Video to Home Delivery of Evidence-Based Psychotherapy to Veterans With Posttraumatic Stress Disorder

Abstract

Background: The Veterans Health Administration (VHA) has pioneered the implementation of video to home (VTH) technology to increase access to mental health treatments for Veterans facing barriers to receiving in-person care, particularly for posttraumatic stress disorder (PTSD). Randomized controlled trials have established the noninferiority of evidence-based psychotherapies (EBPs) for PTSD delivered through VTH, compared to in-person delivery. Less is known about the use of VTH to deliver EBPs for PTSD in routine clinical practice. Objective: We examined the provision of EBPs for PTSD delivered via VTH at a large Southwestern VHA PTSD outpatient clinic. Methods: Data were obtained from chart review of the electronic medical records of Veterans receiving at least one session of Cognitive Processing Therapy or Prolonged Exposure via VTH in the VHA PTSD clinic during the study time frame. Results: Fourteen providers (including six psychology trainees) delivered EBPs for PTSD via VTH between 2016 and 2018. Providers treated 74 Veterans (33.8% women) from diverse sociocultural backgrounds who ranged in age from 25 to 79. Each provider treated about 3.08 (± 2.18) Veterans using VTH, not including one provider who saw more than 30. A hybrid approach, in which VTH-delivery was coupled with in-person delivery, was used with 70.3% of Veterans across treatment (including sessions completed before initiation and after termination of the EBP). This demonstrates the versatility of VTH for meeting individual patient needs. Most EBP sessions (85.4%) were conducted over VTH. Despite Veterans attending an average of 6.85 (± 4.88) EBP sessions, 50% terminated before session 7. This dropout rate is consistent with national and local EBP completion averages within the VHA. Veterans receiving Cognitive Processing Therapy via VTH were more likely to complete treatment than those receiving Prolonged Exposure. No other patient factors predicted attrition.

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

“…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 ].…”

“…A number of recommendations were identified to support the use of digital health to deliver evidence-based psychotherapy to military members, veterans, and PSP. Key recommendations included (1) identify and manage technological issues that may impede the use of digital health [ 25 , 88 ], (2) supplement interventions to increase patient comfort [ 75 , 87 ], (3) consider ways to establish and maintain rapport and trust [ 77 , 89 ], (4) be flexible and provide additional support as needed to facilitate progress and commitment to therapy [ 71 , 77 , 85 ], (5) review previously established standards and practices of delivering certain psychotherapeutic interventions to improve suitability for digital delivery [ 71 , 87 ], (6) address risk and safety issues [ 88 ], (7) understand and accommodate demographic factors that can influence the client experience of clients using digital health [ 62 , 90 ], and finally (8) support therapists through training to promote their effective use and uptake of digital health [ 80 , 84 ]. Specific findings related to these key themes are presented in Table 4 .…”

“…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.…”

Veterans suffering from post-traumatic stress disorder – literature analyzing: symptoms, statistics and therapies

“…As an addition to the basic therapy of PE, VTH can be used to treat PTSD, which helps not only to start but also to complete the cycle of psychotherapy. This helps not only in terms of the convenience of having psychotherapy at home, but also talks about the additional, positive impact of such a place for the therapy itself [21]. Another extension of such therapy is HAI, where PTSD symptoms such as apathy, emotional-numbing or lack of happiness to live are reduced thanks to animals.…”

“…What's more, the fact that the patients had sessions at home, the environment -the home -provided an additional element supporting treatment. [21].…”