(PS6-C71) Effectiveness of Telehealth Delivered Massed Trauma-focused Psychotherapy Among Veterans with PTSD

Objective: Trauma-focused psychotherapies can be effectively delivered using a massed delivery format. Telehealth treatment for posttraumatic stress disorder (PTSD) using evidence-based psychotherapies (EBPs) such as Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing Therapy (EMDR) have been shown to be as effective as in-person treatment. However, the effectiveness of EBPs for PTSD over telehealth using the massed delivery format requires further examination. The purpose of this quality improvement study was to examine changes in PTSD and depressive symptoms among veterans who participated in the four-week Telemental Health Veterans Intensive PTSD (TMH-VIP) treatment program, which included individual EBPs for PTSD as well as required adjunctive group psychotherapy. In the context of the COVID-19 pandemic, the TMH-VIP program provided intensive PTSD treatment to veterans after the temporary closure of the mental health residential rehabilitation program for PTSD. We expected reductions in PTSD and depressive symptoms over the four-week program and that these symptom reductions would be maintained at one-month follow-up. We also examined program attendance and completion rates.



Method:  To examine the effectiveness of telehealth massed PTSD treatment, we reported on a quality improvement study of 33 veterans (75.8% male; mean age: 42.3, SD = 11.0) who participated in a virtual (secure video format) four-week massed PTSD program at a Department of Veterans Affairs (VA) medical center. The four-week TMH-VIP program modeled an intensive outpatient framework, which involved each veteran attending three individual sessions of their selected EBP for PTSD, as well as six group psychotherapy visits per week on Mondays, Wednesdays, and Fridays. Of the 33 Veterans who started treatment in the program, 17 veterans selected PE, 14 chose CPT, and 2 elected EMDR. Each group maintained a process-oriented approach to encourage peer reinforcement of empathy, vulnerability, approach tendencies, accountability, and socialization. Multilevel modeling was conducted to examine the changes in PTSD symptoms, as measured by the PCL-5, weekly version and in depression symptoms, as measured by the PHQ-9 total scores at pretreatment, weekly, posttreatment, and one-month follow-up. The overall best-fitted models were determined by direct comparisons of likelihood ratio tests. Model fit was best with a fixed slope, random intercept for all models. We applied full information maximum likelihood to deal with missing data.



Results:  Twenty-seven (81.8%) veterans completed the treatment and reported large reductions in PTSD (d = 1.48) and depressive symptoms (d = 1.08) at posttreatment and at one-month follow-up (PTSD, d = 1.34, and depression, d = 0.70), as well as high satisfaction with the program. Across the 27 veterans who completed the TMH-VIP treatment, the total number of individual session no-shows (n = 5, 1.4%) and cancellations (n = 9, 2.5%) were low, as well as robust findings for group session no-shows (n = 15, 2.2%) and cancellations (n = 30, 4.5%). 



Conclusion: Results suggested that EBPs for PTSD can be effectively delivered in a massed format over telehealth in a VA medical setting.