Optimising mental health and quality of life for Australia’s military personnel and veterans with PTSD
Background: Prolonged Exposure (PE) is the gold standard evidence-based treatment for PTSD. Standard PE (SPE) requires weekly treatment for 10 weeks, which can pose a barrier to treatment for some military personnel and for veterans and other civilian populations. Whereas Intensive PE (IPE) delivers the same intervention but over 10 days across a two-week period. The aim of this study is to compare the effectiveness of the standard and intensive versions of prolonged exposure in the treatment of PTSD in veterans and serving members.
Method: Participants will be ADF members (ex-serving or currently serving, between 18-75 years of age, both males and females) with a diagnosis of PTSD, as assessed by the CAPS-5. Participants will be randomly allocated (blinded/masking used) to either the IPE or SPE condition. Sessions will be conducted individually, by psychologists. SPE consists of 10 weekly sessions (90 minutes in duration) and associated homework tasks. IPE consists of a 10 daily sessions (90 minutes in duration, conducted in the morning) with 2-hour homework tasks each afternoon. The key outcome measures include: PTSD symptomatology (measured via the CAPS-5), self-reported PTSD symptomatology (measured via the PCL-5), comorbid anxiety and depression (measured via the HADS), anger (measured via the DAR-5), disability (measured via the WHODAS 2.0), quality of life (measured via the AQoL-6D), and physiological arousal in response to imaginal exposure (assessed by skin conductance responses obtained on finger electrodes). Participants will be assessed on these measures at pre-treatment and at 4-weeks, 12-weeks, and 12-months post-treatment.
Results: Baseline characteristics of the IPE and SPE groups will be tabulated using appropriate summary statistics. Analyses of the quantitative outcome measures at each of the follow-up time points will be performed using linear regression (dependent variable = change from baseline, covariate of interest = treatment group), adjusting for the baseline value of the outcome measure and the stratification variables used in the randomisation. Results will be presented as adjusted differences in mean change from baseline in each outcome measure compared between IPE and SPE groups, along with the 95% CIs and p-values.
If the IPE model is as effective as the SPE model, then it has the potential to increase how accessible and acceptable this evidence-based treatment is to veterans, serving members, civilians, and their families.