Implementation of Prolonged Exposure in the Army: Is consultation necessary for effective dissemination?

Aug 19, 2014

With the dramatic increase in the number of military service members identified with posttraumatic stress disorder (PTSD), one thing is clear: Military mental health providers need effective treatments at their disposal to help patients recover and regain their lives as soon as possible.

Research with civilians has shown Prolonged Exposure (PE) therapy to be highly effective, treating PTSD to the point of remission in approximately 80% of cases. While the Defense Department has made efforts to encourage military mental health providers to use PE and other evidence-based treatments, questions remain about dissemination methods: What is the best way to train providers so that they feel confident with evidence-based therapies and use them effectively in their practices? How can adequate training be provided most cost effectively to help the DoD stay within ever-tightening budget constraints?

Investigators affiliated with the STRONG STAR Consortium have designed a study to answer these important questions. Under the leadership of Dr. Edna Foa of the University of Pennsylvania, who developed PE, investigators are working with the Army to evaluate two different approaches to provider training.

Participating mental health providers at collaborating Army bases receive one of the following:

• Standard PE Training, which involves an intensive four-day training workshop along with training materials and treatment manuals;
• Extended PE Training, which includes the components of standard training plus in-depth consultation on two PE training cases via weekly telephone supervision by a PE expert.

Study investigators then evaluate the efficacy of the two training models by comparing provider attitudes toward the treatment, how frequently and effectively they use it, and how well their patients respond to the treatment.

Investigators hypothesize that Extended PE Training will improve both the frequency and efficacy of the therapy’s use by Army mental health providers. If that turns out to be the case, it could show that the added expense of extended provider training would result in the pay-off of improved patient care and higher rates of PTSD recovery among our service members.