(PS4-C65) A Pilot Trial of Written Exposure Therapy Delivered Online in Veterans with Posttraumatic Stress Disorder

Introduction: Military veterans experience disproportionally high rates of posttraumatic stress disorder (PTSD) compared to the general population. It is estimated that PTSD affects 8% of the civilian population compared to around 14% of veterans returning from Afghanistan or Iraq (Tanielian et al., 2008). Evidence-based trauma-focused psychotherapies for PTSD are considered first line treatments for PTSD. However, access to these treatments is limited by barriers such as transportation, finances, and provider availability (Morland et al., 2017) as well as a lack of trained providers (Becker et al., 2004). One way to address these barriers is to deliver treatments in an accessible, online format. Written exposure therapy (WET) is an evidence-based trauma-focused treatment for PTSD that is easily adaptable to online therapy due to its highly structured format and straightforward instructions.

Methods: The current study is testing the efficacy of a web-based exposure therapy program in a randomized controlled trial. The aims of this study are to evaluate the efficacy and efficiency of WET compared with imaginal exposure delivered online with peer support facilitation. This study is also evaluating negative trauma related cognitions, emotion regulation, and exposure related subjective distress as potential mediators of PTSD change. Veterans with clinically significant symptoms of PTSD (a score of 31 or more on the PCL-5) and access to a computer in their home have been enrolled in the study. Participants completed measures assessing sociodemographics, trauma exposure, functioning and impact of symptoms, emotion regulation, and negative trauma-related cognitions at baseline. Participants were randomized to one of two treatment conditions, audio (imaginal) exposure or written exposure. The web program is four-to-eight 45-minute sessions long, with the exact number of assigned sessions depending on how fast each participants’ symptoms decline. Each session, participants chat with peer coaches who offer guidance, support, and encouragement before and after each exposure – mirroring the WET protocol. Participants complete online measures assessing PTSD symptoms, depressive symptoms, functioning and impact of symptoms, emotion regulation, and negative trauma-related cognitions at midpoint (prior to level 3), 2-week post use, and at a 3-month follow up.

Results: We are currently still in data collection phase. N = 105 participants have enrolled in the study. N = 33 participants have completed the midpoint. N = 22 participants have graduated in total.

Conclusion: Delivering treatment online is a promising strategy to address the large proportion of veterans who do not access mental health care. Important features of this study, such as its variable length design, will help us better understand the fluctuating rate at which veterans recover from PTSD in exposure therapy. This study will also help us understand mediators of change across two forms of exposure, written and imaginal. Lastly, due to the use of peer coaches rather than therapist support, this program could be a highly accessible form of PTSD treatment.