PTSD: National Center for PTSD
Dissemination and Training Division Research
Dissemination and Training Division Research
The Dissemination and Training Division, headquartered in Palo Alto, CA, conducts research on provider and patient needs and preferences, implementation and effectiveness of evidence-based assessments and treatments in VA and community settings, and development and testing of novel assessments and treatments that exploit the potential unique benefits of technology-based delivery of services to improve access, quality and outcomes in VA care.
Dissemination and Implementation Research
Three new studies focus on providers. The first concerns the use of web technology in training clinicians in evidence-based interventions and testing variations in training procedures as they impact quality of skills in implementing the interventions. A second important new study is the development of a 28-site practitioner network across both VA and Department of Defense (DoD) that focuses on implementation of measurement-based care, specifically on the use of symptom measures during the course of treatment to guide treatment planning. The study will evaluate the impact of different facilitation models in regards to success in uptake of measurement based treatment across all sites. The third study is a randomized controlled trial that focuses on increasing awareness, receptivity to, and implementation of clinical practice guidelines for management of posttraumatic stress.
Barriers to Care and Patient Preferences
Several survey studies continue to address identification and engagement of Veterans in need of care. A Health Services Research & Development (HSR&D) funded study is testing a brief screen for drug use among primary care patients with and without PTSD. A QUERI-funded RRP examined barriers to cannabis treatment among Veterans with PTSD. With collaborators at the Women's Health Sciences Division, Division staff completed research and evaluation work on screening and treatment of military sexual trauma. Analysis is underway of an HSR&D-funded study on patient preferences for gender-specific mental health care. A Career Development Award is underway to examine barriers to treatment engagement among male Veterans who experienced military sexual trauma with the goal of developing patient-centered interventions for this population.
Randomized controlled trials are underway evaluating implementation strategies and patient outcomes in a variety of treatment settings. A large multisite NIH-funded clinical trial is assessing the effectiveness of a flexibly delivered evidence-based PTSD treatment among civilian public sector women and will examine how variations in delivery affect patient outcomes. Two new trials that have obtained funding address substance use. One study will evaluate ACT in patients with comorbid PTSD and substance use problems and the other will evaluate the effectiveness of exercise in resolving cannabis dependence.
Several other projects are ongoing using advanced neuroimaging methodologies, in conjunction with the aforementioned pharmacotherapy trials. These projects will yield additional insight into the neurobiology of PTSD and the neural mechanisms involved in treatment response or resistance. Work also continues on a biomarker informed placebo controlled trial designed to investigate the utility of a recently developed 7 Tesla 1H-MRS methods combined with magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) to evaluate the psychopharmacologic effects of riluzole on PTSD symptoms, hippocampal volume and anterior cingulate glutamate levels.
Evaluation of the national rollout of Prolonged Exposure (PE) psychotherapy continued, with recent results confirming PE's effectiveness in a national sample of over 1,800 Veterans. Investigators from the Division and the Minneapolis VAMC obtained VA HSR&D funding for a study of organization and team-level factors influencing use of evidence-based PTSD psychotherapies in VA clinics.
Technology has been introduced to support and extend treatment. A new study is assessing the efficacy of group Skills Training in Affect and Interpersonal Regulation (STAIR) delivered via telemental health for women Veterans living in rural areas. A DoD-funded trial of telephone case management for Veterans with PTSD has been completed. Division staff also collaborated with colleagues at the Center's Pacific Islands Division on two clinical trials of psychotherapy delivered via video teleconferencing and the results of these have been recently published. Several pilot studies are assessing the potential of the PTSD Coach smart phone app in helping Veterans and civilians cope with PTSD. A pilot randomized controlled trial has been completed identifying the benefits of introducing PTSD Coach among patients waiting for treatment and has demonstrated reduction in PTSD symptoms as compared to those in waitlist-as-usual. The Division is collaborating with investigators from the Minneapolis VAMC on a study testing a web-based intervention to help National Guard families encourage their loved ones to seek mental health care.
Other studies address novel approaches to clinical problems in trauma survivors. New Congressionally Directed Medical Research Programs funding has been obtained to assess adaptive changes in cardiac autonomic status, physical activity, social cognition and social interaction in real time among Veterans participating in the VA Service Animal Training Intervention program. NIH funding is supporting an investigation of web-based social networks for a highly stressed population, cancer survivors, to evaluate the types of social networking activities and level of engagement that may be related to positive mental and physical health outcomes. A DoD-funded study is testing whether teaching relaxation skills improves OEF/OIF/OND Veterans' driving behavior.