Interdisciplinary residential treatment of posttraumatic stress disorder and traumatic brain injury: effects on symptom severity and occupational performance and satisfaction.

OBJECTIVE. This study examined outcomes of an 8-wk residential treatment program for veterans with posttraumatic stress disorder (PTSD) and a history of traumatic brain injury (TBI). METHOD. Twenty-six veterans completed the Canadian Occupational Performance Measure, Clinician-Administered PTSD Scale, Beck Depression Inventory-2nd Edition, and PTSD Checklist before and after treatment. RESULTS. Veterans demonstrated significant improvements in occupational performance and satisfaction with their performance, as well as in PTSD and depression symptom severity after residential PTSD/TBI treatment. Additionally, improvements in occupational performance and satisfaction were associated with decreases in depression symptom severity. CONCLUSION. Although preliminary, results suggest that veterans with PTSD and a history of TBI experienced significant decreases in PTSD and depression symptom severity and improvement in self-perception of performance and satisfaction in problematic occupational areas. Changes in occupational areas and depression symptom severity were related, highlighting the importance of interdisciplinary treatment.

A home-based telehealth randomized controlled trial of skills training in affective and interpersonal regulation versus present-centered therapy for women veterans who have experienced military sexual trauma.

OBJECTIVE: This randomized trial tested the effectiveness of Skills Training in Affective and Interpersonal Regulation (STAIR) compared to present-centered therapy (PCT) delivered virtually to women veterans who had experienced military sexual trauma (MST) and screened positive for posttraumatic stress disorder (PTSD). METHOD: One hundred sixty-one eligible women veterans were randomized into the study. The primary outcome was clinician-assessed PTSD severity (Clinician-Administered PTSD Scale-5), while secondary outcomes included social support and several other symptom measures at posttreatment through 2- and 4-month follow-up. RESULTS: PTSD severity decreased in both conditions by posttreatment but significantly more (p = .028, d = 0.39) in STAIR (d = 1.12 [0.87, 1.37]) than PCT (d = .78 [0.54, 1.02]). STAIR was also superior in improving social support and emotion regulation and reducing depression and negative cognitions. Improvement in psychosocial functioning was moderate and did not differ between conditions. All changes were maintained through 2- and 4-month follow-ups. Dropout rates were low and did not differ (19.0% and 12.2%, respectively). CONCLUSION: STAIR provided superior outcomes compared to PCT regarding PTSD, social support, and multiple types of mental health problems among women veterans with MST. The application of STAIR to other populations with social support and related concerns warrants investigation. The substantial effect sizes for PTSD symptoms in both treatments suggest that they are practical alternatives for individuals who do not wish to participate in trauma-focused therapy and may increase engagement in mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supporting equitable engagement and retention of women patients in a trauma-informed virtual mental health intervention: Acceptability and needed adaptations.

OBJECTIVE: This study examines barriers and facilitators to participation in webSTAIR, a telemental health program providing virtual coaching sessions for veterans with posttraumatic stress disorder (PTSD) and depression symptoms, among women veterans from racial and ethnic minority groups. METHOD: Using qualitative interviews (n = 26), we compared women veterans from racial and ethnic minority groups who completed (completers; n = 16) and did not complete (noncompleters; n = 11) webSTAIR at rural-serving facilities in the Veterans Health Administration (VA). Interview data were analyzed using rapid qualitative analysis. Chi-square and t tests assessed differences between completers and noncompleters by sociodemographic characteristics and baseline PTSD and depression symptomatology. RESULTS: There were no statistically significant sociodemographic differences at baseline between completers and noncompleters; completers reported significantly higher baseline PTSD and depression symptomatology. Noncompleters were more likely to describe feeling angry, depressed, and unable to control their environments during participation in the program as barriers to webSTAIR completion. Completers, despite higher symptomatology, cited internal motivation and support from concurrent mental health services as facilitators. Both groups made recommendations for how VA can better support women veterans from racial and ethnic minority groups, including providing space for peer support and community building, addressing stigma associated with seeking mental health services and fostering mental health provider diversity and retention. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although previous research has identified racial and ethnic disparities in PTSD treatment retention, mechanisms to improve retention have been unclear. Women veterans from racial and ethnic minority groups should be collaboratively engaged in the design and implementation of telemental health programs for PTSD to improve equitable retention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study.

BACKGROUND: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. OBJECTIVE: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. METHODS: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. RESULTS: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. CONCLUSIONS: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming.

Increasing access to care for trauma-exposed rural veterans: A mixed methods outcome evaluation of a web-based skills training program with telehealth-delivered coaching.

PURPOSE: While rural veterans with trauma exposure report high rates of posttraumatic stress disorder (PTSD), depression, and functional impairment, utilization of health services is low. This pilot study used mixed qualitative and quantitative methods to evaluate the potential benefits of a transdiagnostic web-based skills training program paired with telehealth-delivered coaching to address a range of symptoms and functional difficulties. The study directed substantial outreach efforts to women veterans who had experienced military sexual trauma given their growing representation in the Veterans Healthcare Administration (VHA) and identified need for services. METHODS: Participants were 32 trauma-exposed veterans enrolled in rural-serving VHA facilities who screened positive for either PTSD or depression. Symptoms of PTSD, depression, emotion regulation, and interpersonal problems were assessed at baseline, midpoint, posttreatment, and 3-month follow-up. Veterans completed exit interviews to identify benefits and limitations of the program. RESULTS: Intent-to-treat analyses revealed significant symptom reduction for all outcomes, with large to moderate effect sizes at 3-month follow-up. Outcomes did not differ by gender or military sexual trauma status. Veterans' rating of the therapeutic alliance was high and interview responses indicated that the presence of the coach was critical to success in the program. CONCLUSION: This remotely delivered transdiagnostic intervention provided significant benefits across a range of symptoms and functional outcomes and was viewed positively by veterans. The results indicate that further research (ie, a randomized controlled trial) is warranted. Attention to the role of the coach as a means by which to increase engagement and retention in technology-delivered interventions is warranted.

A Resource Building Virtual Care Programme: improving symptoms and social functioning among female and male rural veterans.

Background: Veterans have higher rates of PTSD and depression compared to the general population and experience substantial functional impairment. Impairment in social functioning has been a significant concern among Veterans, particularly rural Veterans, who have limited access to mental health care and are at risk for social isolation. Objective: A mixed-method study was implemented to evaluate the feasibility and effectiveness of webSTAIR, a web-based skills training programme, paired with home-based telehealth sessions. It was hypothesized that the programme would lead not only to reductions in PTSD and depression but also to improvements in social functioning. Method: Participants were 80 trauma-exposed Veterans enrolled in rural-serving VHA facilities with clinically elevated symptoms of either PTSD or depression. The study directed substantial outreach efforts to rural women Veterans and those who have experienced military sexual trauma (MST). Results: Significant improvements were obtained with PTSD and depression symptoms as well as in social functioning, emotion regulation, and interpersonal problems at post-treatment and 3-month follow-up. Ratings of therapeutic alliance were high as were reports of overall satisfaction in the programme. There were no differences by gender or MST status in symptom outcomes or satisfaction. Conclusions: The results support the feasibility and effectiveness of this integrated telehealth web-based skills training programme for both male and female Veterans as well as for those with and without MST. The focus on resource building and improved functioning make this programme of particular interest. Further testing is warranted.

Antecedentes: Los veteranos tienen tasas más altas de TEPT y depresión en comparación con la población general y experimentan un deterioro funcional sustancial. El deterioro del funcionamiento social ha sido una preocupación importante entre los Veteranos, particularmente los Veteranos rurales, que tienen acceso limitado a la atención de salud mental y están en riesgo de aislamiento social, lo que contribuye significativamente a problemas de salud.Objetivo: Se implementó un estudio de método mixto para evaluar la viabilidad y efectividad de webSTAIR, un programmea de capacitación en habilidades basado en la web, combinado con sesiones de telesalud en el hogar. Se planteó la hipótesis de que el programmea conduciría no solo a reducciones en el trastorno de estrés postraumático y la depresión, sino también a mejoras en el funcionamiento social.Método: Los participantes fueron 80 Veteranos expuestos a traumas inscritos en el sistema VHA de servicio rural, con síntomas clínicamente elevados de TEPT o depresión. El estudio dirigió importantes esfuerzos de divulgación a las mujeres rurales Veteranas y aquellas que han experimentado un trauma sexual militar (TSM).Resultados: Se obtuvieron mejoras significativas con el TEPT y los síntomas de depresión, así como en el funcionamiento social, la regulación de las emociones y los problemas interpersonales en el postratamiento y en el seguimiento a los 3 meses. Las puntuaciones de la alianza terapéutica fueron altas, al igual que los informes de satisfacción general en el programmea. No hubo diferencias por sexo o estado de TSM en los resultados de los síntomas o la satisfacción.Conclusiones: Los resultados respaldan la viabilidad y efectividad de este programmea integrado de capacitación en habilidades de telesalud basado en la web para veteranos masculinos y femeninos, así como para aquellos con y sin MST. El enfoque en el desarrollo de recursos y la mejora del funcionamiento hace que este programmea sea de especial interés. Se requieren nuevos estudios.