Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD

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Abstract

Purpose of review

Effective treatments for posttraumatic stress disorder (PTSD) remain underutilized and individuals with PTSD often have difficulty accessing care. Telehealth, particularly clinical videoconferencing (CVT), can overcome barriers to treatment and increase access to care for individuals with PTSD. The purpose of this review is to summarize the literature on the delivery of PTSD treatments through office-based and home-based videoconferencing, and outline areas for future research.

Recent findings

Evidence-based PTSD treatments delivered through office-based and home-based CVT have been studied in pilot studies, non-randomized trials, and randomized clinical trials. The studies have consistently demonstrated feasibility and acceptability of these modalities as well as significant reduction in PTSD symptoms, non-inferior outcomes, and comparable dropout rates when compared with traditional face-to-face office-based care. Finally, it has been shown that using CVT does not compromise the therapeutic process.

Summary

Office-based and home-based CVT can be used to deliver PTSD treatments while retaining efficacy and therapeutic process. The use of these modalities can increase the number of individuals that can access efficacious PTSD care.

Related collections

Most cited references 38

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National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria.

Dean G. Kilpatrick, Heidi S Resnick, Melissa E Milanak … (2013)

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM-5; 2013) and fourth edition (DSM-IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self-administered survey. Traumatic event exposure using DSM-5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past-12-month, and past 6-month PTSD prevalence using the Same Event definition for DSM-5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM-5 prevalence estimates were slightly lower than their DSM-IV counterparts, although only 2 of these differences were statistically significant. DSM-5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM-IV criteria, but not DSM-5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.

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Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials.

Robert Zachariae, Marlene Lyby, Lee Ritterband … (2015)

Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. Eleven randomized controlled trials examining a total of 1460 participants were included. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.

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Empirical validation of the Insomnia Severity Index in cancer patients.

M Savard, Sébastien Simard, Hans Ivers … (2005)

Despite the elevated prevalence of insomnia in cancer patients, there is a lack of brief validated instruments for the evaluation of this particular problem in this population. The goal of this study is to empirically validate the Insomnia Severity Index (ISI) and to evaluate its ability to screen insomnia in 1670 cancer patients. The results support the internal consistency and temporal stability of the ISI. Its two-component factor structure is clear and stable between different cancer diagnoses. The construct validity of that instrument is also supported by correlations obtained with various measures of sleep and one measure of quality of life. The ISI is also sensitive to therapeutic changes. A clinical cut-off score of 8 on the ISI is associated with optimal sensitivity and specificity for the detection of sleep difficulties. In conclusion, the ISI appears to be an excellent evaluation and screening tool in the context of cancer.

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Author and article information

Contributors

Leslie A. Morland: Leslie.morland@va.gov

Journal

Journal ID (nlm-ta): Curr Treat Options Psychiatry

Journal ID (iso-abbrev): Curr Treat Options Psychiatry

Title: Current Treatment Options in Psychiatry

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2196-3061

Publication date (Electronic): 30 May 2020

Pages: 1-21

Affiliations

[1 ]GRID grid.410371.0, ISNI 0000 0004 0419 2708, VA San Diego Healthcare System, ; 3375 La Jolla Village Drive, San Diego, CA USA

[2 ]GRID grid.266100.3, ISNI 0000 0001 2107 4242, University of California, San Diego, ; San Diego, USA

[3 ]GRID grid.497281.1, ISNI 0000 0004 0374 606X, Pacific Island Division, , National Center for PTSD, ; Honolulu, HI USA

[4 ]Durham VA Health Care System, Durham, NC USA

[5 ]GRID grid.484300.b, ISNI 0000 0004 0420 8001, VISN 6 Mid-Atlantic MIRECC, ; Durham, NC USA

[6 ]GRID grid.413720.3, ISNI 0000 0004 0419 2265, Department of Veterans Affairs Healthcare System, ; Little Rock, AR USA

[7 ]GRID grid.241054.6, ISNI 0000 0004 4687 1637, University of Arkansas for Medical Sciences (UAMS), ; Little Rock, AR USA

[8 ]Behavioral Health Strategy, Livongo Health, Inc, Silicon Valley, CA USA

[9 ]GRID grid.429666.9, ISNI 0000 0004 0374 5948, Dissemination & Training Division, , National Center for PTSD, ; Palo Alto, CA USA

[10 ]GRID grid.168010.e, ISNI 0000000419368956, Stanford University School of Medicine, ; Palo Alto, CA USA

Article

Publisher ID: 215

DOI: 10.1007/s40501-020-00215-x

PMC ID: 7261035

PubMed ID: 32837831

SO-VID: bc69c181-edf0-4851-beab-361c5e9d4300

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

Advances in PTSD Treatment Delivery: Review of Findings and Clinical Considerations for the Use of Telehealth Interventions for PTSD

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Abstract

Purpose of review

Recent findings

Summary

Related collections

Telehealth & Medicine Today

Most cited references 38

National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria.

Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - A systematic review and meta-analysis of randomized controlled trials.

Empirical validation of the Insomnia Severity Index in cancer patients.

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