BEHAVIORAL ACTIVATION AND THERAPEUTIC EXPOSURE FOR POSTTRAUMATIC STRESS DISORDER: A NONINFERIORITY TRIAL OF TREATMENT DELIVERED IN PERSON VERSUS HOME-BASED TELEHEALTH

TLDR

Combat veterans with PTSD and major depression face barriers such as stigma, travel time, and cost, necessitating alternative delivery methods like home‑based telehealth that have yet to be compared to clinic‑based care in adequately powered trials. This study aimed to determine whether behavioral activation and therapeutic exposure delivered via home‑based telehealth is noninferior to in‑person clinic delivery for reducing PTSD and depression symptoms. A randomized controlled design with 232 veterans measured PTSD and depression symptoms at baseline, posttreatment, and 3‑ and 12‑month follow‑ups to compare the two delivery modes. Results showed comparable symptom improvement across both modalities, with home‑based telehealth effectively addressing logistical and stigma barriers while matching clinic outcomes.

Abstract

Combat veterans returning to society with impairing mental health conditions such as PTSD and major depression (MD) report significant barriers to care related to aspects of traditional psychotherapy service delivery (e.g., stigma, travel time, and cost). Hence, alternate treatment delivery methods are needed. Home-based telehealth (HBT) is one such option; however, this delivery mode has not been compared to in person, clinic-based care for PTSD in adequately powered trials. The present study was designed to compare relative noninferiority of evidence-based psychotherapies for PTSD and MD, specifically Behavioral Activation and Therapeutic Exposure (BA-TE), when delivered via HBT versus in person, in clinic delivery.A repeated measures (i.e., baseline, posttreatment, 3-, 6-month follow-up) randomized controlled design powered for noninferiority analyses was used to compare PTSD and MD symptom improvement in response to BA-TE delivered via HBT versus in person, in clinic conditions. Participants were 232 veterans diagnosed with full criteria or predefined subthreshold PTSD.PTSD and MD symptom improvement following BA-TE delivered by HBT was comparable to that of BA-TE delivered in person at posttreatment and at 3- and 12-month follow-up.Evidence-based psychotherapy for PTSD and depression can be safely and effectively delivered via HBT with clinical outcomes paralleling those of clinic-based care delivered in person. HBT, thereby, addresses barriers to care related to both logistics and stigma.