Can families help veterans get more from PTSD treatment? A randomized clinical tria examining Prolonged Exposure with and without family involvement

• Type of Material: Article
• Authors: Laura A Meis, Minneapolis Veterans Affairs Health Care System; Shirley M Glynn, VA Greater Los Angeles Healthcare System; Michele R Spoont, Minneapolis Veterans Affairs Health Care System; Shannon M Kehle-Forbes, Minneapolis Veterans Affairs Health Care System; David Nelson, Minneapolis Veterans Affairs Health Care System; Carl E Isenhart, VA Desert Pacific Healthcare Network VISN 22; Afsoon Eftekhari, VA Palo Alto Hlth Care Syst; Princess E Ackland, Minneapolis Veterans Affairs Health Care System; Erin B Linden, Minneapolis Veterans Affairs Health Care System; Robert J Orazem, Minneapolis Veterans Affairs Health Care System; Andrea Cutting, Minneapolis Veterans Affairs Health Care System; Emily Hagel M Campbell, Minneapolis Veterans Affairs Health Care System; Millie Astin, Emory University; Katherine E Porter, VA Ann Arbor Healthcare System; Erin Smith, VA Ann Arbor Healthcare System; Christopher D Chuick, Minneapolis Veterans Affairs Health Care System; Kristen E Lamp, Atlanta VA Health Care System; Tessa C Vuper, VA Ann Arbor Healthcare System; Taylor A Oakley, University of Missouri-Kansas City; Lila B Khan, University of Minnesota, Minneapolis; Sally K Keckeisen, Augsburg University; Melissa A Polusny, Minneapolis Veterans Affairs Health Care System
• Language: English
• Date: 2022-03-30
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s13063-022-06183-2
• Title of Journal or Parent Work: TRIALS
• Volume: 23
• Issue: 1
• Start Page: 243
• End Page: 243
• Grant/Funding Information: This research was supported by a grant from the Department of Veterans Affairs (HSR&D IIR 15-322). The material is the result of work supported with the use of resources and facilities at the Minneapolis Veterans Affairs Health Care System, VA Ann Arbor Healthcare System, and the Atlanta Veterans Affairs Medical Center. The findings and conclusions in this document are those of the authors and do not represent the views of the Department of Veterans Affairs or the United States government. No investigators have affiliations or financial involvement that conflict with the material presented. The funding body (VA HSR&D) played no role in the design of the study or the collection, analysis, or interpretation of the data.
• Keywords: SUPPORT; Research & Experimental Medicine; METAANALYSIS; Adherence; PSYCHOTHERAPY; Life Sciences & Biomedicine; POSTTRAUMATIC-STRESS-DISORDER; COUPLE; Family; SYMPTOMS; INTERVENTIONS; THERAPY; PTSD; Evidence based treatments; Science & Technology; Medicine, Research & Experimental; EFFICACY; CARE; Couples
• Research Categories: Psychology, Behavioral; Health Sciences, Public Health; Sociology, Individual and Family Studies

Abstract

Background: Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans’ treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence. Methods: One hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA. Discussion: While the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments. Trial registration: ClinicalTrials.govNCT03256227. Registered on August 21, 2017.