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Articles   |    
RCT of a Brief Phone-Based CBT Intervention to Improve PTSD Treatment Utilization by Returning Service Members
Tracy Stecker, Ph.D.; Gregory McHugo, Ph.D.; Haiyi Xie, Ph.D.; Katrina Whyman, B.A.; Meissa Jones, B.A.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300433
View Author and Article Information

Dr. Stecker is with the White River Junction Veterans Affairs Medical Center and with the Department of Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire (e-mail: tracy.stecker@dartmouth.edu). Dr. McHugo, Dr. Xie, Ms. Whyman, and Ms. Jones are with the Dartmouth Psychiatric Research Center, Dartmouth College, Lebanon.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Many service members do not seek care for mental health and addiction problems, often with serious consequences for them, their families, and their communities. This study tested the effectiveness of a brief, telephone-based, cognitive-behavioral intervention designed to improve treatment engagement among returning service members who screened positive for posttraumatic stress disorder (PTSD).

Methods  Service members who had served in Operation Enduring Freedom or Operation Iraqi Freedom who screened positive for PTSD but had not engaged in PTSD treatment were recruited (N=300), randomly assigned to either control or intervention conditions, and administered a baseline interview. Intervention participants received a brief cognitive-behavioral therapy intervention; participants in the control condition had access to usual services. All participants received follow-up phone calls at months 1, 3, and 6 to assess symptoms and service utilization.

Results  Participants in both conditions had comparable rates of treatment engagement and PTSD symptom reduction over the course of the six-month trial, but receiving the telephone-based intervention accelerated service utilization (treatment engagement and number of sessions) and PTSD symptom reduction.

Conclusions  A one-time brief telephone intervention can engage service members in PTSD treatment earlier than conventional methods and can lead to immediate symptom reduction. There were no differences at longer-term follow-up, suggesting the need for additional intervention to build upon initial gains.

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Figure 1 Mean changes to depression and PTSD scores among 274 OEF/OIF veterans over timea

a Veterans received (intervention) or did not receive (control) one hour of brief cognitive-behavioral therapy by telephone one week after baseline. Depression was measured with the nine-item Patient Health Questionnaire (PHQ-9), and PTSD was measured with the PTSD Checklist–Military Version (PCL). Possible scores range from 17 to 85 for the PCL and from 0 to 36 for the PHQ-9, with higher scores indicating greater severity of symptoms. OEF/OIF, Operation Enduring Freedom and Operation Iraqi Freedom

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Table 1Baseline characteristics of veterans receiving or not receiving a brief cognitive-behavioral therapy intervention for PTSD
Table Footer Note

a Possible scores range from 17 to 85, with higher scores indicating more severe PTSD symptoms.

Table Footer Note

b Patient Health Questionnaire. Possible scores range from 0 to 36, with higher scores indicating more severe depression symptoms.

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Table 2Rates of PTSD treatment initiation after veterans received or did not receive brief cognitive-behavioral therapy and mean number of treatment sessions attended over time
Table Footer Note

a Comparisons between groups were significant (p<.05).

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Table 3Mean PTSD and depression symptom severity scores over time among 274 veterans
Table Footer Note

a Possible scores range from 17 to 85, with higher scores indicating more severe PTSD symptoms.

Table Footer Note

b Patient Health Questionnaire. Possible scores range from 0 to 36, with higher scores indicating more severe depression symptoms.

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