Batten et al, 2009 ) and preliminary evidence that family inclusive care may offer a bolstering effect to trauma-focused treatment (Thompson-Hollands et al, 2021b ). Our results suggest that there are multiple avenues that could be pursued to more emphatically promote family involvement in care.…”

“…EBPs are the treatments that have the most evidence for meaningfully reducing PTSD symptoms (U.S. Department of Veteran Affairs and Department of Defense, 2017), and they must be prioritized. However, accumulating evidence suggests that certain family member behaviors (Meis et al, 2019;Sayer et al, 2017), or the incorporation of families into treatment (Thompson-Hollands et al, 2021b), enhances treatment retention in CPT and PE and therefore that these approaches may strengthen rather than detract from EBPs. For clinicians looking to increase their use of family involvement to support EBPs there are several lower-intensity protocols available, including Veteran-Centered Brief Family Consultation (U.S. Department of Veterans Affairs, 2018; VA Family Services) and the Brief Family Intervention for PTSD (Thompson-Hollands et al, 2021c;Thompson-Hollands et al, 2021b); both are specific to veterans and typically range from 1 to 3 sessions.…”

“…One study using nationwide VA administrative data found that Veterans with PTSD who had at least one family session experienced a statistically significant drop in symptoms following that session, and the positive effects were even more pronounced when they had higher numbers of family-inclusive sessions (Laws et al, 2018). Family member behaviors can even substantially buffer the risk of dropout from evidence-based protocols (EBPs) for PTSD, resulting in dropout rates that are 50% lower (Meis et al, 2019;Thompson-Hollands et al, 2021b). This is especially notable because veterans in PTSD treatment are at high risk of nonengagement and dropout (e.g., Hale et al, 2019).…”