Telemedicine for PTSD no less effective than in-person therapy

Soldier sitting on the sofa during psychological therapy (iStock)

Veterans with posttraumatic stress disorder (PTSD) who have difficulties making it to in-person therapy sessions may be able to get treatment that's just as good by videoconference.

Researchers compared home-delivered prolonged exposure therapy - which helps patients confront memories and situations that trigger their symptoms - to the same treatment given in U.S. Veterans Affairs clinics, and found no difference in effectiveness.

"The best treatment for PTSD, with the most empirical support, can be delivered at no loss of effectiveness, directly into a veteran's home, rather than having the veteran come into clinic," lead study author Ron Acierno told Reuters Health by email.

"We can now save the travel time and bring the treatment right to them" if a veteran lives too far away to attend 12 to 15 weekly sessions, can't take off work or feels stigmatized coming into the clinic, said Acierno, a psychologist and researcher with the Ralph H. Johnson VA Medical Center in Charleston, South Carolina.

For the study, published in Behaviour Research and Therapy, Acierno and colleagues recruited 132 veterans who had been diagnosed with PTSD, 127 of them men.

All the participants were assessed with standard PTSD scales designed to measure symptom severity and depression. They were then randomly assigned to two groups - each would receive 10 to 12 prolonged exposure therapy sessions, but one group would attend sessions at a VA medical center while the other would have sessions at home by video conference.

The participants who got treatment at home were provided with videoconferencing software to use on their own computers, tablets or smartphones. Videophones or tablets were provided to participants who didn't own the proper equipment.

The researchers repeated the PTSD scales after three months of treatment and again three months later. They found that at both time points, the vets who were treated at home showed similar improvements in PTSD symptom severity as those treated in the clinic.

The at-home treatment scores for depression were not as good at three months, but by six months they were similar to the scores of the group treated in the clinic.

"Our effects with PTSD were just as good in person vs. home based telehealth," Acierno said, "however, people doing the treatment via home-based telehealth did report more difficulty."

About 33 percent of the at-home group did not complete the program compared to 19 percent of the clinic group.

Acierno said participants who dropped out reported difficulties such as feeling worried about losing control during exposures, the feeling they couldn't tolerate assignments to go out in public and that imagined exposures made them feel bad.

Acierno said he and his collaborator Dr. Melba Hernandez-Tejada are exploring the idea of pairing peers who have been through prolonged exposure therapy and no longer meet criteria for PTSD with veterans currently receiving the treatment via telehealth to help them through the difficult parts of the therapy.

Acierno said the Charleston VA currently offers the home-based therapy to patients.

"We have had tremendous response combining home telehealth with peer support during exposure, which is new," Acierno said, adding that in the past peers were involved only to encourage people to get into treatment, not actually helping to perform the treatment.

Peter Kane, a psychologist at the University of Wisconsin in Madison said the study was able to show that, at least in the VA health system, effective PTSD treatments can be successfully delivered in multiple ways.

"Patients with PTSD could be treated effectively in the clinic or by using home based telehealth," Kane said. The findings are especially important given the common barriers that make it harder for those who need these services to access them, he noted.

"Studies such as this one may change how mental health services are delivered in general, not just for PTSD or within the VA system," Kane said. "It may be the case at some point in the future that mental health clinics may offer home based telehealth as an alternative to traditionally clinic-based care."