Project Remission: Maximizing Outcomes with Intensive Treatments for Combat-Related PTSD

Dec 22, 2017

This study by the Consortium to Alleviate PTSD aims to maximize improvements and, if possible, treat patients with combat-related PTSD into remission so they can return to full fitness for military duty or successfully integrate into civilian life.

The need for tailored, intensive treatment programs

Effective treatment of combat-related PTSD requires tailored and enhanced approaches that work quickly in getting PTSD into remission. The leading exposure therapies, in which patients confront traumatic memories and environmental triggers rather than avoid them, show 80 percent success rates with civilian victims of assault, accidents, and similar traumas. But the rate of remission with service members and veterans has been lower and often is less than 50 percent of those studied.

Reasons for the lower success rate with combat PTSD include the fact that service members in combat zones are more likely to experience multiple types of trauma and repeated exposure to trauma. That may require extra time and attention to address multiple, varied traumatic memories and more trauma-related issues. Also, military culture may increase concerns about the stigma of mental health care, perhaps making service members reluctant to seek treatment in the first place, while work schedules may interfere with patients’ ability to complete treatment.

How the CAP IOP study works

With those challenges in mind, Alan Peterson, PhD, of The University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System leads a study for the Consortium to Alleviate PTSD to evaluate two versions of intensive outpatient treatment programs for military service members and veterans with PTSD. Patients involved in this study will participate in a three-week, fulltime treatment program at a designated treatment center. The aim with this approach is to both maximize improvements and streamline the treatment length.

The study will compare two intensive, enhanced forms of Prolonged Exposure (PE), the PTSD treatment with the most scientific support for efficacy with civilians.

Rather than the traditional PE treatment of 10 therapy sessions delivered over a period of three to four months, participants will receive more sessions in a shorter time period, three weeks. They will be randomly placed into one of two treatment arms with different levels of therapy enhancement:

  • Massed-PE format, with 15 daily sessions over three weeks, or
  • Intensive Outpatient PE (IOP-PE) format, also with 15 daily sessions over three weeks, but with additional enhancements to better tailor the treatment to those with combat-related PTSD or otherwise help improve treatment outcomes.

The researchers hypothesize that both formats will result in improved outcomes over standard PE delivery and that IOP-PE will provide maximum benefit. Participants in this randomized clinical trial will include 100 active duty military service members recruited worldwide and 100 veterans, treated at military and Department of Veterans Affairs sites in South and Central Texas.

Potential benefits

If the intensive outpatient format is found to be highly effective at reducing PTSD symptoms, it will offer the military and VA a valuable option that would increase access to care, boost patient retention, and improve treatment outcomes. It also could enable creation of specialized PTSD treatment centers to which service members could travel from around the world for short-term, state-of-the-art care. This would make it possible for more service members to stay on active duty and for veterans to reintegrate more quickly into civilian life, potentially saving the nation millions of dollars in long-term disability payments to veterans.