Changing the Treatment Course: Clinical Trial of Sequenced Interventions to Optimize Treatment for Veterans With PTSD
The University of Texas Health Science Center at San Antonio
Summary
By doing this research project, the investigators hope to learn which strategies work best to help veterans who are not benefiting from their first PTSD treatment or not completing between-session homework assignments regularly that might improve treatment response. The investigators also want to learn how best to match the right type and amount of treatment to each individual veteran. By conducting this research project, they hope to: * See if trying a different treatment strategy for veterans not responding to their first PTSD treatment would be more helpful * See if sending text message prompts between sessions encourages more completion of between-session homework
Description
This study is designed to assist the investigators in answering the clinical question of how to address non-response to first line PTSD treatments. Utilizing an innovative Hybrid Experimental Design (HED), the proposed study involves multiple, sequential randomizations to both therapist-delivered and digital interventions operating on short and long timescales to determine the optimal combination and sequencing of evidence-based interventions to maximize response. This will result in actionable data and, consistent with a personalized medicine approach, an implementable, adaptive treatment reg…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Veterans eligible for PE and CPT at the participating PTSD treatment-providing clinic who are 2. At least 18 years or older 3. Score ≥ 31 on the PCL-5 secondary to a Criterion A traumatic event 4. Own a mobile device that can be used for the therapy companion mobile app (Prolonged Exposure (PE) coach or Cognitive Processing Therapy (CPT) coach). Exclusion Criteria: 1. Acute suicide risk requiring clinical intervention 2. Need for detoxification 3. Unmanaged psychosis or bipolar disorder 4. Severe cognitive impairment that makes it unlikely that participants can adhere…
Interventions
- BehavioralModular Cognitive Processing Therapy
CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of Contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need. Modular CPT contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need.
- BehavioralModular Prolonged Exposure Therapy
PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. Modular PE is comprised of the same elements of standard PE, but clinicians select and dose modules (i.e., imaginal exposure, in vivo exposure) based on individual patient need.
- BehavioralStep Down Treatment
Self-managed treatment will involve receiving a self-help version of the remaining treatment materials and ongoing use of the intervention companion app (CPT Coach or PE Coach).
- BehavioralDigital Interventions
The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).
Locations (4)
- Augusta VAAugusta, Georgia
- Ann Arbor VAAnn Arbor, Michigan
- Battle Creek VABattle Creek, Michigan
- Salt Lake City VASalt Lake City, Utah