Rates of posttraumatic stress disorder (PTSD) among military personnel have surged in recent years. In response, the Department of Veterans Affairs (VA) has launched nationwide training initiatives to disseminate two PTSD treatments with strong empirical support: prolonged exposure (PE) therapy and cognitive processing therapy (CPT). Despite the well-documented effectiveness of PE and CPT, only a minority of Veterans with PTSD initiate these trauma-focused treatments. One approach to addressing PTSD in a non-trauma focused fashion is to utilize empirically supported treatments focused on safety aid reduction. Safety aids are maladaptive cognitive and/or behavioral strategies designed to prevent, avoid, or alleviate anxiety. Initially introduced as a way to explain how pathological anxiety can persist despite repeated exposure to feared stimuli, safety aids have been found to play a critical role in the etiology and maintenance of various anxiety and related conditions including PTSD. Importantly, a separate line of research suggests that safety aids are amenable to change through cognitive behavioral interventions. While promising, these trials did not include patients with PTSD. In this context, the purpose of the proposed Clinical Science Research and Development (CSR&D) Career Development Award-2 (CDA-2) is to adapt and extend an existing safety aid reduction treatment protocol for use among Veterans with PTSD. This treatment protocol, termed Safety Aid Reduction Treatment for PTSD (START-PTSD), will then be evaluated for acceptability and feasibility, prior to testing the efficacy compared to a wait-list control. Participants will include individuals with a diagnosis of PTSD who decline to participate in evidence-based psychotherapies (EBPs) for PTSD, namely PE or CPT.
This investigation has the potential to benefit Veterans and the Department of Veterans Affairs (VA) in several ways. Veterans will benefit from the Safety Aid Reduction Treatment Protocol for PTSD (START-PTSD) by engaging in an empirically based treatment designed to identify and eliminate safety aids. This will: a) lead to reductions in posttraumatic stress disorder (PTSD) symptom severity; and b) potentially prepare Veterans for more intensive trauma-focused treatments. In turn, this could yield long-term benefits for the VA by increasing evidence-based psychotherapy (EBP; i.e., prolonged exposure [PE] therapy and/or cognitive processing therapy [CPT]) initiation and enrollment.