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Morland LA ( National Center for PTSD - Pacific Island Division - VAPIHCS), Greene CJ
(National Center for PTSD - Dissemination and Training Division - VAPAHCS), Rosen C
(National Center for PTSD - Dissemination and Training Division - VAPAHCS), Frueh CB
(The Menninger Clinic and Baylor College of Medicine), Grubbs K
(National Center for PTSD - VAPIHCS), Morgan T
(National Center for PTSD - VAPIHCS)
Objectives:
To demonstrate the non-inferiority of a telemedicine service delivery modality compared to traditional in-person care for the administration of an evidence-based anger management intervention in a population of rural combat veterans with PTSD.
Methods:
A randomized controlled non-inferiority trial recruited 126 male veterans with PTSD and severe anger difficulties from three VA outpatient clinics from October 2005 through February 2008. Participants were assessed using clinical and process measures at baseline, mid-treatment, post-treatment, and at 3- and 6-months post-treatment. Participants were randomly assigned to receive a 12-session, manualized, cognitive-behavioral anger management intervention delivered either in-person (n = 65) or via video-teleconferencing (n = 61). The treatment for each cohort was delivered by the same therapist using the same standardized protocol for both conditions.
Results:
Participants in both groups showed significant reductions in anger symptoms immediately post-treatment. Participants who received anger management treatment via video-teleconferencing demonstrated a reduction in anger symptoms that was similar (“non-inferior”) to the symptom reduction among recipients who received the in-person comparison treatment. In addition, no significant differences were found between the two conditions on process variables, including: attrition and treatment compliance, satisfaction, treatment expectancy, and therapeutic alliance.
Implications:
Anger management group psychotherapy delivered by video-teleconferencing is non-inferior to the same treatment delivered in-person.
Impacts:
Access to evidence-based care for remote combat veterans with post-traumatic stress disorder (PTSD) is a significant problem for rural military personnel across the nation. There are no prior clinical trials using a non-inferiority design to demonstrate the effectiveness of a telemedicine modality (video-teleconferencing) to provide evidence-based care for this population. Clinical and process outcomes indicate that the video-teleconferencing modality is an effective and feasible way to increase access to evidence-based care group treatment for PTSD-related problems for veterans residing in rural or remote locations.
