Message Delivery for the Treatment of Posttraumatic Stress Disorder: Longitudinal Observational Study of Symptom Trajectories.

Matteo Malgaroli,Thomas Derrick Hull,Patricia Resick,Shannon Wiltsey Stirman

doi:10.2196/15587

Abstract

BackgroundIndividuals with posttraumatic stress disorder (PTSD) face symptoms that can hinder access to treatment, such as avoidance and guilt. Telemedicine offers a technological solution to increase access to mental health care and overcome barriers to treatment. Although an increasing body of literature focused on synchronous telehealth (eg, live video), no studies have examined the delivery of PTSD treatment via two-way multimedia messages (ie, texting or messaging).ObjectiveThe aim of this study was to conduct a longitudinal observation of treatment for PTSD delivered using two-way asynchronous messaging. We also sought to identify individual and treatment characteristics that could predict the observed outcome differences.MethodsOutpatients diagnosed with PTSD (N=475) received interventions from licensed therapists, which were delivered via messaging once or more than once per day, 5 days a week for 12 weeks. PTSD symptoms were assessed every 3 weeks using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5. Trajectories of PTSD symptoms were identified using growth mixture modeling (GMM). Using logistic regression, the demographic, treatment, and messaging characteristics of patient groups that improved were compared with the characteristics of patient groups that did not improve.ResultsThe GMM identified 4 trajectories of PTSD symptoms: moderate improvement (197/475, 41.4%), high symptoms (197/475, 41.4%), chronic symptoms (61/475, 12.9%), and acute improvement (20/475, 4.3%). Patients with a clinically significant reduction in PTSD symptoms (231/475, 48.6%) were more likely to communicate via video (odds ratio [OR] 1.01, 95% CI 1.01-1.05; P=.03), have a higher working alliance with their therapist (OR 1.03, 95% CI 1.01-1.05; P=.02), and be at their first treatment experience (OR 2.03, 95% CI 1.18-3.54; P=.01). Treatment adherence was associated with greater therapeutic alliance (OR 1.07, 95% CI 1.03-1.10; P<.001), education (OR 2.13, 95% CI 1.13-4.03; P=.02), and more patient-generated messages per week (OR 1.08, 95% CI 1.04-1.13; P<.001).ConclusionsMultimedia message delivery for PTSD treatment showed symptom-reduction rates similar to traditional forms of treatment delivery, suggesting further study of messaging as a treatment medium. Most patients completed an 8-week course, reflecting the acceptability of messaging interventions. Delivering treatment via two-way messaging offers increased opportunities for widespread access to mental health care.

Highlights

Over the course of a lifetime, most people are exposed to at least one potentially traumatic event [1], and approximately 9.7% of women and 3.6% of men [2] will develop posttraumatic stress disorder (PTSD) [3]
Outpatients diagnosed with PTSD (N=475) received interventions from licensed therapists, which were delivered via messaging once or more than once per day, 5 days a week for 12 weeks
Patients with a clinically significant reduction in PTSD symptoms (231/475, 48.6%) were more likely to communicate via video, have a higher working alliance with their therapist, and be at their first treatment experience

Summary

Introduction

Over the course of a lifetime, most people are exposed to at least one potentially traumatic event [1], and approximately 9.7% of women and 3.6% of men [2] will develop posttraumatic stress disorder (PTSD) [3]. In addition to traditional barriers to treatment, including cost, insurance, stigma, and physical impairments [13,14,15], individuals with PTSD face additional hindrances such as avoidance and shame that often result in isolation from their communities. Geographic remoteness can prevent access to care, and in areas with ongoing violence (and high incidence of PTSD), it can be dangerous for mental health professionals to practice [16]. These obstacles tend to reduce seeking and obtaining of treatment, perpetuating the economic and social costs of untreated illness [17]. Individuals with posttraumatic stress disorder (PTSD) face symptoms that can hinder access to treatment, such as avoidance and guilt. An increasing body of literature focused on synchronous telehealth (eg, live video), no studies have examined the delivery of PTSD treatment via two-way multimedia messages (ie, texting or messaging)

Methods

Results

Discussion

Conclusion