Re-engaging Dropouts of Prolonged Exposure for PTSD Delivered via Home-Based Telemedicine or In Person: Satisfaction wit
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ress correspondence to Melba A. Hernandez-Tejada, PhD, DHA, Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee St., Charleston, SC 29425, USA. Email: [email protected]. Melba A. Hernandez-Tejada, PhD, DHA, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences | Trauma & Resilience Center, University of Texas Health Science Center at Houston, 1941 East Road, BBSB 3120, Houston, TX 77054, USA. Ron Acierno, PhD, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences | Trauma & Resilience Center, University of Texas Health Science Center at Houston, 1941 East Road, BBSB 3120, Houston, TX 77054, USA. Ron Acierno, PhD, Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee St., Charleston, SC 29425, USA. David Sánchez-Carracedo, PhD, Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
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Journal of Behavioral Health Services & Research, 2020. 1–11. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09734-0
Veteran-to-Veteran Support During PE
HERNANDEZ-TEJADA ET AL.
Introduction Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD) in Veterans, defined both in terms of symptom amelioration and subsequent reduced use of mental health services.1–4 Indeed, among therapies for PTSD, PE has the most consistent support for its efficacy.5 Unfortunately, rate of dropout from PE and other evidence-based PTSD treatments is about 28% in randomized control trials (RCTs) and even higher in actual clinical practice.6 As such, identifying and resolving barriers to effective treatment completion are paramount. Telemedicine-delivered PE, specifically home-based telemedicine delivered PE in particular, was posited as a strategy to reduce dropout by addressing several factors related to psychotherapy attrition, such as travel time, cost, and stigma associated with visiting mental health clinics.7 Moreover, home-based telemedicine offers an affordable way to provide mental health services to rural and remote populations, or to those with physical conditions that make office-based care difficult to obtain.8,9 Despite apparent advantages of telemedicine in delivering evidence-based PTSD treatment such as PE, recent research demonstrates comparable rates of dropout across in person and telemedicine modalities.10 In their examination of dropouts from two very large treatment outcome studies, Hernandez-Tejada et al. 10 noted that, whereas Veterans receiving in person treatment expectedly cited problems with logistics (e.g., parking, travel time) as reasons for leaving treatment, those receiving care via home-based telemedicine reported higher levels of discomfort during PE in vivo exposure homework, although they did complete more therapy sessions prior to dropout (see also Morland, Greene, Ruzek, and Godleski).11 Similar findings were observed by Tuerk, Ruggiero, Yoder, Gros, and Acierno,12 who noted increased hyper-vigilance symptoms in patients r
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