A Self-Management Program for Completers of Trauma-Focused Therapy for PTSD

Impact: Findings from this project will improve the mental health and well-being of Veterans
with posttraumatic stress disorder (PTSD) by refining and evaluating the first post-trauma
focused therapy (TFT) intervention designed to help Veterans increase self-efficacy for
managing their PTSD symptoms, maintain or build upon gains made in TFT, and increase
community engagement. The current VA / Department of Defense PTSD clinical practice
guidelines recommend decreasing the frequency and intensity of care (e.g. stepping-down)
following successful TFT completion; this project is the initial step in developing the first
evidence-based intervention for this important process. The project will advance RR&D's
missions of evaluating interventions designed to maximize psychological recovery and
prioritizing functional outcomes and societal engagement. Finally, the project will advance
the scientific literature by being the first examination of a self-management intervention
designed to be used to step down from an intensive course of therapy for PTSD.

Background: TFTs reduce the suffering associated with PTSD; a majority of Veterans who
complete prolonged exposure or cognitive processing therapy report improvements in PTSD
symptomology, quality of life, and functioning. Despite their effectiveness, emerging data
suggest that Veterans who complete TFTs continue to perceive a need for mental health
treatment; the investigators' pilot data demonstrated that the primary post-TFT mental health
treatment need among completers who experienced at least a partial improvement in PTSD
symptoms is support for additional practice and reinforcement of skills learned in TFT.
Veterans expressed low self-efficacy for maintaining or building upon their existing gains
and believed continued contact with their TFT therapist would increase their likelihood of
success. These treatment needs are particularly well-suited to a therapist-assisted
self-management approach. Self-management protocols teach patients to be responsible for the
day-to-day management of their symptoms, thereby emphasizing patients' roles in wellness. The
existing literature on self-management interventions for PTSD has demonstrated that such
approaches are acceptable, safe, and effective; however, they have exclusively been used as
stand-alone treatments or as the first step up in a stepped-care model. Therefore, the
investigators are proposing the first examination of a self-management intervention designed
to be used to step down from an intensive course of TFT for PTSD.

Objectives: The objective of this study is to complete stages 1A and 1B of the Stage Model of
Treatment Development for the self-management program for Veterans who have recently
completed a course of TFT for PTSD. Specifically, the investigators will: (1) Refine a
self-management treatment protocol through eliciting feedback from experienced TFT providers,
(2) Conduct a pilot open trial to assess the (a) acceptability of the self-management program
components, structure, and materials and (b) feasibility of the self-management program
(retention and intervention fidelity) and study approach (screening, recruitment, assessment
process), and (3) Explore the effects of the program on Veterans' confidence in managing
their PTSD (self-efficacy), functioning, quality of life, community engagement, and mental
health symptoms.

Methods: To achieve Aim 1, the investigators will conduct semi-structured individual
interviews with a sample of TFT providers (n = 10-12), during which participants will be
asked to provide feedback on the planned components and structure of the self-management
program. To achieve Aims 2 and 3, the investigators will enroll twelve Veterans in a
non-randomized, open-trial pilot test of the intervention at the Minneapolis VA Healthcare
Systems (VAHCS). Enrolled Veterans will complete survey batteries immediately post-TFT, and
survey batteries and qualitative interviews two weeks after the final self-management program
therapist contact. Findings from this project will strongly position us to apply for Merit
funding to conduct a randomized clinical trial (Stage 2 of the Stage Model of Treatment
Development) of this innovative self-management program.

Inclusion Criteria:

Patients will be eligible to participate if they:

- completed a course of individually-delivered trauma-focused therapy (TFT) with a
provider trained to deliver the self-management intervention at the Minneapolis VAMC

- experienced a clinically meaningful reduction in PTSD symptomology (PCL decrease of at
least 10 points) from pre-TFT to the time of the enrollment

- at the time of enrollment are not planning to initiate another active course of
psychotherapy for PTSD in the following three months

- are willing to participate in a self-management intervention, and

- can provide informed consent

Exclusion Criteria:

- Veterans will be excluded if they have suicidal or homicidal ideation that in the
opinion of their TFT therapist needs to be the focus of treatment.