VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
J Telemed Telecare. 2020 Aug-Sep;26(7-8):443-451. doi: 10.1177/1357633X19832419. Epub 2019 Apr 11.
Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care.
Data were drawn from veterans ( = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions.
FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan-Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment.
Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.
暴露疗法（PE）和认知加工疗法（CPT）等干预措施已被证明可有效治疗军事性创伤后应激障碍（MST）后 PTSD。然而，MST 幸存者报告了许多妨碍治疗参与的后勤和社会障碍。为了应对这些障碍，退伍军人健康管理局提供使用临床视频技术（CVT）的远程服务。有证据表明，PE 和 CPT 可以通过 CVT 有效地提供。但是，尚不清楚通过远程方式为 MST 提供 PTSD 治疗的退伍军人保留率是否与标准护理中的面对面治疗相当。
数据来自 PTSD 后接受 MST 的退伍军人（ = 171，18.1%CVT 注册），他们接受了通过 CVT 或面对面进行的 PE 或 CPT。退伍军人与提供者合作选择他们喜欢的治疗方式和交付格式。分析数据以评估协议的完全完成（FP）和完成最少足够的护理（MAC）次数。
治疗交付格式对 FP 治疗完成率没有显著影响。在评估接受 MAC 护理时，使用 CVT 的退伍军人完成的可能性明显较低。两个生存期的 Kaplan-Meier 分析检测到了退出速度的显著差异，CVT 组在治疗早期的每次会话中退出率更高。
从 CVT 提供的治疗中脱离通常与早期的想象暴露和创伤叙事的写作同时发生。CVT 提供者可能必须特别注意建立融洽关系并解决预期的完成障碍，以留住幸存者接受有效的创伤焦点干预。
