Abstract
BackgroundPosttraumatic stress disorder (PTSD) rarely remits over time, and if left untreated, leads to significant distress, functional impairment, and increased health care costs. Fortunately, effective evidence-based treatments (EBTs) for PTSD, such as Prolonged Exposure (PE), exist. Despite their availability and efficacy, a significant number of individuals with PTSD do not initiate treatment when offered or dropout prematurely. One proposed theory suggests that the emotional-numbing symptoms of PTSD (e.g., blunted affect, apathy) can serve as a barrier to engaging in, and successfully completing, treatment; and the broad human-animal interaction (HAI) literature available suggests that HAI can potentially reduce emotional numbing related to PTSD. Accordingly, this manuscript describes an ongoing, federally funded, randomized controlled trial testing the efficacy of RESCUE, an HAI intervention, as a viable adjunctive treatment component for PE.Methods/designThe study will include 70 veterans with PTSD treated at a Southeastern Veterans Affairs Medical Center (VAMC). All participants in the trial receive up to 12 sessions of PE. Participants are randomly assigned 1:1 to (1) volunteer at a local animal shelter or (2) volunteer at a community agency of their choice as part of their in-vivo exposure exercises for PE. Outcomes will be examined via standard clinical interviews, self-report questionnaires, and thematic interviews.DiscussionIt is hypothesized that participants in the HAI condition will report greater decreases in emotional-numbing symptoms and increased treatment compliance and completion rates relative to those in the community volunteer condition. If successful, RESCUE, could be easily incorporated into standard PE and broadly disseminated.Trial registrationClinicalTrials.gov. ID: NCT03504722. Retrospectively registered on 2 May 2017.
Highlights
Posttraumatic stress disorder (PTSD) rarely remits over time, and if left untreated, leads to significant distress, functional impairment, and increased health care costs
Given the wide-scale availability of Prolonged Exposure (PE) and other evidencebased treatment (EBT) for PTSD in Veterans Affairs (VA) and Department of Defense (DoD) treatment settings, and the robust effect sizes for treatment completers, there is a need for novel methods that can improve PTSD treatment engagement and decrease attrition
Consistent with this rationale, we propose to test the efficacy of an human-animal interaction (HAI) adjunct to PE for decreasing emotional-numbing symptoms and improving treatment engagement and outcomes
Summary
Despite systemic efforts by the DoD and VA to ensure that EBTs are available to all veterans with PTSD, many veterans are not initiating or completing treatment. As with other psychiatric disorders (e.g., depression), the symptoms that pose as a barrier to treatment engagement should be targeted directly to improve treatment initiation, engagement, and completion [36] In this effort, the current clinical trial focuses on addressing the emotionally numbing symptoms of PTSD using a HAI model. As is often the case with clinical trials, the current study design is geared to provide more interpretable effects given a positive outcome rather than a negative outcome This is important for HAI research at this stage, negative findings will be somewhat more difficult to interpret and would not rule out the potential for other more intense, or more active HAI augmentations to EBTs. Implications and conclusions PTSD is one of the most prevalent mental health disorders among post-deployed veterans [38]. RESCUE has the potential to yield significant and meaningful cost savings at the individual level with regard to suffering and lost work productivity as well as at the systems level with regard to disability and health care utilization patterns
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