Category: Treatment - CBT


In-Home Delivery of Prolonged Exposure Therapy: Bridging the Access Gap

Sunday, November 19
10:15 AM - 11:45 AM
Location: Indigo Ballroom E, Level 2, Indigo Level

Keywords: Prolonged Exposure | Implementation
Presentation Type: Symposium

Posttraumatic stress disorder (PTSD) is significant social and economic burden in both military and civilian populations.  It is well documented that veterans have high prevalence of PTSD and low treatment utilization (Hoge, et al 2006). This is likely due to stigma and other common logistical barriers to mental health care (e.g. long distances to clinics, inability to take time off from work, lack of local providers) (Hoge. et al 2004).

Prolonged Exposure therapy (PE; Foa et al., 2007) has been identified as one of the most efficacious cognitive behavior treatments for PTSD. Despite its well documented efficacy, traditional in-office delivery of PE is unavailable or unacceptable to many individuals who would benefit from it. Researchers have examined the use of novel treatment delivery modalities to mitigate those barriers.  Numerous studies (e.g. Morland et al., 2010) have demonstrated that telehealth delivery of evidence based psychotherapy is as clinically effective as face-to-face delivery. Those studies used a clinic-based system in which the patient sat in a local satellite clinic and the therapist was in a larger medical center.

Although that clinic-based telehealth modality successfully lessens many barriers to care, it has been posited that accessibility could be further increased by delivering telehealth to patients in their homes. Preliminary studies suggest that home-based telehealth shows promise as a convenient and private means to delivery evidence based psychotherapy (Acierno et al., 2016).

This presentation discusses a recently completed, 4-year federally funded trial comparing three delivery modalities of PE for PTSD: home-based teleconferencing (HBT), office-based teleconferencing (OBT), and in-home, in-person therapy (IHIP).

Results will be presented including clinical efficacy, treatment preference, and dropout data for 169 veterans. The unique affordances and challenges of in-home delivery will be discussed including safety and practical concerns, methods for creating a home environment conducive to psychotherapy and implications for cost sustainability.

Leslie Morland

Director of TMH for San Diego VA Health Care System (VASDHCS); Associate Professor of Psychiatry
San Diego VA Health Care System; University of CA, San Diego


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In-Home Delivery of Prolonged Exposure Therapy: Bridging the Access Gap

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