Peer Social Support During In Vivo Exposure for PTSD (PEP)

Peer Social Support During In Vivo Exposure for PTSD: A Program to Address Dropout From Prolonged Exposure

Veterans who have prematurely dropped out of exposure therapy for PTSD will be contacted and offered the opportunity to return to treatment, this time with the assistance of an in vivo exposure therapy 'workout buddy'. This peer will meet them at the in vivo exposure therapy location and offer support an encouragement while the patient remains in that location. As the PTSD treatment standards in Charleston and other VA sites across the country increasingly include telemedicine delivered care, both in person and telemedicine based exposure therapy recipients will be included. There will be no randomization; all participants will receive the peer support 'workout buddy' for exposure therapy assignments.

Study Overview

• Status: Completed
• Conditions: Anxiety Disorders; Stress Disorders, Post-Traumatic; Mental Disorder; Traumatic Disorder
• Intervention / Treatment: Behavioral: Prolonged Exposure

Detailed Description

Veterans (participants and peers) with PTSD will be recruited from the Charleston VA Medical Center catchment area. Participants will have been assigned to exposure therapy for PTSD and either started treatment, or dropped out before treatment; peers will have successfully completed exposure therapy for PTSD. Those eligible to participate will also include Veterans who are identified as "at-risk" of dropping out, Veterans who are uncomfortable completing in vivo exposure activities, and those who may have PTSD symptoms, but at the sub-threshold level. Participants will receive 8-12 weekly sessions of exposure therapy treatment with assistance of a PE Peer. Half of subjects will be randomized to the PE+Workout Buddy condition, where they will complete treatment with the assistance of a Veteran who will meet them at least once per week for in vivo exposure therapy assignments, for 3-4 weeks at the beginning of treatment. Half of subjects will be randomized to the PE+General Support condition, where they will complete treatment with the assistance of a Veteran who will call them via telephone once per week to encourage session attendance and ask about treatment progress, life stresses, etc. General support peers will also meeting Veterans 2-4 times per month to check in about treatment progress. All participants and peers will be consented. Participants will be assessed at baseline, post-treatment, and 3- & 6-month follow-up.

• Study Type: Interventional
• Enrollment (Actual): 140
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • South Carolina
    • Charleston, South Carolina, United States, 29401
      • Ralph H. Johnson VA Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Participant Inclusion Criteria:

1. Adult male or female over the age of 18 that has served, or is currently serving in the military.
2. Either diagnosis of PTSD as determined by a Clinician Administered PTSD Scale for DSM-5 (CAPS-5) clinical interview or CAPS-5 severity ≥ 25, and a PCL-5 score of ≥25.
3. Attempted PE treatment in the past, but did not complete treatment (defined as dropping out from treatment or refusal to engage in in vivo exposure assignments) OR identified as "at-risk" of dropping out of current exposure therapy treatment (defined as failure to complete 3 sessions of therapy within any 6 week period or verbally indicating that they are not comfortable with the exposure activities).

Participant Exclusion Criteria:

1. Active psychosis or dementia at screening.
2. Suicidal ideation with clear intent.
3. Concurrent enrollment in another clinical trial for PTSD or depression.

Peer Inclusion Criteria:

1. Adult male or female over the age of 18 that has served, or is currently serving, in the military.
2. Successful competition of exposure therapy treatment in the past and willingness to act as peer in the program.
3. PCL-5 score of 32 or lower.

Peer Exclusion Criteria:

1. Active psychosis or dementia at screening.
2. Suicidal ideation with clear intent.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PE+Exposure Workout Buddy; Prolonged Exposure with assistance of Veteran who has successfully completed treatment to meet patients at exposure sites in the community to offer support during exposure.	Behavioral: Prolonged Exposure; Practice guidelines have identified that trauma-focused psychotherapies have most evidence for treatment PTSD. Prolonged Exposure (PE) is one type of trauma-focused psychotherapy. PE teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can decrease your PTSD symptoms. Treatment will last anywhere from 8-12 weeks for 75-90 minutes, once per week.
Active Comparator: PE+Peer General Support; Prolonged Exposure with assistance of Veteran who has successfully completed treatment to call and talk to patients once per week, informally meet at patient appointments, encourage session attendance and check in about progress.	Behavioral: Prolonged Exposure; Practice guidelines have identified that trauma-focused psychotherapies have most evidence for treatment PTSD. Prolonged Exposure (PE) is one type of trauma-focused psychotherapy. PE teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can decrease your PTSD symptoms. Treatment will last anywhere from 8-12 weeks for 75-90 minutes, once per week.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Administrated PTSD Scale (CAPS)	The Clinician Administered PTSD (Posttraumatic stress disorder) Scale (CAPS) is a 30-item structured interview that corresponds to the Diagnostic and Statistical Manual of Mental Disorders, 5th Version (DSM-V) criteria for PTSD. The CAPS can be used to make a current (past month) or lifetime diagnosis of PTSD or to assesses symptoms over the past week. CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20). A symptom cluster score may also be calculated for dissociation by summing items 19 and 20. Scores range from 0 to 80.	36 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mini International Neuropsychiatric Interview (M.I.N.I.)	The MINI is a brief structured interview that assesses the criteria for DSM-V Axis I diagnoses. The MINI will be used to assess for a diagnosis of current depression, panic symptoms, generalized anxiety symptoms, eating disorders, psychotic symptoms and to screen for substance dependence.	Baseline
Mini International Neuropsychiatric Interview (M.I.N.I.)	The MINI is a brief structured interview that assesses the criteria for DSM-V Axis I diagnoses. The MINI will be used to assess for a diagnosis of current depression, panic symptoms, generalized anxiety symptoms, eating disorders, psychotic symptoms and to screen for substance dependence.	36 weeks
PTSD Checklist, 5th Version (PCL-5)	The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including, monitoring symptom change during and after treatment, screening individuals for PTSD, and making a provisional PTSD diagnosis. Description information provided by the National Center for PTSD.	Baseline
PTSD Checklist, 5th Version (PCL-5)	The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including, monitoring symptom change during and after treatment, screening individuals for PTSD, and making a provisional PTSD diagnosis. Description information provided by the National Center for PTSD.	13 weeks
PTSD Checklist, 5th Version (PCL-5)	The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including, monitoring symptom change during and after treatment, screening individuals for PTSD, and making a provisional PTSD diagnosis. Description information provided by the National Center for PTSD.	24 weeks
PTSD Checklist, 5th Version (PCL-5)	The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD. The PCL-5 has a variety of purposes, including, monitoring symptom change during and after treatment, screening individuals for PTSD, and making a provisional PTSD diagnosis. Description information provided by the National Center for PTSD.	36 weeks
Deployment Risk and Resilience Inventory-2 (DRRI-2)	The Deployment Risk and Resilience Inventory-2 (DRRI-2) is a suite of 17 individual scales that assess key deployment-related risk and resilience factors with demonstrated implications for Veterans' post-deployment health.	Baseline
Patient Health Questionnaire (PHQ-9)	The Patient Health Questionnaire -9 is widely used, well-validated measure of depression severity with high internal consistency (alpha .83 to .92; Cameron, Crawford, et al, 2008), and is correlated strongly with other depression measures. Its 9 items assess affective and somatic symptoms and correspond to diagnostic criteria for MDD.	Baseline
Patient Health Questionnaire (PHQ-9)	The Patient Health Questionnaire -9 is widely used, well-validated measure of depression severity with high internal consistency (alpha .83 to .92; Cameron, Crawford, et al, 2008), and is correlated strongly with other depression measures. Its 9 items assess affective and somatic symptoms and correspond to diagnostic criteria for MDD.	13 weeks
Patient Health Questionnaire (PHQ-9)	The Patient Health Questionnaire -9 is widely used, well-validated measure of depression severity with high internal consistency (alpha .83 to .92; Cameron, Crawford, et al, 2008), and is correlated strongly with other depression measures. Its 9 items assess affective and somatic symptoms and correspond to diagnostic criteria for MDD.	24 weeks
Patient Health Questionnaire (PHQ-9)	The Patient Health Questionnaire -9 is widely used, well-validated measure of depression severity with high internal consistency (alpha .83 to .92; Cameron, Crawford, et al, 2008), and is correlated strongly with other depression measures. Its 9 items assess affective and somatic symptoms and correspond to diagnostic criteria for MDD.	36 weeks
Medical Outcome Study Short Form-36 Health Survey (SF-36)	The SF-36 is a 36-item questionnaire that measures health status, social support, and functioning over the past four weeks. The SF-36 has good test-retest reliability as well as sensitivity to change in health.	Baseline
Medical Outcome Study Short Form-36 Health Survey (SF-36)	The SF-36 is a 36-item questionnaire that measures health status, social support, and functioning over the past four weeks. The SF-36 has good test-retest reliability as well as sensitivity to change in health.	13 weeks
Medical Outcome Study Short Form-36 Health Survey (SF-36)	The SF-36 is a 36-item questionnaire that measures health status, social support, and functioning over the past four weeks. The SF-36 has good test-retest reliability as well as sensitivity to change in health.	24 weeks
Medical Outcome Study Short Form-36 Health Survey (SF-36)	The SF-36 is a 36-item questionnaire that measures health status, social support, and functioning over the past four weeks. The SF-36 has good test-retest reliability as well as sensitivity to change in health.	36 weeks
Combat Exposure Scale (CES)	The Combat Exposure Scale (CES) is a 7-item self-report measure that assesses wartime stressors experienced by combatants. Items are rated on a 5-point frequency (1 = "no" or "never" to 5 = "more than 50 times"), 5-point duration (1 = "never" to 5 = "more than 6 months"), 4-point frequency (1 = "no" to 4 = "more than 12 times") or 4-point degree of loss (1 = "no one" to 4 = "more than 50%") scale. Scores range from 0-41 and is calculated by using a sum of weighted scores, which can be classified into one of five categories of combat exposure ranging from "light" to "heavy."	Baseline
Treatment Credibility Questionnaire	This questionnaire is used to assess for differences in outcome expectancy using treatment credibility scales. The questionnaire asks how the participant feels about the current treatment she is receiving, how logical it seems, how likely she would be to recommend it to a friend, and how successful she believes it is in decreasing different symptoms of PTSD, such as fear.	2 weeks
Modified Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS-VA)	The Modified Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS-VA) is 16-item measure, with a Likert scale response format, based on a general measure of patient satisfaction. There are 16 questions which can be rated from "N/A" to "Excellent." There is no total score for this measure.	13 weeks
PEP Satisfaction Scale (PEP-SS)	The PEP Satisfaction Scale (PEP-SS) is a 25-item measure that assesses participant satisfaction with the peer support. Items range from "poor" to "excellent" with some questions having a "n/a" option. Lower scores indicate worse outcomes. There is no total score for this measure.	13 weeks
Barriers to Therapeutic Exposure Scale (BTES)	The Barriers to Therapeutic Exposure Scale (BTES) is a 45 item questionnaire assessing factors that may affect participation in Prolonged Exposure therapy. Items range from "never a problem" to "very often a problem" with lower scores indicating worse outcomes. There is no total score for this measure.	13 weeks

Collaborators and Investigators

• Sponsor: Medical University of South Carolina
• Collaborators: Charleston Research Institute
• Investigators: Principal Investigator: Wendy Muzzy, MRA, MLIS, Medical University of South Carolina; Principal Investigator: Ron Acierno, PhD, Ralph H. Johnson VA Medical Center

Publications and helpful links

General Publications

• Hernandez-Tejada MA, Muzzy W, Price M, Hamski S, Hart S, Foa E, Acierno R. Peer support during in vivo exposure homework to reverse attrition from prolonged exposure therapy for posttraumatic stress disorder (PTSD): description of a randomized controlled trial. Trials. 2020 Apr 28;21(1):366. doi: 10.1186/s13063-020-04302-5.

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2018
• Primary Completion (Actual): March 3, 2023
• Study Completion (Actual): May 31, 2023

Study Registration Dates

• First Submitted: March 7, 2018
• First Submitted That Met QC Criteria: March 29, 2018
• First Posted (Actual): April 2, 2018

Study Record Updates

• Last Update Posted (Actual): August 29, 2023
• Last Update Submitted That Met QC Criteria: August 25, 2023
• Last Verified: August 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Stress Disorders, Traumatic; Anxiety Disorders; Stress Disorders, Post-Traumatic; Mental Disorders
• Other Study ID Numbers: Pro00075914; W81XWH-18-1-0081 (Other Grant/Funding Number: U.S. Army Medical Research and Materiel Command)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No