Women who have served in the military are a rapidly growing minority in the US population and the fastest growing group of new users in the Department of Veterans Affairs (VA). Recent studies suggest that compared to civilians, women Veterans report significantly higher rates of trauma exposure and consequent high rates of PTSD. Despite the existence of evidence-based treatments for PTSD, most women Veterans underutilize VA care. One innovation in treatment delivery that has the potential to reach and engage these women is use of the Internet to administer treatment. A few web-based CBT interventions for PTSD have been developed and evaluated. However, all but one of these evaluations was conducted outside of the US and with civilian populations. The exception, Delivery of Self Training and Education for Stressful Situations (DESTRESSS), has been primarily tested on male service members and Veterans; only a handful of women participated in the two clinical trials evaluating its efficacy. Thus, there are limited data on its efficacy for this population, suggesting the need to evaluate whether it will meet the needs of women Veterans. Moreover, DESTRESS may not be optimal for women as it was not designed to target women Veterans' unique trauma experiences and needs. For example, DESTRESS does not include psychoeducation on interpersonal traumas nor does it address social support and relationship concerns central to women Veterans. To this end, we propose to conduct qualitative research with women Veterans and clinicians with content expertise to elicit their feedback on DESTRESS, make modifications to the program based on this feedback, and then conduct a pilot randomized clinical trial (RCT) evaluating the revised web-based, phone-assisted intervention with phone support only. Specifically, in Phase I we will conduct semi-structured interviews with 20 women Veterans with PTSD as well as with 4-6 expert providers regarding their impressions of DESTRESS. Changes will be made to DESTRESS as a result of this formative work, and the same women Veterans and expert providers will be re-interviewed to provide feedback on the changes made. In Phase II, we will conduct a pilot RCT wherein 70 women Veterans with PTSD are randomized to the intervention or phone support only. Measures of PTSD symptom severity (primary outcome) and depression and quality of life (secondary outcomes) will be collected at baseline, post-treatment, and 12- and 24-week follow-up assessments. Information about program utilization, dropout, patient satisfaction, and acceptability will also be collected. The long-term objective of this line of research is to develop low cost, accessible interventions for women Veterans with PTSD. Findings should improve our general knowledge about women Veterans' responses and preferences for care regarding tailored treatments for them, as well as result in an innovative, web-based intervention for women Veterans with PTSD.
Women Veterans, who often have been exposed to multiple traumas, carry a high burden of PTSD. Although observational studies documenting and describing such trends have been extensive, fewer than 3% of women's health studies on this population have been clinical trials. Using innovative methodologies, this study will address this gap by conducting a pilot RCT based on empirical, web-based approaches for PTSD with women Veterans. It is hoped that the results will offer new treatment options for women Veterans with PTSD and help us improve existing treatments.
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