Telemedicine for Improved Delivery of Psychosocial Treatments for Post Traumatic Stress Disorder

• Clinician-administered PTSD Scale (CAPS) diagnostic interview [ Time Frame: Pre-treatment, post-treatment (14 weeks after pre-treatment assessment), follow-up six months after post-treatment assessment ] [ Designated as safety issue: No ]
  Measure of PTSD diagnosis and severity
• Neuropsychological testing battery to assess cognitive functioning [ Time Frame: Pre-treatment and post-treatment (14 weeks after pre-treatment assessment) ] [ Designated as safety issue: No ]
  1. Wechsler Test of Adult Reading
  2. Rey Complex Figure task
  3. California Verbal Learning Test
  4. Wisconsin Card Sort Test
  5. WAIS Digit Span
  6. D-KEFS Verbal Fluency
  7. D-KEFS Color-Word Interference
  8. D-KEFS Trails

• Clinician-administered PTSD Scale (CAPS) diagnostic interview [ Time Frame: Pre-treatment, post-treatment, six-month follow-up ] [ Designated as safety issue: No ]
• Neuropsychological testing battery to assess cognitive functioning [ Time Frame: Pre-treatment and post-treatment ] [ Designated as safety issue: No ]

• PHQ-9 (self-reported depression) [ Time Frame: Pre-treatment, weekly during 12 weeks of treatment, post-treatment (14 weeks after pre-treatment assessment), follow-up six months after post-treatment assessment ] [ Designated as safety issue: Yes ]
  Measure of depressive symptoms
• PTSD Checklist (PCL; self-reported PTSD symptoms) [ Time Frame: Pre-treatment, weekly during 12 weeks of treatment, post-treatment (14 weeks after pre-treatment assessment), follow-up six months after post-treatment assessment ] [ Designated as safety issue: No ]
  Measure of 17 posttraumatic stress disorder (PTSD) symptoms from specific event (PCL-S)

• PHQ-9 (self-reported depression) [ Time Frame: Pre-treatment; weekly during treatment; post-treatment; 6-month follow-up ] [ Designated as safety issue: Yes ]
• PTSD Checklist (PCL; self-reported PTSD symptoms) [ Time Frame: Pre-treatment, weekly during treatment; post-treatment; and 6-month follow-up ] [ Designated as safety issue: No ]

The objective of the proposed study is to conduct a systematic comparison of post traumatic stress disorder (PTSD) outcomes for veterans receiving exposure therapy via telemedicine versus in-person care. The primary aim is to determine feasibility: whether telemedicine can be used as a tool to extend effective, specialized mental health services, such as Prolonged Exposure therapy (PE; a therapy designed to help clients face fears related to a traumatic event), to veterans with limited access to care. A secondary aim is to determine if therapy delivered by telemedicine affects the quality of care in terms of clinical outcomes and the quality of patient-therapist interaction. A tertiary aim is to examine whether results from neuropsychological testing predict treatment outcomes.

• Posttraumatic Stress Disorders
• Depression
• Anxiety

• Experimental: 1
  Psychotherapy via telemedicine (video teleconferencing technology).
  Intervention: Behavioral: Prolonged exposure therapy
• Active Comparator: 2
  Face-to-face (in person) psychotherapy
  Intervention: Behavioral: Prolonged exposure therapy

Inclusion Criteria:

• Primary diagnosis of chronic PTSD due to combat; comorbid mood and anxiety disorders are expected, and will be permitted (to maximize generalizability) if PTSD symptoms are judged to be predominant based on primacy and severity of symptoms
• Age 18 or older
• English literacy

Exclusion Criteria:

• Unmanaged psychosis or manic episodes in past year
• Concurrent psychotherapies targeting PTSD or depression or that entail exposure therapy [veterans who are engaged in treatment for non-PTSD symptoms (e.g., 12-step programs for substance problems) will be eligible]
• Severe cardiovascular or respiratory disease that would make it difficult to ensure regular attendance at psychotherapy sessions
• Probable dementia; OR
• Head trauma resulting in loss of consciousness longer than 20 minutes. Potential participants who have had changes in the type and dosage of psychotropic medications in the preceding two months will be asked to wait until their medication regimen has stabilized to minimize treatment confounds.

• Department of Defense
• University of Pennsylvania