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PTSDNCT01177488

Innovative Service Delivery for Secondary Prevention of PTSD

A study testing Behavioral Activation Therapeutic Exposure (BATE) in people with PTSD, run by Charleston Research Institute at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine whether therapy for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with Post-traumatic Stress Disorder (PTSD) symptoms can be delivered effectively using videoconferencing technology ("telepsychology"), which allows a therapist and patient who are not in… Read more about this study

Who is it for?
Ages 21 years and older
Conditions the study is for
PTSD
What is being tested?
Behavioral Activation Therapeutic Exposure (BATE)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
280 participants
Where
2 sitesUnited States
Study dates
Mar 2008to Feb 2015
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Participants will be OIF/OEF military personnel,
  • age 21 and above, and
  • with symptoms of posttraumatic stress disorder (PTSD) assigned on the basis of the Clinician Administered PTSD Scale (CAPS) and PTSD Checklist-Military (PCL-M).

Who cannot join

  • Actively psychotic or demented persons,
  • individuals with both suicidal ideation and clear intent, and
  • individuals meeting criteria for substance dependence will be excluded from participation.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Medical University of South Carolina

    Charleston, South Carolina, 29403

  • Ralph H. Johnson VAMC

    Charleston, South Carolina, 29403

Other trials in United States

About this study

Official title: Innovative Service Delivery for Secondary Prevention of PTSD in At-Risk OIF-OEF Service Men and Women

The purpose of this study is to determine whether therapy for Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans with Post-traumatic Stress Disorder (PTSD) symptoms can be delivered effectively using videoconferencing technology ("telepsychology"), which allows a therapist and patient who are not in the same room as one another to communicate.

Read the detailed description

OIF and OEF service men and women exposed to high levels of violence are at risk for developing mental health disorders including Post-traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD). Even those with less severe symptoms who fail to meet diagnostic criteria for a mental health disorder may struggle to return to pre-deployment functioning. Studies suggest that a significant percentage of veterans may suffer from "subthreshold" PTSD; although their symptom presentation is less severe, these veterans experience emotional distress and reduced quality of life.

Given that Veterans Affairs (VA) mental-health service providers are faced with the important and challenging task of alleviating the emotional suffering of our service men and women while staying within budget confines, we need effective, practical, evidence-based treatments that can be delivered in an expedient and cost-effective manner. Thus, the current project has two primary objectives: 1) to develop, implement, and evaluate a treatment program (Behavioral Activation and Therapeutic Exposure, BATE) for OIF and OEF veterans with PTSD symptoms, and 2) to determine whether or not this program delivered via telepsychology will be as effective as in-person treatment. Secondary objectives include determining: 1) which treatment modality is more effective in terms of process variables (e.g., treatment satisfaction, session attendance), 2) which treatment modality is more cost-effective, and 3) whether treatment effects differ across race and gender. Study participants will be randomized to two treatment conditions, BATE delivered via telepsychology (BATE-T) and BATE delivered in-person (BATE-IP).

The current treatment protocol is based on two, research-supported therapeutic rationales, Behavioral Activation (BA) and Therapeutic Exposure (TE). Briefly, the treatment aims to increase the participant's engagement in healthy activities (i.e., activities that are naturally reinforcing and promote the participant's life values) and exposure activities (i.e., activities that target specific PTSD symptoms such as avoidance and hyperarousal). Treatment will be implemented in eight, one and half hour sessions. Although research supports the effectiveness of behavior- and exposure-based treatments for trauma-related mental health problems, a potential risk for any counseling program that targets avoidance symptoms is a temporary increase in emotional distress. Therapists will inform participants that this is a normal "side effect" of treatment. However, over the course of treatment should a participant's emotional distress rise to a level above what can be handled via outpatient counseling, the participant will be removed from the study and appropriate referrals will be made.

The anticipated duration of this study is four years. Based on results of the study, we will finalize the treatment manual. In terms of clinical applicability, we plan to present study findings at conferences and disseminate the treatment manual to VA mental health service providers in approximately four to five years. Study findings will address important gaps in the PTSD literature, yielding several contributions to the field. First, to the extent that BATE effectively reduces symptom severity, this investigational treatment may benefit individual OIF/OEF service men and women by alleviating emotional suffering and improving quality of life. Second, to the extent that BATE prevents the development of full-blown PTSD in subclinical military personnel, this investigational treatment may reduce attrition from the military due to untreated mental health problems. Third, only a small percentage of those who might benefit from counseling actually seek services due to barriers associated with traditional service delivery practices such as geographic distance from the VA hospital and stigma of psychological treatment. Thus, as telemedicine has been shown to circumvent these barriers to care, the current project has the potential to reach an otherwise underserved population: subclinical OIF and OEF service men and women who may be reluctant to seek care. Fourth, to the extent that BATE-T produces results comparable to BATE-IP, this study may potentially identify a cost-effective alternative to in-person treatment thereby reducing post-service treatment costs to VA's.

Conditions
PTSD
Being tested
Behavioral Activation Therapeutic Exposure (BATE)
Keywords
Military, Health Service Delivery, Behavioral Symptoms, Telepsychology, Behavioral Activation, Exposure Therapy, Veterans, Telemedicine
Medical subject headings
Stress Disorders, Post-Traumatic, Behavioral Symptoms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Behavioral Activation Therapeutic Exposure (BATE)Behavioural

    This intervention combines Behavior Activation Therapy and Exposure Therapy to treat PTSD symptoms.

Study groups in NCT01177488
Study groupRoleWhat they receive
BATE-TExperimentalBehavioral Activation Therapeutic Exposure done while the patient is at home via videoconferencing technology
Receives: Behavioral: Behavioral Activation Therapeutic Exposure (BATE)
BATE-IPActive comparatorBehavioral Activation Therapeutic Exposure done in the therapist's office
Receives: Behavioral: Behavioral Activation Therapeutic Exposure (BATE)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The major objective of this study is to determine if Behavioral Activation with Therapeutic Exposure (BATE) delivered via Telemedicine is as effective as BATE In Person.

    This is measured in terms of (1) clinical (PTSD and Depression); (2) process (Treatment Satisfaction and Attrition); and (3) economic (Cost) outcomes.

    Measured: 1 year

Secondary outcomes (23)
  1. Clinician Administered PTSD Scale (CAPS)

    Measured: Baseline

  2. Clinician Administered PTSD Scale (CAPS)

    Measured: 8 weeks

  3. Clinician Administered PTSD Scale (CAPS)

    Measured: 3 months

  4. Clinician Administered PTSD Scale (CAPS)

    Measured: 1 year

  5. The Deployment Risk and Resiliency Inventory (DRRI)

    Measured: Baseline

  6. PTSD Checklist-Military (PCL-M)

    Measured: Baseline

  7. PTSD Checklist-Military (PCL-M)

    Measured: 4 weeks

  8. PTSD Checklist-Military (PCL-M)

    Measured: 8 weeks

  9. PTSD Checklist-Military (PCL-M)

    Measured: 3 months

  10. PTSD Checklist-Military (PCL-M)

    Measured: 1 year

  11. Beck Depression Inventory-II (BDI-II)

    Measured: Baseline

  12. Beck Depression Inventory-II (BDI-II)

    Measured: 4 weeks

  13. Beck Depression Inventory-II (BDI-II)

    Measured: 8 weeks

  14. Beck Depression Inventory-II (BDI-II)

    Measured: 3 months

  15. Beck Depression Inventory-II (BDI-II)

    Measured: 1 year

  16. Health Related Functioning: Medical Outcome Study Short Study Forms-36 Health Survey (SF 36)

    Measured: Baseline

  17. Health Related Functioning: Medical Outcome Study Short Study Forms-36 Health Survey (SF 36)

    Measured: 4 weeks

  18. Health Related Functioning: Medical Outcome Study Short Study Forms-36 Health Survey (SF 36)

    Measured: 8 weeks

  19. Health Related Functioning: Medical Outcome Study Short Study Forms-36 Health Survey (SF 36)

    Measured: 3 months

  20. Health Related Functioning: Medical Outcome Study Short Study Forms-36 Health Survey (SF 36)

    Measured: 1 year

  21. Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS-VA)

    Measured: 8 weeks

  22. Service Delivery Perceptions Questionnaire

    Measured: 8 weeks

  23. Prior Experience with Computer and Audiovisual Technology

    Short measure to learn more about participants' prior experience and comfort level with computers and audiovisual technology

    Measured: Baseline

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Aug 2010 (estimated)
  2. Study startMar 2008
  3. Primary completionAug 2014
  4. Study completionFeb 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
280 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01177488
Sponsor's protocol ID
DoD Acierno
Status last verified
Sep 2015
First submitted
12 Apr 2010
Last updated
14 Sep 2015
Results posted
No
Data monitoring committee
No

Publications

  • Acierno R, Rheingold A, Amstadter A, Kurent J, Amella E, Resnick H, Muzzy W, Lejuez C. Behavioral activation and therapeutic exposure for bereavement in older adults. Am J Hosp Palliat Care. 2012 Feb;29(1):13-25. doi: 10.1177/1049909111411471. Epub 2011 Jun 17.

    PubMed 21685428
  • Gros DF, Price M, Yuen EK, Acierno R. Predictors of completion of exposure therapy in OEF/OIF veterans with posttraumatic stress disorder. Depress Anxiety. 2013 Nov;30(11):1107-13. doi: 10.1002/da.22207. Epub 2013 Oct 21.

    PubMed 24151141
  • Gros DF, Price M, Strachan M, Yuen EK, Milanak ME, Acierno R. Behavioral activation and therapeutic exposure: an investigation of relative symptom changes in PTSD and depression during the course of integrated behavioral activation, situational exposure, and imaginal exposure techniques. Behav Modif. 2012 Jul;36(4):580-99. doi: 10.1177/0145445512448097. Epub 2012 Jun 7.

    PubMed 22679240
  • Gros DF, Strachan M, Ruggiero KJ, Knapp RG, Frueh BC, Egede LE, Lejuez CW, Tuerk PW, Acierno R. Innovative service delivery for secondary prevention of PTSD in at-risk OIF-OEF service men and women. Contemp Clin Trials. 2011 Jan;32(1):122-8. doi: 10.1016/j.cct.2010.10.003. Epub 2010 Oct 14.

    PubMed 20951235
  • Gros DF, Veronee K, Strachan M, Ruggiero KJ, Acierno R. Managing suicidality in home-based telehealth. J Telemed Telecare. 2011;17(6):332-5. doi: 10.1258/jtt.2011.101207. Epub 2011 Aug 15.

    PubMed 21844180
  • Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL. Ten year revision of the brief behavioral activation treatment for depression: revised treatment manual. Behav Modif. 2011 Mar;35(2):111-61. doi: 10.1177/0145445510390929.

    PubMed 21324944
  • Price M, Gros DF, Strachan M, Ruggiero KJ, Acierno R. Combat experiences, pre-deployment training, and outcome of exposure therapy for post-traumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom veterans. Clin Psychol Psychother. 2013 Jul-Aug;20(4):277-85. doi: 10.1002/cpp.1768. Epub 2012 Jan 18.

    PubMed 22253233
  • Price M, Gros DF, Strachan M, Ruggiero KJ, Acierno R. The Role of Social Support in Exposure Therapy for Operation Iraqi Freedom/Operation Enduring Freedom Veterans: A Preliminary Investigation. Psychol Trauma. 2013 Jan 1;5(1):93-100. doi: 10.1037/a0026244.

    PubMed 23869250
  • Strachan M, Gros DF, Ruggiero KJ, Lejuez CW, Acierno R. An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings. Behav Ther. 2012 Sep;43(3):560-9. doi: 10.1016/j.beth.2011.03.003. Epub 2011 May 24.

    PubMed 22697444
  • Strachan M, Gros DF, Yuen E, Ruggiero KJ, Foa EB, Acierno R. Home-based telehealth to deliver evidence-based psychotherapy in veterans with PTSD. Contemp Clin Trials. 2012 Mar;33(2):402-9. doi: 10.1016/j.cct.2011.11.007. Epub 2011 Nov 11.

    PubMed 22101225

Questions about this trial

What is this clinical trial studying?

A study testing Behavioral Activation Therapeutic Exposure (BATE) in people with PTSD, run by Charleston Research Institute at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 14 Sep 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The major objective of this study is to determine if Behavioral Activation with Therapeutic Exposure (BATE) delivered via Telemedicine is as effective as BATE In Person. (time frame: 1 year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01177488, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Sep 2015.

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