Accepted for/Published in: JMIR Mental Health
Date Submitted: Aug 24, 2021
Date Accepted: Feb 18, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans
ABSTRACT
Background:
Blended models which incorporate elements of both internet and face-to-face therapies have been shown to be effective. Therapist and patients have expressed concerns that less rather more therapy sessions relative to self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates and poorer outcomes.
Objective:
A multi-site quasi-experimental comparison study with a noninferiority design conducted in routine clinical care was used to assess webSTAIR, a 10-module blended therapy for trauma-exposed individuals delivered with 10 weekly therapist sessions (Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be “as good as” Coach10 regarding a range of outcomes.
Methods:
: A total of 202 Veterans were enrolled in the study (Coach5 n = 101, Coach10 n = 101). PTSD symptoms, depression, emotion regulation, interpersonal problems and social functioning measures were collected at pretreatment, mid, posttreatment and 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons of continuous and categorical measures regarding participant and therapist activities were conducted.
Results:
: Participants reported moderate to severe levels of baseline PTSD and/or depression. Significant reductions were obtained on all symptom measures at post and 3-month follow-up. Coach5 was not inferior to Coach10 on any outcome. Therapeutic alliance was high and equivalent across the two treatment conditions and completion rates and web usage were similar. Coach5 therapists’ total session time was substantially less than Coach10. Both programs were associated with a low and equal number of therapist activities related to scheduling and crisis/motivational sessions.
Conclusions:
A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions among individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes in high versus low dose of therapist support will help create flexible technology-based intervention programming.
Citation
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