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J Telemed Telecare. 2019 Apr 11:1357633X19832419. doi: 10.1177/1357633X19832419. [Epub ahead of print]

Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches.

Author information

1
1 VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
2
2 Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
3
3 Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
4
4 Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
5
5 VA Atlanta Healthcare System, Atlanta, GA, USA.

Abstract

INTRODUCTION:

Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care.

METHODS:

Data were drawn from veterans ( Nā€‰=ā€‰171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions.

RESULTS:

FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan-Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment.

DISCUSSION:

Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

KEYWORDS:

Military sexual trauma; PTSD; clinical video telehealth; telemental health; treatment retention

PMID:
30975048
DOI:
10.1177/1357633X19832419

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