Associations between delivery modality and treatment dose and density of trauma-focused evidence-based psychotherapy for posttraumatic stress disorder

Recommended evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), including Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) are being delivered by video telehealth at high rates. Although clinical trials suggest that the treatment dose of PTSD EBPs is similar between in-person and video telehealth modalities, large-scale studies have not investigated whether this remains consistent in routine clinical practice. To fill this gap, we identified a national sample of veterans who initiated PTSD EBP from 4/2022–4/2023 (n = 23,812) in the Veterans Health Administration (VHA). We measured adequate dose (receipt of eight or more in six months) and treatment density (number of sessions in 14 weeks) of PTSD EBP. We used Bayesian hierarchical logistic regression (for the dichotomous adequate dose outcome) and negative binomial regression (for the count density outcome) to understand the risk-adjusted differences in treatment dose and density across delivery modalities. Veterans who received at least half of their PTSD EBP via video telehealth had a higher risk-adjusted odds of receiving an adequate dose compared to in-person treatment (MPOR = 1.19, 90 %CI = 1.10, 1.29; ROPE = 44.0 %); however, treatment density was similar across modalities (MPRR = 0.98; 90 % CI = 0.91, 1.05). Interactions suggested slightly worse metrics in PE delivered by video telehealth than in-person. Results suggested that PTSD EBPs can be delivered via video telehealth in routine clinical practice with similar treatment dose and density to in-person treatment. Future research is needed to understand how important correlates of treatment dose and density may interact with delivery modality.