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Randomized Controlled Trial
. 2019 Sep;42(3):305-313.
doi: 10.1037/prj0000334. Epub 2018 Nov 29.

A pilot study comparing peer supported web-based CBT to self-managed web CBT for primary care veterans with PTSD and hazardous alcohol use

Kyle Possemato  1 , Emily M Johnson  1 , J Bronte Emery  1 , Michael Wade  1 , Michelle C Acosta  2 , Lisa A Marsch  3 , Andrew Rosenblum  2 , Stephen A Maisto  2
Affiliations
Randomized Controlled Trial

A pilot study comparing peer supported web-based CBT to self-managed web CBT for primary care veterans with PTSD and hazardous alcohol use

Kyle Possemato et al. Psychiatr Rehabil J. 2019 Sep.

Abstract

Objective: Many combat veterans struggle with posttraumatic stress disorder (PTSD) and hazardous alcohol use and are hesitant to engage in behavioral health services. Combining peer support with an eHealth intervention may overcome many barriers to care. This pilot study investigated the feasibility of adding peer support to a web-based cognitive behavior therapy (CBT) targeting PTSD symptoms and hazardous drinking, called Thinking Forward.

Method: Thirty primary care patients with PTSD and hazardous alcohol use were randomized to receive Thinking Forward with or without peer support. Participants were assessed at pretreatment, posttreatment, and 24-week follow-up. Feasibility was analyzed with descriptive statistics. Preliminary outcomes were analyzed with multilevel modeling and effect sizes are presented.

Results: Peer support specialists can be feasibly trained to support the Thinking Forward intervention with good fidelity. Both participants and peers reported good satisfaction with the protocol; although peers discussed a mismatch between the philosophies of peer support and diagnostically focused CBT. All participants experienced significant improvements in PTSD, quality of life, resiliency, and coping from pre- to posttreatment, with no differences between conditions. Pretreatment patient activation predicted outcomes regardless of whether participants received peer support.

Conclusions and implications for practice: Peer support interventions to facilitate eHealth programs should strive to be consistent with the person-centered, recovery orientation of peer support, explicitly focus on patient activation, and consider characteristics of the patients, such as their level of problem recognition and willingness to engage in traditional behavioral health modalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trial registration: ClinicalTrials.gov NCT00261183.

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Conflict of interest statement

Conflict of Interest Statement: One of the investigators, Dr. Marsch, is affiliated with the business that developed the web-based psychosocial intervention platform that was used in the study. This relationship is extensively managed by Dr. Marsch and her academic institution.

Figures

Figure 1:
Figure 1:
Consort Flow Diagram
Figure 2:
Figure 2:
Summary of Participant and Peer Intervention Feedback
See this image and copyright information in PMC

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References

    1. Acosta MC, Possemato K, Maisto SA, Marsch LA, Barrie K, Lantinga L, Rosenblum A (2017). Web-delivered CBT reduces heavy drinking in OEF-OIF veterans in primary care with symptomatic substance use and PTSD. Behavior Therapy, 48(2), 262–276. doi: 10.1016/j.beth.2016.09.001 - DOI - PMC - PubMed
    1. Attkisson CC, & Zwick R (1982). The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann, 5(3), 233–237. - PubMed
    1. Babor TF, Higgins-Biddle JC, Saunders JB, & Monteiro MG (2001). Audit. The Alcohol Use Disorders Identification Test (AUDIT): Guidelines for use in primary care.
    1. Bassuk EL, Hanson J, Greene RN, Richard M, & Laudet A (2016). Peer-delivered recovery support services for addictions in the United States: A systematic review. Journal of Substance Abuse Treatment, 63, 1–9. doi: 10.1016/j.jsat.2016.01.003 - DOI - PubMed
    1. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, & Keane TM (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90. - PubMed

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