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Telepsychiatrists and in-person therapists deliver similar therapy to veterans suffering from posttraumatic stress disorder

Therapists can conduct cognitive behavioral therapy (CBT) with veterans suffering from posttraumatic stress disorder (PTSD) equally well via videoconferencing (telepsychiatry) or in person, concludes a new study. This finding can help address the shortage of access to mental health care by veterans in rural and other underserved areas, notes B. Christopher Frueh, Ph.D., of the University of Hawaii at Hilo.

Dr. Frueh and colleagues compared the quality of CBT for combat-related PTSD by a therapist in the same room as affected male veterans with the quality of CBT by the same therapist via telepsychiatry. Overall, 21 of 38 male veterans seeking treatment for PTSD at a Veterans Affairs medical center were randomized to in-room treatment and 17 were randomized to telepsychiatry.

The researchers used independent raters to assess therapist competence and adherence to CBT best practices. For example, they looked at the therapist's ability to structure the therapeutic sessions; implement session activities such as social skills training, role playing, or anxiety management training; provide feedback to the patient; deal with difficulties that emerge during therapy; develop rapport with the patient; and convey empathy. CBT treatment for combat-related PTSD targets interpersonal difficulties commonly associated with combat-related PTSD, such as social anxiety, social alienation, and withdrawal, excessive anger and hostility, explosive episodes, and marital and family conflict.

The active treatment phase consisted of weekly, 90-minute group treatment sessions over the course of 14 weeks, with three followup sessions over the 3 months after the active treatment phase. There was no significant difference in therapist adherence to the CBT treatment manual for both groups. Also, the teletherapist and in-person therapist were rated good to excellent for rapport and empathy, which are considered critical components of successful psychotherapy.

The study was funded in part by the Agency for Healthcare Research and Quality (HS11642).

See "Therapist adherence and competence with manualized cognitive-behavioral therapy for PTSD delivered via videoconferencing technology," by Dr. Frueh, Jeannine Monnier, Ph.D., Anouk L. Grubaugh, Ph.D., and others, in the November 2007 Behavior Modification 34(6), pp. 856-866.

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