Elsevier

Behavior Therapy

Volume 42, Issue 2, June 2011, Pages 276-283
Behavior Therapy

Exposure Therapy for PTSD Delivered to Veterans via Telehealth: Predictors of Treatment Completion and Outcome and Comparison to Treatment Delivered in Person

https://doi.org/10.1016/j.beth.2010.07.005Get rights and content

Abstract

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth (n = 62) or in person (n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.

Section snippets

Participants

Patients were selected from a large southeastern Veterans Administration Medical Center (VAMC; direct service population estimated at 550,000 at 2000 U.S. Census) and its associated community-based outpatient clinics (CBOCs; service populations ranged from 140,000 to 290,000 at 2000 U.S. Census) as part of standard clinic practice. All patients had been referred for exposure therapy for PTSD within the PTSD clinic at the VAMC. As the study was conducted within standard clinical practice,

Treatment Outcome in Telehealth and In-Person Patients

Prior to investigating treatment effectiveness, demographics, baseline symptom levels, and number of sessions were investigated across the two treatment conditions in treatment completers only. As expected, two-variable χ2 tests revealed no group differences in sex, race, combat theater, and disability status (χ2 < 4.3, p > .05). Similarly, one-way analyses of variance (ANOVA) demonstrated no differences in patient age and baseline symptoms levels on the BDI-II and PCL-M (F < 3.8, p > .05). The

Discussion

The present study was a preliminary exploration of the effectiveness of exposure therapy delivered via telehealth and in person in a sample of veterans with PTSD. The study sought to compare 12-session exposure therapy across two treatment modalities and identify predictors of treatment completion and treatment outcome in the telehealth condition. The findings suggested that exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, depression, general anxiety,

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    This material is the result of work supported with resources and the use of facilities at the (Ralph H. Johnson VAMC, Charleston, SC). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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