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

Laura A Meis, Shirley M Glynn, Michele R Spoont, Shannon M Kehle-Forbes, David Nelson, Carl E Isenhart, Afsoon Eftekhari, Princess E Ackland, Erin B Linden, Robert J Orazem, Andrea Cutting, Emily M Hagel Campbell, Millie C Astin, Katherine E Porter, Erin Smith, Christopher D Chuick, Kristen E Lamp, Tessa C Vuper, Taylor A Oakley, Lila B Khan, Sally K Keckeisen, Melissa A Polusny, Laura A Meis, Shirley M Glynn, Michele R Spoont, Shannon M Kehle-Forbes, David Nelson, Carl E Isenhart, Afsoon Eftekhari, Princess E Ackland, Erin B Linden, Robert J Orazem, Andrea Cutting, Emily M Hagel Campbell, Millie C Astin, Katherine E Porter, Erin Smith, Christopher D Chuick, Kristen E Lamp, Tessa C Vuper, Taylor A Oakley, Lila B Khan, Sally K Keckeisen, Melissa A Polusny

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.gov NCT03256227 . Registered on August 21, 2017.

Keywords: Adherence; Couples; Evidence-based treatments; Family; PTSD.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schedule of enrolment, interventions, and assessments for each dyad member. Note. V = Veteran; SP = Support Person. Etc. = pattern of weekly assessments continues in the same pattern throughout treatment. CAPS-5 = Clinician-Administered PTSD Scale for DSM-5; PCL-5 = PTSD Checklist for the DSM-5; PHQ-9 = Patient Health Questionnaire; World Health Organization - Quality of Life, Brief = WHOQOL; Quality of Relationships Inventory = QRI; SORTS = Significant Others’ Responses to Trauma Scale

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Source: PubMed

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