- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05789329
Non-Inferiority Trial of TrIGR for PTSD (TrIGR/CPT)
Non-Inferiority Trial of Trauma Informed Guilt Reduction Therapy (TrIGR) for PTSD
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Trauma-related guilt is common and impairing among trauma survivors, particularly among treatment seeking Veterans with posttraumatic stress disorder (PTSD). Although evidence-based trauma-focused PTSD treatments such as Cognitive Processing Therapy (CPT) are effective to treat PTSD and trauma-related guilt, many still experience symptoms or maintain their diagnosis after treatment, and dropout from these generally 12+ session protocols is high. Veterans show lower response and higher dropout than others with PTSD. Delivering protocols that are generally 12 or more sessions challenges the Veterans Affairs (VA) healthcare system given high demand for mental health care. For these reasons, additional and less burdensome approaches are needed. Brief treatment that targets mechanisms that are distressing and associated with multiple problems and disorders may be an understudied but promising way to treat PTSD and other posttraumatic psychopathology. The investigators' work shows that a brief treatment targeting trauma-related guilt and shame, Trauma Informed Guilt Reduction Therapy (TrIGR), can reduce guilt, PTSD, depression, and distress among Veterans and help them reengage with activities they find meaningful. Whether TrIGR is no less effective than longer, more resource heavy evidence-based PTSD treatments disseminated across by VA, like CPT, is the next critical question.
The proposed randomized clinical trial (RCT) will be the first non-inferiority trial of TrIGR and the first to compare TrIGR to a first tier PTSD treatment, specifically CPT. It will also be the first to evaluate TrIGR with Veterans from all eras with guilt from any type of traumas, as the investigators previous work was exclusively with Veterans of the conflicts in Iraq and Afghanistan with deployment-related traumas. 158 Veterans across two VA sites will be randomized to TrIGR or CPT. Exclusion criteria will be minimal so that generalizability will be high. Treatment will be delivered in VA mental health clinics. The primary aim is to evaluate if TrIGR is non-inferior to CPT in reducing PTSD symptom severity among Veterans with PTSD who endorse trauma-related guilt. Secondary aims are to evaluate TrIGR's non-inferiority relative to CPT regarding depression severity. The investigators will explore potential mechanisms of treatment, such as the relationship between change in guilt and shame change in PTSD symptoms. The study is critical to establish whether TrIGR is effective for a much larger group of Veterans and whether it is as effective as longer treatments already available in VA to inform if TrIGR warrants further study and dissemination in VA.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sonya B Norman, PhD
- Phone Number: 5198 (858) 552-8585
- Email: Sonya.Norman@va.gov
Study Contact Backup
- Name: Kaitlyn Panza, PhD
- Phone Number: (858) 552-8585
- Email: kaitlyn.panza@va.gov
Study Locations
-
-
California
-
San Diego, California, United States, 92161-0002
- Recruiting
- VA San Diego Healthcare System, San Diego, CA
-
Principal Investigator:
- Sonya B. Norman, PhD
-
Contact:
- Sonya B Norman, PhD
- Phone Number: 5198 858-552-8585
- Email: Sonya.Norman@va.gov
-
-
Florida
-
Tampa, Florida, United States, 33612
- Recruiting
- James A. Haley Veterans' Hospital, Tampa, FL
-
Contact:
- Risa Nakase-Richardson, PhD
- Phone Number: 8139722000
- Email: risa.Nakase-Richardson@va.gov
-
Contact:
- Brittany Davis, PhD
- Phone Number: 813-972-2000
- Email: brittany.davis@va.gov
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- U.S. Veterans age 18 or older;
- meets diagnostic criteria for PTSD or subthreshold PTSD;
- a score of 2 or higher ("true" to "extremely true") on feeling trauma-related guilt much or all of the time or scoring 3 or higher ("very true" or "extremely true") on at least one guilt cognition factor (hindsight bias/responsibility, wrongdoing, or lack of justification) on the Trauma Related Guilt Inventor.
- not currently receiving trauma-focused treatment such as CPT or PE; and
- willingness to attend psychotherapy and assessment sessions.
Exclusion Criteria:
- Impaired mental status as measured by the Montreal Cognitive Assessment (MoCA) (score < 21) and confirmed by a neuropsychologist,
- Veterans with significant current risk of suicidal/homicidal behavior will be referred to more appropriate treatment;
- Current severe substance use disorder (in the past two months) based on DSM-5 criteria;
- Current unmanaged psychosis or mania;
- life threatening or unstable medical illness; or
- inability to read.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Trauma Informed Guilt Reduction Therapy (TrIGR)
behavioral intervention aimed to reduce trauma-related guilt and shame
|
behavioral intervention aimed to reduce trauma-related guilt and shame
Other Names:
|
Active Comparator: Cognitive Processing Therapy (CPT)
behavioral intervention aimed at reducing PTSD symptoms
|
behavioral intervention aimed at reducing PTSD symptoms
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in Clinician Administered PTSD Scale - 5 (CAPS-5)
Time Frame: baseline to 28 weeks later
|
Clinician Administered PTSD Scale - 5 (CAPS-5) - score range 0 - 80; higher scores are indicative of more severe PTSD symptoms.
Reduction in scores is considered a positive outcome.
|
baseline to 28 weeks later
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
change in Patient Health Questionnaire - 9 (PHQ-9)
Time Frame: baseline to 28 weeks later
|
change in Patient Health Questionnaire - 9 (PHQ-9) - score ranges 0-27.
higher scores are indicative of more severe depressive symptoms.
Reduction in scores is considered a positive outcome.
|
baseline to 28 weeks later
|
Trauma Related Guilt Inventory (TRGI)
Time Frame: baseline to 28 weeks later
|
Trauma Related Guilt Inventory (TRGI) - score ranges 0-4.
higher scores are indicative of more severe trauma-related guilt.
Reduction in scores is considered a positive outcome.
|
baseline to 28 weeks later
|
Trauma Related Shame Inventory (TRSI)
Time Frame: baseline to 28 weeks later
|
Trauma Related Shame Inventory (S) - score ranges 0-72.
higher scores are indicative of more severe trauma-related shame.
Reduction in scores is considered a positive outcome.
|
baseline to 28 weeks later
|
Collaborators and Investigators
Investigators
- Principal Investigator: Sonya B. Norman, PhD, VA San Diego Healthcare System, San Diego, CA
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- MHBP-003-22S (VA CSR&D)
- I01CX002584 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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