Journal Article

Effect of massed v. standard prolonged exposure therapy on PTSD in military personnel and veterans: a non-inferiority randomised controlled trial

Bryant, Richard, Battersby, Malcolm, O'Donnell, Meaghan, Forbes, David, Morton, David, Tuerk, Peter W., Wallace, Duncan, Sbisa, Alyssa M., Dell, Lisa, Hodson, Stephanie, Forbes, Andrew

2023

Overview

A short, effective therapy for posttraumatic stress disorder (PTSD) could decrease barriers to implementation and uptake, reduce dropout, and ameliorate distressing symptoms in military personnel and veterans. This non-inferiority RCT evaluated the efficacy of 2-week massed prolonged exposure (MPE) therapy compared to standard 10-week prolonged exposure (SPE), the current gold standard treatment, in reducing PTSD severity in both active serving and veterans in a real-world health service system. This single-blinded multi-site non-inferiority RCT took place in 12 health clinics across Australia. The primary outcome was PTSD symptom severity measured by the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) at 12 weeks. 138 military personnel and veterans with PTSD were randomised. 71 participants were allocated to SPE, with 63 allocated to MPE. The intention-to-treat sample included 138 participants, data were analysed for 134 participants (88.1% male, = 46 years). The difference between the mean MPE and SPE group PTSD scores from baseline to 12 weeks-post therapy was 0.94 [95% confidence interval (CI) -4.19 to +6.07]. The upper endpoint of the 95% CI was below +7, indicating MPE was non-inferior to SPE. Significant rates of loss of PTSD diagnosis were found for both groups (MPE 53.8%, SPE 54.1%). Dropout rates were 4.8% (MPE) and 16.9% (SPE). MPE was non-inferior to SPE in significantly reducing symptoms of PTSD. Significant reductions in symptom severity, low dropout rates, and loss of diagnosis indicate MPE is a feasible, accessible, and effective treatment. Findings demonstrate novel methods to deliver gold-standard treatments for PTSD should be routinely considered.

• Publisher: Cambridge University Press
• Subject: Alcohol use / Anxiety / Armed forces / Clinics / COVID-19 / Diagnosis / Dropping out / Drug use / Efficacy / Employees / Exposure therapy / Female / Health services / Humans / Implosive Therapy - methods / Male / Medical diagnosis / Medical treatment / Mental depression / Mental disorders / Mental health / Military Personnel / Original / Original Article / Post traumatic stress disorder / Quality of life / Research ethics / Severity / Stress Disorders, Post-Traumatic - therapy / Substance abuse treatment / Symptoms / Telemedicine / Therapists / Therapy / Treatment methods / Treatment Outcome / Uptake / Veterans