Clinical Effectiveness and Implementation of Massed Prolonged Exposure for PTSD Among Veterans in Intensive Outpatient Substance Use Treatment
Abstract
Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) often co-occur. PTSD+SUD comorbidity is associated with more severe PTSD, worse treatment outcomes for substance use, greater suicide risk and worse functioning than having one of these disorders. First-line treatments for PTSD, particularly Prolonged Exposure Therapy (PE), are effective in treating PTSD among those with an SUD, and delivering these treatments concurrent to SUD programming is recommended by the VA/DoD Clinical Practice Guidelines. While PE is one of the most effective treatment options for PTSD among those with PTSD+SUD, effects are smaller and dropout is higher than among people with PTSD without an SUD. A promising way to enhance outcomes is to offer PE in a massed format (M-PE; i.e., multiple sessions per week instead of once weekly). M-PE has been shown to be effective in improving PTSD symptoms and substantially reducing dropout in military and Veteran populations. Preliminary findings suggest M-PE delivered concurrent to intensive SUD programming is a promising strategy that warrants further study. Evaluating the effectiveness of M- PE delivery in of SUD intensive outpatient programming (IOP) in improving PTSD and other mental health outcomes and reducing dropout as compared to weekly PE delivery (W-PE) is the necessary next step in this critical research. The primary goal of this project is to determine whether a promising way to treat PTSD among those with SUD, M-PE, will help Veterans with their PTSD symptoms and lead to better treatment completion rates more than PE delivered weekly and whether the massed format will reduce substance use comparably to weekly PE among those in intensive SUD treatment. We will also evaluate whether M-PE helps Veterans function better and feel less depressed. M-PE is a one-on-one talk therapy that is delivered over twelve sessions several times a week. The therapy is brief because of the massed format so that it can be delivered at times when lengthy interventions may not be realistic, such as military mental health clinics on bases where military personnel may be getting ready to redeploy. Our preliminary work with Veterans in intensive SUD treatment showed M-PE to lead to improvements in PTSD and depression symptoms with no dropout, making this larger evaluation of M-PE compared to PE delivered in the traditional longer (weekly) format a critical next step. We will accomplish this by randomly assigning participants who are in intensive SUD treatment to receive either M-PE or W-PE. We propose to have 200 Veterans who served post 9/11 go through this study, and the entire study is expected to take 4 years to complete. We will run the study across four VAs (San Diego, Tampa, Chicago, and Atlanta). We will use a research design that will let us concurrently compare M-PE and W-PE while also learning about what strategies are helpful to implement M-PE into DOD and VA healthcare settings and what barriers may come up to make implementation more challenging. This design will prepare us to successfully implement M- PE into intensive substance use treatment if we find it to work well. We will include a panel of Veterans that will help guide us on making decisions in how we conduct the study so that it is most relevant to Veterans. We will interview participants, therapists, and administrators to learn about the benefits and challenges of offering M-PE so that we can use that information to guide us in the future. The proposed study holds promise for identifying a better method by which to treat Service Members and Veterans with PTSD and SUD, with better PTSD outcomes and lower dropout. If found to be effective, M-PE can be immediately delivered in VA and military healthcare settings since providers are already trained in it in both settings. The treatment is brief and thus would be minimally disruptive to an active-duty schedule or the busy life of a returning Veteran. The expect
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310669
Entities
People
- Sonya B Norman
Organizations
- United States Army
- Veterans Medical Research Foundation of San Diego