Military personnel and veterans with war-related post-traumatic stress disorder (PTSD) often do not receive adequate mental health services. Stigma and structural barriers may prevent a large proportion who need specialty care from seeking it. Because most get primary care, this setting allows early intervention for unmet PTSD treatment needs. However, many primary care patients with PTSD may not link trauma to symptoms, may hesitate to use primary care for mental health treatment, and may go unrecognized by busy primary care clinicians. An effective PTSD self-management program may empower affected primary care patients and clinicians and decrease patients' unmet treatment needs. We propose to test an Internet-based, nurse assisted, cognitive-behavioral (CBT) self-management program, DeIivery of Self-Training & Education for Stress Symptoms-Primary Care version (DESTRESS-PC) for individuals with PTSD related to Operation Iraqi or Enduring Freedom. Primary outcome will be PTSD symptom severity; secondary outcomes will be functional impairment; depression, anxiety and somatic symptoms; and attitudes regarding mental health treatment. Our proposed design is a 4 clinic, 2 group, parallel arm randomized controlled trial with blinded outcome assessment. We will enroll 160 eligible participants and compare 6-weeks of DESTRESS-PC (plus optimized usual primary care PTSD management) to optimized usual care alone with follow-up at 6 and 12 weeks post-randomization. Entry criteria will include OlF/OEF-related psychological trauma; primary care referral to a study nurse manager for PTSD; PTSD diagnosis on the Clinician Assessment for PTSD Scale; and absence of unstable medical or psychiatric illness. DESTRESS-PC is derived directly from an Internet-based self-management PTSD treatment successfully tested in a pilot study by the investigators. DESTRESS-PC is an innovative use of Internet-based telehealth technology that may provide an efficiently- delivered and stigma-reducing treatment option for war-related PTSD in patients with unmet treatment needs and may eventually expand primary care options for PTSD after disasters, terrorist attacks, and other traumas. ? ? ?
| Engel, Charles C; Litz, Brett; Magruder, Kathryn M et al. (2015) Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care. Gen Hosp Psychiatry 37:323-8 |
