Telemental Health and Cognitive Processing Therapy for Rural Combat Veterans With Posttraumatic Stress Disorder (PTSD)

The proposed project is a 5-year prospective randomized clinical trial which conducts a
direct comparison of the VTC and in-person modalities using rigorous methodology and a
sophisticated analysis of equivalency between clinical and process outcome domains. In
addition, cost effectiveness of this modality will be addressed. Approximately 130 combat
Reservists, National Guardsmen, or veterans will be recruited from multiple clinical sites.
Prospective participants will receive a comprehensive assessment at baseline to determine
eligibility. The exclusion criteria selected are consistent with large PTSD randomized
clinical trials as well as research using the CPT protocol with military populations with
PTSD. The treatment will be delivered twice a week over 6 weeks by a doctoral level
psychologist. Quality control procedures will be incorporated into the study's design to
ensure integrity, fidelity and standard administration of the CPT intervention across both
conditions. Participants will receive additional assessments at mid-treatment, immediately
post-treatment, and at 3 and 6 months post-treatment. Outcome domains include: 1) clinical
outcomes (symptom severity, social functioning); 2) process outcomes (perception of
treatment, satisfaction, group therapy alliance, treatment compliance, and attrition and
treatment credibility); and (3) cost-effectiveness outcomes.

Inclusion Criteria:

- diagnosis of current combat related PTSD determined by the Clinician Administered
PSTD Scale (CAPS-1)

- participants taking psychoactive medications have to have a stable regimen for at
least 45 days prior to study entry

Exclusion Criteria:

- active psychotic symptoms/disorder as determined by the SCID for DSM-IV

- active homicidal or suicidal ideation as determined by the structured clinical
interview

- any significant cognitive impairment or history of Organic Mental Disorder as
determined by the structured clinical interview

- active (current) substance dependence as determined by the SCID (lifetime substance
dependence/abuse not excluded)

- unwillingness to refrain from substance abuse during treatment

- female veterans