title: Cognitive processing therapy for posttraumatic stress disorder delivered to rural veterans via telemental health: a randomized noninferiority clinical trial.
abstract: OBJECTIVE
  To compare clinical and process outcomes of cognitive processing therapy-cognitive only version (CPT-C) delivered via videoteleconferencing (VTC) to in-person in a rural, ethnically diverse sample of veterans with posttraumatic stress disorder (PTSD).
  
  
  METHODS
  A randomized clinical trial with a noninferiority design was used to determine if providing CPT-C via VTC is effective and "as good as" in-person delivery. The study took place between March 2009 and June 2013. PTSD was diagnosed per DSM-IV. Participants received 12 sessions of CPT-C via VTC (n = 61) or in-person (n = 64). Assessments were administered at baseline, midtreatment, immediately posttreatment, and 3 and 6 months posttreatment. The primary clinical outcome was posttreatment PTSD severity, as measured by the Clinician-Administered PTSD Scale.
  
  
  RESULTS
  Clinical and process outcomes found VTC to be noninferior to in-person treatment. Significant reductions in PTSD symptoms were identified at posttreatment (Cohen d = 0.78, P < .05) and maintained at 3- and 6-month follow-up (d = 0.73, P < .05 and d = 0.76, P < .05, respectively). High levels of therapeutic alliance, treatment compliance, and satisfaction and moderate levels of treatment expectancies were reported, with no differences between groups (for all comparisons, F < 1.9, P > .17).
  
  
  CONCLUSIONS
  Providing CPT-C to rural residents with PTSD via VTC produced outcomes that were "as good as" in-person treatment. All participants demonstrated significant reductions in PTSD symptoms posttreatment and at follow-up. Results indicate that VTC can offer increased access to specialty mental health care for residents of rural or remote areas.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00879255.
authors.affiliation: National Center for PTSD-Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka St, Honolulu, HI 96819 leslie.morland@va.gov.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Morland
authors.forename: Margaret-Anne
authors.initials: MA
authors.lastname: Mackintosh
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Greene
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Chard
authors.forename: Patricia
authors.initials: P
authors.lastname: Resick
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011615:Psychotherapy, Group / Q000295:instrumentation / Q000379:methods / Q000592:standards; D012424:Rural Population; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*