Abstract
BackgroundEffective treatments for posttraumatic stress disorder (PTSD) (e.g., prolonged exposure (PE); cognitive processing therapy (CPT)) exist and are widely adopted by the Departments of Veterans Affairs (VA) and Defense (DoD). Unfortunately, dropout from these treatments regularly exceeds 30%. However, in a recent survey of patients who dropped out of PE, approximately half indicated a greater likelihood of completion if a peer who had completed treatment were available to help with the in vivo exposure homework.MethodsWe will use a between-groups randomized controlled design with repeated assessment at baseline, post treatment, and 3- and 6-month follow-up across measures of PTSD, depression, and functioning with 150 veterans who have indicated that they intend to drop out of treatment. Participants will be randomly assigned to one of two PE + Peer Support conditions: (1) a peer will offer support directly during in vivo exposure homework for 3–4 weeks; vs (2) a peer will call weekly for 3–4 weeks to offer general support and to check in on treatment progress.DiscussionThe present study was designed to test the hypothesis that dropout from exposure-based PTSD treatment may be mitigated by using peers as support agents directly during PE in vivo homework experiences. Specifically, we intend to determine: whether patients who have dropped out of PE and are offered the “in vivo peer” adjunctive component to PE therapy will (1) return and complete treatment and (2) evince reduced PTSD symptomatology, compared to the same PE treatment, but with general peer support more reflective of current VA practices.Trial registrationThis study protocol is approved and information is available at ClinicalTrials.gov, ID: NCT03485391. Registered on 2 April 2018.
Highlights
Posttraumatic stress disorder (PTSD) is a debilitating mental health condition associated with diminished occupational and social functioning, poor physical health outcomes, substance abuse, depression, and risk of suicide [1,2,3,4,5,6]
We proposed pairing veterans who had successfully completed prolonged exposure (PE) and no longer meet the criteria for posttraumatic stress disorder (PTSD), with veterans who are currently in treatment and at high risk of dropout or have dropped out from treatment
Exposure homework logistics Our pilot study experience allowed us to refine the methods of initiating the peer support to the following steps: once patients have agreed to re-initiate treatment, peers will be instructed by the project coordinator to call in via televideo/meet in person to the therapy session to make introductions and listen to the patient and therapists review the item of the in vivo exposure hierarchy in depth
Summary
We will use a between-groups randomized controlled design with repeated assessment at baseline, post treatment, and 3- and 6-month follow-up across measures of PTSD, depression, and functioning with 150 veterans who have indicated that they intend to drop out of treatment. Participants will be randomly assigned to one of two PE + Peer Support conditions: (1) a peer will offer support directly during in vivo exposure homework for 3–4 weeks; vs (2) a peer will call weekly for 3–4 weeks to offer general support and to check in on treatment progress
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