Many people experience traumatic life events, in which they directly experience or witness something that poses a serious risk to the safety of themselves or others (like violence or an accident). Some of these individuals struggle with significant emotional difficulties after these events, including difficulties with “reliving” the experience in different ways (e.g., having nightmares) and a strong desire to avoid reminders. These problems are characteristic of posttraumatic stress disorder (PTSD). PTSD has been a significant concern for military veterans (and, in turn, their care providers and loved ones) for several decades, given increased chances for this group to experience certain traumatic events (e.g., witnessing death or being injured in combat and training exercises). Fortunately, several different forms of psychotherapy and medications have been tested in research over the years and found to be very helpful in relieving PTSD symptoms. These treatment options have been prioritized by the Veterans Affairs healthcare system, to help ensure that they are available for veterans who need them.
A key next step, and the overarching goal of this research project, is to directly compare these established PTSD treatments to determine which is most helpful. More specifically, the proposed study will compare a front-line type of psychotherapy for PTSD (i.e., an approach that has the strongest evidence to show that it is helpful) called prolonged exposure and treatment with one of the front-line medication options that are currently being used to treat PTSD (both of which are antidepressant medications). The study will also test whether undergoing prolonged exposure therapy while also taking one of these medications is more helpful than either treatment alone, since this option is chosen by many patients. Many veterans seeking treatment for PTSD will take part in the study to strengthen confidence in comparisons of these treatment options. In addition to PTSD symptoms, the study will look at the impact of these treatments on other life domains that patients consider important, including their mood and social lives. Both patients and care providers will be directly involved in the research process throughout the project to provide helpful input on study plans, progress, and findings. The results will provide critically helpful information for patients and care providers to consider when choosing from among the available treatment options.
Even if a particular treatment is more helpful to most patients, it can be challenging for individual patients to anticipate which one might be best for them personally. To this end, another goal of the proposed research project is to use information collected from patients to develop a statistical decision tool for predicting what treatment option is best for an individual, based on the individual’s personal characteristics (e.g., their marital status, the type of trauma they experienced). A range of characteristics will be examined to maximize how well this tool predicts improvement, and in turn how useful it is for patients (and their care providers).
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.