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

• 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
• Journal Title: TRIALS
• Volume: Volume 23, Number 1
• Publisher: BMC | 2022-03-30, Pages 243-243
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s13063-022-06183-2
• Subjects: Sociology, Individual and Family Studies; Psychology, Behavioral; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Medicine, Research & Experimental; Research & Experimental Medicine; PTSD; Adherence; Evidence based treatments; Couples; Family; POSTTRAUMATIC-STRESS-DISORDER; INTERVENTIONS; PSYCHOTHERAPY; EFFICACY; COUPLE; THERAPY; SUPPORT; CARE; METAANALYSIS; SYMPTOMS

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.