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Publication Briefs

Study Suggests PTSD Treatment via Video-Teleconferencing as Effective as In-Person Treatment

BACKGROUND: The prevalence of PTSD is estimated to be 9%-15% among Vietnam Veterans and 10%-20% among Veterans of the Iraq and Afghanistan wars. However, among Veterans in need of treatment for PTSD, 50%-90% attend an insufficient number of visits or do not initiate them at all. One efficacious treatment for PTSD is cognitive processing therapy (CPT) – a trauma-focused psychotherapy that can be delivered in individual or group formats. CPT targets the cognitive symptoms of PTSD, and CPT-cognitive only (CPT-C) therapy is a variant of this therapy. This study is the first randomized controlled trial to compare the efficacy of delivering CPT-C via video-teleconferencing (VTC) to in-person delivery among a sample of rural Veterans. Investigators recruited 125 male Veterans from four VA healthcare facilities across the Hawaiian Islands; of these patients, 64 received in-person treatment and 61 received treatment via VTC. Approximately 77% of Veterans completed treatment by attending at least 10 of the 12 group treatment sessions, which occurred twice weekly over a six-week period. Veterans were assessed at baseline, mid-treatment, immediately post-treatment, and 3 and 6 months post-treatment. Measures included attrition, treatment adherence, patient satisfaction, treatment expectancy, and group therapeutic alliance.


  • The use of clinical video-conferencing services to provide CPT-C therapy to Veterans with PTSD who lived in rural settings was found to be as effective as face-to-face treatment. Significant reductions in PTSD symptoms were identified at post-treatment and 3- and 6-month follow-ups.
  • High levels of therapeutic alliance, treatment compliance, and satisfaction, and moderate levels of treatment expectancies were reported, with no differences between groups. For example, at post-treatment, Veterans reported high levels of satisfaction with both in-person and VTC therapies, rating 11 of 14 items on the satisfaction scale as "very good" or "excellent."
  • VTC technology evidenced very few disruptions, and no sessions were canceled due to technological difficulties. There were no adverse events associated with delivering CPT-C through videoconferencing.


  • For Veterans living in rural areas, their local mental health facilities may not have the technological equipment necessary for VTC.
  • Veterans with acute safety concerns (homicidal or suicidal) or current substance dependence were excluded.
  • This study did not include female Veterans. However, a complementary female Veteran study was just completed by Dr. Morland and her team and will be published this summer.

This study was partly funded by HSR&D (DHI 07-259). Dr. Morland is part of the National Center for PTSD-Pacific Island Division, VA Pacific Islands Health Care System.

PubMed Logo Morland L, Mackintosh M, Greene C, et al. Cognitive Processing Therapy for Post-traumatic Stress Disorder Delivered to Rural Veterans via Telemental Health: A Randomized Non-Inferiority Clinical Trial. Journal of Clinical Psychiatry. May 2014;75(5):470-76.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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