With the potential for people in rural and remote areas of Australia to now access services via video conferencing the question is, can Cognitive Processing Therapy delivered by video work?
There are now four noninferiority trials (yes trials to find out if video conference delivery was inferior or not) showing that Cognitive Processing Therapy (CPT) delivered via telehealth is just as effective as if delivered in person.
Morland et al (2014) tested Group CPT via telehealth with a sample of male Veterans, predominantly of the Vietnam era. They reported that clinical and process outcomes for CPT video conference were noninferior to CPT in-person treatment. Significant reductions in PTSD symptoms were identified at posttreatment and maintained at 3-month and 6-month follow-up. High levels of therapeutic alliance, treatment compliance, and satisfaction and moderate levels of treatment expectancies were reported, with no differences between video conference therapy and in person therapy groups.
Morland et al (2015) tested individual CPT+A with women, 20% of whom were veterans. They found improvements in PTSD symptoms in the CPT video conferencing condition were noninferior to outcomes in the in-person CPT therapy condition. Clinical outcomes obtained when both conditions were pooled together demonstrated that PTSD symptoms declined substantially posttreatment and gains were maintained at 3-month and 6-month follow-up. Veterans demonstrated smaller symptom reductions posttreatment than civilian women.
Maieritsch et al. 2015 tested individual CPT with Operation Iraqi Freedom and Operation Enduring Freedom veterans who were predominantly male. There were some limitations in this study, including a dropout rate of 43.3%. Despite this Maieritsch et al. 2015 reported that a trend was observed which suggested that CPT via video conference may be equivalent to the treatment delivered in person, as suggested by previous studies. Regardless of treatment, veterans who received the intervention in both conditions reported significant decreases on post-treatment measures.
Liu et al. (2019) examined veterans who had an average age of 48, almost 50% of the CPT video conferencing group had participated in World War two. They reported that both completer and intention to treat analyses showed that improvement in CAPS scores in the video conference condition was non-inferior to that in the in-person CPT therapy condition at six-month follow-up. Unlike the previous trials the video conferencing condition was inferior to in person therapy condition for improvement in CAPS at post-treatment. Non-inferiority was supported by completer analyses for PCL–S and PHQ–9 in both post-treatment change and six-month follow-up change, and the intention to treat analysis supported the significant non-inferiority for PCL at posttreatment change.
Summary
CPT can be effectively delivered by video conferencing facilities. More research is needed to understand differences in response over time.
References
Liu, L., Thorp, S. R., Moreno, L., Wells, S. Y., Glassman, L. H., Busch, A. C., . . . Agha, Z. (2019). Videoconferencing psychotherapy for veterans with PTSD: Results from a
randomized controlled non-inferiority trial. Journal of Telemedicine and Telecare. Advance online publication. PTSDpubs ID: 52097
Maieritsch, K. P., Smith, T. L., Hessinger, J. D., Ahearn, E. P., Eickhoff, J. C., & Zhao, Q. (2016). Randomized controlled equivalence trial comparing videoconference and in person delivery of cognitive processing therapy for PTSD. Journal of Telemedicine and Telecare, 22(4), 238-243. doi:http://dx.doi.org/10.1177/1357633X15596109
Morland, L. A., Mackintosh, M., Greene, C. J., Rosen, C. S., Chard, K. M., Resick, P., & Frueh, B. C. (2014). Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: A randomized noninferiority clinical trial. The Journal of Clinical Psychiatry, 75(5), 470-476. doi:http://dx.doi.org/10.4088/JCP.13m08842
Morland, L. A., Mackintosh, M., Rosen, C. S., Willis, E., Resick, P., Chard, K., & Frueh, B. C. (2015). Telemedicine versus in-person delivery of cognitive processing therapy for women with posttraumatic stress disorder: a randomized noninferiority trial. Depression and Anxiety, 32(11), 811-820. doi:http://dx.doi.org/10.1002/da.22397