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Written Exposure Therapy Versus Prolonged Exposure: a Non-inferiority Trial

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ClinicalTrials.gov Identifier: NCT03962504
Recruitment Status : Not yet recruiting
First Posted : May 24, 2019
Last Update Posted : May 24, 2019
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
The goal of this study is to examine whether a brief, exposure-based treatment (Written Exposure Therapy) approach is just as effective in the treatment of posttraumatic stress disorder (PTSD) compared with a more commonly used time-intensive approach called Prolonged Exposure. One hundred and fifty Veterans diagnosed with PTSD will be randomly assigned to either Written Exposure therapy or Prolonged Exposure. Veteran participants will be assessed at pre-treatment, and 10-, 20-, and 30- weeks post first treatment session. Primary outcome measure will be PTSD symptom severity. The secondary outcome measure will be quality of life. In addition, treatment dropout during the first five sessions will be examined. WET is expected to have a lower treatment dropout rate relative to PE.

Condition or disease Intervention/treatment Phase
PTSD Behavioral: trauma-focused treatment Not Applicable

Detailed Description:
Although Written Exposure Therapy (WET) is listed in the upcoming VA/DoD PTSD Practice Guidelines as an evidence-based, recommended PTSD treatment, there are limited data supporting the use of WET with Veterans suffering from PTSD. Additional research is needed to support the use of WET for the treatment of Veterans diagnosed with PTSD. The goal of this study is to investigate whether WET is non-inferior in the treatment of PTSD in a sample of Veterans diagnosed with PTSD. Men and women Veterans diagnosed with PTSD will be randomly assigned to either WET (n = 75) or Prolonged Exposure (PE; n = 75). PTSD symptom severity will serve as the primary outcome. Quality of life will serve as a secondary outcome measure. Assessments will be conducted by independent evaluators at baseline, 10-, 20-, and 20-week post first treatment session. WET is expected to be non-inferior to PE in reducing PTSD symptom severity and functioning. In addition, WET is expected to have significantly lower treatment dropout rate relative to the first five sessions of PE (i.e., better treatment engagement). If WET is found to be non-inferior to the more time intensive PE treatment then the VA will have evidence to support the use of a brief PTSD treatment, which will assist in addressing the high demand for PTSD clinical services.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: The study is a non-inferiority design to examine if a brief intervention for PTSD is non-inferior to a more time-intensive intervention.
Masking: Single (Outcomes Assessor)
Masking Description: Assessors will be unaware of participant conditions. Assessors will not have access to any study materials in which unmasking could occur. Participants will be instructed to not reveal their treatment condition to the assessors.
Primary Purpose: Treatment
Official Title: An Efficient, Exposure-based Treatment for PTSD Compared to Prolonged Exposure: A Non-inferiority Randomized Trial
Estimated Study Start Date : October 1, 2019
Estimated Primary Completion Date : February 1, 2023
Estimated Study Completion Date : June 30, 2023

Arm Intervention/treatment
Experimental: written exposure therapy
The WET condition consists of 5 weekly treatment sessions, with the first session lasting 1 hour and each subsequent session lasting approximately 40 minutes. The first session consists of education about common trauma reactions and the WET rationale. The participant is then given general instructions for completing the trauma narratives and specific instructions for completing the first 30-minute narrative writing session. All WET sessions begin with the therapist reading the specific writing instructions, clarifying any questions the person has, and leaving the instructions with the participant during the 30-minute writing session. Writing instructions begin with a focus on the details of the trauma and then shift to the meaning of the trauma event. After 30 minutes of writing, the therapist stops the writing and conducts a 5-10 minute check-in regarding how the writing session went for the participant.
Behavioral: trauma-focused treatment
cognitive behavioral treatment for posttraumatic stress disorder that consists of exposure to the trauma memory.

Active Comparator: Prolonged Exposure
Prolonged Exposure (PE) is a 8-15, 90 minute trauma-focused treatment which consists of imaginal and in vivo exposures
Behavioral: trauma-focused treatment
cognitive behavioral treatment for posttraumatic stress disorder that consists of exposure to the trauma memory.




Primary Outcome Measures :
  1. Clinician Administered PTSD Scale for Diagnostic (CAPS-5) and Statistical Manual of Mental Disorders (DSM-5) [ Time Frame: change from baseline to 20- weeks post first treatment session ]

    The CAPS-5 is a structured diagnostic interview and the gold standard for assessing the DSM-5 symptoms of PTSD (American Psychiatric Association, 2013). The scale also assesses social and occupational functioning, dissociation symptoms, and the validity of symptom reports. The CAPS-5 uses a single 5-point ordinal rating scale to measure symptom severity. Symptom severity ratings combine information about symptom frequency and intensity obtained by the interviewer. Psychometric properties indicate high criterion and construct validity and high agreement with a self-report measure of PTSD (Weathers et al., 2018). The CAPS-5 requires approximately 40 minutes to administer.

    Scores can range from 0-80, with higher scores indicating greater severity.



Secondary Outcome Measures :
  1. World Health Organization Quality of Life BREF [ Time Frame: change from baseline to 20- weeks post first treatment session ]

    The World Health Organization Quality of Life BREF (WHOQOL-BREF; WHO, 1998) instrument comprises 26 items, which measure the following broad domains: physical health, psychological health, social relationships, and environment. The WHOQOL-BREF is a shorter version of the original instrument that is more convenient for use in large research studies or clinical trials. This measure requires 5-10 minutes to complete.

    Scores can range from 26-130, with higher scores indicating greater quality of life.




Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Veteran status
  • Current DSM-5 diagnosis of PTSD (assessed with the Clinician Administered PTSD Scale for DSM-5; CAPS-5)
  • If taking psychotropic medication, on a stable dose for at least 30 days prior to study entry

Exclusion Criteria:

  • Current engagement psychosocial treatment for PTSD
  • Current diagnosis of substance dependence

    • abuse will not be excluded; determined with severe combined immunodeficiency (SCID)
  • Current psychosis or unstable bipolar disorder diagnosis

    • determined with the Mini International Neuropsychiatric Interview (MINI)clinician-administered interview
  • High suicidal risk

    • i.e., intent with a plan; assessed with the MINI suicide module
  • Significant cognitive impairment (assessed with the Montreal Cognitive Assessment [MoCA] and clinical judgment)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03962504


Contacts
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Contact: Denise M Sloan, PhD (857) 364-6333 Denise.Sloan@va.gov
Contact: Brian P Marx, PhD (857) 364-6071 brian.marx@va.gov

Locations
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United States, Massachusetts
VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA Not yet recruiting
Boston, Massachusetts, United States, 02130
Contact: Denise M Sloan, PhD    857-364-6333    Denise.Sloan@va.gov   
Contact: Brian P Marx, PhD    (857) 364-6071    brian.marx@va.gov   
Principal Investigator: Denise M Sloan, PhD         
United States, South Carolina
Ralph H. Johnson VA Medical Center, Charleston, SC Not yet recruiting
Charleston, South Carolina, United States, 29401-5799
Contact: Ronald Acierno, PhD       ron.acierno@va.gov   
Contact: Wendy Muzzy, MA       wendy.muzzy@musc.edu   
United States, Wisconsin
William S. Middleton Memorial Veterans Hospital, Madison, WI Not yet recruiting
Madison, Wisconsin, United States, 53705
Contact: Michael Messina, PhD    608-256-1910 ext 17557    michael.messina@va.gov   
Sponsors and Collaborators
VA Office of Research and Development
Investigators
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Principal Investigator: Denise M Sloan, PhD VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

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Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT03962504     History of Changes
Other Study ID Numbers: MHBB-005-18F
CX001967-01 ( Other Grant/Funding Number: Department of Veterans Affairs )
First Posted: May 24, 2019    Key Record Dates
Last Update Posted: May 24, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: Datasets meeting VA standards for disclosure to the public will be made available within 1 year of publication. Prior to distribution, a local privacy officer will certify that all datasets contains no protected health information (PHI). Final data sets will be maintained locally until enterprise-level resources become available for long-term storage and access. Guidance on request and distribution processes will be provided by Office of Research and Development (ORD). Those requesting data will be asked to sign a Letter of Agreement.
Supporting Materials: Study Protocol
Statistical Analysis Plan (SAP)
Informed Consent Form (ICF)
Time Frame: one year

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by VA Office of Research and Development:
PTSD
psychosocial treatment
cognitive behavioral treatment
veterans
quality of life