PE-Web: An online training program for 

providers in Prolonged Exposure for PTSD

Kenneth J. Ruggiero, Ph.D.

Associate Director and Research Health Scientist 

HSR&D Center of Innovation, Ralph H. Johnson VAMC

Professor and Director of Research Coordination 

Department of Psychiatry & Behavioral Sciences

Medical University of South Carolina
 Presentation Overview 

• Behavioral health needs of Veterans

• Providers’ readiness to deliver EBTs

• Benefits of web-based training approaches

• Evaluation of web-based approaches 

• Process of developing PE-Web

• Description of the PE-Web site
 Key Collaborators

University of Pennsylvania

• Edna Foa, Ph.D., Director of CTSA, Professor, Developer of PE

Ralph H. Johnson VAMC / Med Univ South Carolina

• Ron Acierno, Ph.D., Director of PTSD Clinical Team

• Mary Mauldin, Ed.D., Professor in Library Sciences, Informatics

• Alyssa Rheingold, Ph.D., Associate Prof, Dir. Clinical Operations

• Jonathan Coultas, B.A., Media Specialist

• Cheryl-Lyn Samuels, M.S., Information Resource Consultant

• Martha Strachan, Ph.D., Research Associate, Project Coordinator

• Kyleen Welsh, B.A., Research Coordinator

Other VA-Affiliated Contributors

• Josef Ruzek, Ph.D., Director, Dissemination branch NC PTSD

• Afsoon Eftekhari, Ph.D., PE Training Initiative Proj Coordinator

• Ken Weingardt, Ph.D., National Director for Web Services

• Jessica Hamblen, Ph.D., National Center for PTSD
 Veterans’ MH Needs

• Veterans are at risk for behavioral health problems

– Posttraumatic stress disorder (PTSD) is prevalent 

– Depression and substance use problems often co-occur 

• Untreated PTSD, depression may negatively affect 

overall health and wellness

• Ensuring that Veterans have access to effective 

treatment for PTSD is a major priority

• Prolonged Exposure is a best-practice intervention
 Web-based training

• National dissemination initiative in VA (Karlin, Ruzek, 

et al., 2010, JTS, vol. 23, pps. 663-673) 

• Technology-based provider training resources may 

support dissemination

• Wide dissemination of ESTs is limited by a lack of 

easily accessible, cost-effective training resources.

• Web-based training is a promising mechanism for 

delivering basic training in ESTs.
POLL

• Have you ever completed a web-based 

training for CE credits?

– Yes

– No
Prior Successes

• Our team has developed several online providertraining websites in evidence-based treatment

– Trauma Focused CBT (www.musc.edu/tfcbt)

– Cognitive Processing Therapy (http://cpt.musc.edu) 

– Helping Heroes (http://helping-heroes.org)

– Child Traumatic Grief (www.musc.edu/ctg)

• In our HSR&D project, we developed PE-Web 

(http://pe.musc.edu), a web course for providers 

working with adults with PTSD

– Veteran focused, but relevant to range of populations
 TF-CBT Web Data

• Funded by SAMHSA

• 8-10 hour web-based training course for providers

• Free learning opportunity with CE credits offered

• Asynchronous learning (i.e., learn at your own pace)

• Developed between 2003-2005

• Launched in October, 2005
TF-CBTWeb is a webbased, distance 

education training 

course for learning 

Trauma-Focused 

Cognitive-Behavioral 

Therapy (TF-CBT).

TF-CBTWeb

Launched on

October 1, 2005
•Web-based learning

•Learn at your own pace

•Learn when you want

•Learn where you want

•Return anytime

•10 hours of CE

TF-CBTWeb is offered 

free of charge.

TF-CBTWeb
Each module has: 

•Concise explanations

•Video demonstrations

•Clinical scripts

•Cultural considerations

•Clinical Challenges

TF-CBTWeb
 TF-CBT Web Learners 

From October 1, 2005 to September 30, 2010: 

– TF-CBTWeb had 73,714 registered learners.

• On average, 40.4 learners registered for TF-CBTWeb each 

day.

– 6,482 (8.8%) learners lived outside the U.S.

• 111 countries represented, Albania to Zimbabwe.

• Most learners were from countries where English is 

prevalent. 
 Degrees of Learners

Graduate 

Student

13.8%

Masters

74.2%

Ph.D.

9.9%

MD

2.1%
 Learners’ Professions

 

18.5%

41.0%

25.3%

9.0%

1.0%

2.0%

3.2%

Psychology

Social Work

Counseling

M/F Therapy

Nursing

Psychiatry

Other
 Clinical Experience

58.7% 21.3% 13.5% 6.5%

<5 years

5-10 years

10-20 years

>20 years
 Registration/Completion

 

Learners All U.S.1 Outside 

U.S.

Registered 73,714 67,232 6,482

Completed 

(by 9/30/10)

34,742

(47.1%)

33,304

(49.5%)

1,438

(22.2%)

1Includes learners living in the U.S. and U.S. military and Department of 

Defense employed personnel living outside the U.S.
 Days to Complete

• Mean days to complete course = 67 days

• Longest number of days = 1,778 days

• Shortest number of days = 1

• 50% of completers finish within 13 days

• 75% of completers finish within 49 days
 Pre/Post Knowledge

 

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10

Course Module

Mean Score

Post-test

Pre-test
 Learner Evaluation

 

65.4% 57.4% 54.9% 60.5% 52.1% 56.2% 44.9%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Easy

Navigation

Easy to

Learn

Good Look &

Feel

Clear

Directions

Videos

Helped

Scripts

Practical

Clinical

Challenges

Str.Dis+Disagree Agree Strongly Agree
 Learner Evaluation

 

32.7% 57.0%

46.1% 50.0% 45.8% 48.9%

54.9%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Cultural

Helpful

Techniques

Helpful 

Learn

PsychoEd

Learn Stress

Management

Learn Affect Cognitive

Coping

Trauma

Narrative

Str.Dis+Disagree Agree Strongly Agree
 Learner Evaluation

 

49.9% 46.5% 48.2%

33.5% 40.0% 43.8%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Cognitive

Processing

Behavior

Management

Engage Parents Appropriate

Clients

Appropriate

Problems

Will Use TFCBT

Str.Dis+Disagree Agree Strongly Agree
 Development of PE-Web

• Goal: Develop user friendly, but sophisticated web 

course for providers serving Veterans and other 

adults with PTSD

• Designed to be fully sustainable and accessible 

without cost to the learner

• Divided into 13 learning modules

• Addresses all of the major components of Prolonged 

Exposure treatment for PTSD 
 Development Process

• Expertise in PE (Drs. Foa, Eftekhari, Ruzek, and 

Rheingold)

• Video production (MUSC staff, UPenn existing videos)

• Actors (VA/MUSC faculty, staff; existing VA DVD 

training videos)

• Web design and platform development (MUSC)

• Content development 

• Content entry 

• Alpha and beta testing (faculty and staff at UPenn, 

Charleston, and Palo Alto sites)
 Learning Modules

• Module 1: Basics

– Structure of PTSD

– Theoretical framework

– Patient profiles

• Who is a good PE candidate? 

• Case descriptions
 Learning Modules

• Module 2: Assessment

– Overview of Assessment for PE

– Structured diagnostic interviews

– Symptom scales

– Special considerations

– Within-session assessment (e.g., SUDS)
 Learning Modules

• Module 3: Treatment Components

– Overview of major therapeutic components

• Psycheducation 

• In-vivo exposure

• Imaginal exposure 

• Processing

– Session logistics (e.g., audiotaping, 

structure/length of sessions, session agendas)
 Learning Modules

• Module 4: Rationale & Trauma Interview

– Program overview

– PTSD symptoms

– Information gathering (structured trauma 

interview)

– Breathing retraining protocol
 Learning Modules

• Module 5: Psychoeducation

– Common reactions to potentially traumatic events

– Relations between traumatic events and 

symptoms 

– Address common clinical challenges

• Report of suicidality, etc.
 Learning Modules

• Module 6: In-Vivo Exposure

– Rationale

– SUDS

– Constructu hierarchy

– Homework

– Trouble-shooting
 Learning Modules

• Module 7: Imaginal Exposure

– Rationale

– Implementation 

• How to address multiple traumatic events

– Trouble-shooting

• Over-engagers

• Under-engagers

• Avoidance / safety-behavior

– Homework
 Learning Modules

• Module 8: Processing

– Implmentation 

– Do’s and Don’ts
 Learning Modules

• Module 9: Hotspots

– Identification

– Implementation 

– Trouble-shooting (e.g., multiple hot spots)
 Learning Modules

• Module 10: Homework

– Rationale

– Review

– Troubleshooting
 Learning Modules

• Module 11: Special Issues

– Over-engagement 

– Under-engagement 

– Anger, Guilt, and Shame
 Learning Modules

• Module 12: Special Populations

– TBI

– Substance use

– MDD

– MST

– Axis II

– Active duty service members
 Learning Modules

• Module 13: Telehealth

– Optional module with useful implementation and 

safety-related logistics














Poll

Where do you think this type of training approach 

would be most valuable in the training process?

1. Pre workshop

2. Post workshop

3. As a “refresher” course

4. As an ongoing resource that providers can 

refer to as needed
 Next Steps

• DoD funded project on mobile Web 

applications for supervisors and providers

– Web-based

– iOS compatible

– Android compatible

• Expected to be completed within about a year
 Conclusions

• Engaging Web training courses can be developed 

for ESTs

• Web training can effectively build knowledge of 

EST techniques

• Free, modular training approaches are popular 

with mental health professionals. 

• Offering CE credit is critical. 

• Online training is a cost-effective

• Online training is one way to improve the quality 

of mental health services