Will more military service members and veterans participate in effective treatment programs for posttraumatic stress disorder (PTSD)--and perhaps even receive a higher level of care--if that treatment is delivered in their own home? Is such a treatment format even feasible? Those are questions posed by Dr. Alan Peterson of The University of Texas Health Science Center at San Antonio and co-investigator Dr. Patricia Resick of Duke University Medical Center in a STRONG STAR-affiliated study on the effectiveness of in-home Cognitive Processing Therapy (CPT) for combat-related PTSD.

Study rationale and objectives

Even as evidence-based therapies for PTSD are becoming more readily available within the Departments of Defense (DoD) and Veterans Affairs (VA), a recent report by the RAND Corporation shows that the majority of military members and veterans are not receiving adequate care for the psychological wounds they received from tours in Iraq and Afghanistan. Reasons likely vary and are believed to include the following:

• concerns about the stigma of seeking mental health care;
• job and scheduling conflicts;
• an inability to access traditional care in mental health clinics because of limited mobility and transportation issues, particularly among those who are seriously injured or living in rural areas.

This study will evaluate the feasibility and efficacy of a treatment delivery method that could help overcome these barriers to care, potentially making effective PTSD treatment more accessible to underserved military personnel and veterans. It will evaluate one of the leading treatments for PTSD, a form of counseling known as Cognitive Processing Therapy (CPT), when delivered in service members' and veterans' homes, either through in-person therapist visits or via video teleconference (similar to Skype), as compared to standard, face-to-face treatment in a therapist's office.

Why in-home therapy might be better

Traditional CPT already has been shown to yield recovery rates as high as 80% with civilian PTSD patients, and to a lesser degree with veterans with combat-related PTSD. Researchers hypothesize that in-home delivery may further improve CPT's efficacy in treating both PTSD and related problems, such as depression, alcohol dependence, and family strain. Reasons include the decreased likelihood of patients to miss appointments as well as therapists' enhanced ability to see and address patients' personal barriers to successful treatment.

Who will benefit if home-based CPT delivery is shown to be as or more effective than in-office care?

The VA and DoD: Both would have valuable new methods for delivering evidence-based treatment to currently underserved active duty and veteran populations.

Military and veteran PTSD patients: They could see improved access to high-quality care that could give them a greater chance at full recovery, enabling them to resume happy, productive lives in continued military service or as civilians.

Military and VA mental health providers: They would have an opportunity to tailor and enhance individual patient care to potentially improve treatment outcomes. Providers could capitalize on insights gained in the home to (1) help patients translate therapy lessons to daily life; (2) recognize and address environmental and lifestyle factors, as well as co-occurring social and mental health problems, that impede recovery from PTSD; and (3) better manage high-risk and suicidal patients by gaining a clearer sense of overall risk and a direct path to effective risk-management interventions.