The Effects of Web-Prolonged Exposure Among Military Personnel and Veterans With Posttraumatic Stress Disorder

Objective: Web-based treatments address many of the logistical and stigma-related barriers to in-person behavioral health care. Prior studies of web-based treatments for posttraumatic stress disorder (PTSD) did not employ gold-standard treatments and have not compared to in-person therapy. Method: We compared a web version of Prolonged Exposure Therapy, "Web-PE," to in-person Present-Centered Therapy (PCT) in a randomized controlled trial (RCT) with 40 military personnel with PTSD seeking treatment at Fort Hood, Texas. Due to recruitment challenges, we terminated the RCT and subsequently examined the effects of Web-PE in an uncontrolled open trial with 34 service members and veterans recruited nationwide. Both studies assessed PTSD, depressive symptoms, and health functioning at baseline and 1 and 3 months posttreatment; the RCT also included a 6-month assessment. Results: Results of the RCT showed no differential impact for Web-PE and PCT, although more PCT participants achieved clinically significant change at one of the follow-up assessments. Both treatment conditions significantly reduced self-reported and blind independent interviewer-assessed symptoms of PTSD. Results of the open trial showed that Web-PE was associated with significant reductions in self-reported PTSD symptoms, with a much larger effect size than in the RCT. Conclusions: Web-PE significantly reduced PTSD symptoms in both studies, although the reductions in PTSD symptoms were greater among open trial participants, who were specifically seeking a web-based treatment. Future research should evaluate Web-PE relative to another web-based treatment. Clinical Impact Statement The results of the current studies demonstrate the positive effects of a web version of a front-line PTSD treatment, prolonged exposure therapy (Web-PE), in reducing symptoms of PTSD in military populations. A randomized control trial and an open trial both found that Web-PE significantly reduced PTSD symptoms. The effects were greater than in the open trial than the randomized trial, possibly because open trial participants were specifically seeking web treatment. Identifying effective web treatments for PTSD is important because many people with PTSD face barriers in accessing in-person psychotherapy. Thus, Web-PE has potential to increase the reach of effective PTSD treatment to those in need.