title: TELEMEDICINE VERSUS IN-PERSON DELIVERY OF COGNITIVE PROCESSING THERAPY FOR WOMEN WITH POSTTRAUMATIC STRESS DISORDER: A RANDOMIZED NONINFERIORITY TRIAL.
abstract: BACKGROUND
  This study examined the effectiveness of telemedicine to provide psychotherapy to women with posttraumatic stress disorder (PTSD) who might be unable to access treatment. Objectives were to compare clinical and process outcomes of PTSD treatment delivered via videoteleconferencing (VTC) and in-person (NP) in an ethnically diverse sample of veteran and civilian women with PTSD.
  
  
  METHODS
  A randomized controlled trial of Cognitive Processing Therapy, an evidence-based intervention for PTSD, was conducted through a noninferiority design to compare delivery modalities on difference in posttreatment PTSD symptoms. Women with PTSD, including 21 veterans and 105 civilians, were assigned to receive psychotherapy delivered via VTC or NP. Primary treatment outcomes were changes in PTSD symptoms in the completer sample.
  
  
  RESULTS
  Improvements in PTSD symptoms in the VTC condition (n = 63) were noninferior to outcomes in the NP condition (n = 63). Clinical outcomes obtained when both conditions were pooled together (N = 126) demonstrated that PTSD symptoms declined substantially posttreatment (mean = -20.5, 95% CI -29.6 to -11.4) and gains were maintained at 3- (mean = -20.8, 95% CI -30.1 to -11.5) and 6-month followup (mean = -22.0, 95% CI -33.1 to -10.9. Veterans demonstrated smaller symptom reductions posttreatment (mean = -9.4, 95% CI -22.5 to 3.7) than civilian women (mean = -22.7, 95% CI -29.9 to -15.5.
  
  
  CONCLUSIONS
  Providing psychotherapy to women with PTSD via VTC produced outcomes comparable to NP treatment. VTC can increase access to specialty mental health care for women in rural or remote areas.
authors.affiliation: Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Morland
authors.affiliation: Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.
authors.forename: Margaret-Anne
authors.initials: MA
authors.lastname: Mackintosh
authors.affiliation: Dissemination and Training Division, National Center for PTSD, Department of Veterans Affairs Palo Alto Healthcare System, Menlo Park, California.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
authors.affiliation: Pacific Islands Division, National Center for PTSD, Department of Veterans Affairs Pacific Islands Healthcare System, Honolulu, Hawaii.|Pacific Health Research and Education Institute, Honolulu, Hawaii.
authors.forename: Emy
authors.initials: E
authors.lastname: Willis
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Patricia
authors.initials: P
authors.lastname: Resick
authors.affiliation: Trauma Recovery Center, Cincinnati VA Medical Center, Cincinnati, Ohio.|Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Chard
authors.affiliation: Department of Psychiatry, University of Hawaii, Hilo, Hawaii.|The Menninger Clinic, Baylor College of Medicine, Houston, Texas.
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013685:Telecommunications; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
keywords: CBT/cognitive behavior therapy; clinical trials; computer/internet technology; empirical supported treatment; trauma