Contingency Outcomes in Prolonged Exposure
Condition: Posttraumatic Stress Disorder; Substance Use Disorder
MeSH terms: Substance-Related Disorders; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The aim of this research is to assess whether Contingency Management is effective in
      improving treatment adherence in substance use disordered (SUD) patients with comorbid PTSD.
      Although Prolonged Exposure therapy (PE) is the gold standard treatment for PTSD, the few
      studies of this treatment in substance users have shown poor adherence. Contingency
      Management is a well-established approach that could be used to enhance adherence to PE. From
      a consented sample of 125 opioid-dependent and methadone-treated patients at Addiction
      Treatment Services, an intent-to-treat sample of 62 patients with co-occurring current PTSD
      will be offered PE. Half of the 62 participants will be randomly assigned to a Prolonged
      Exposure with Contingency Management (PE+CM) condition that provides monetary-based
      incentives for attending the PE therapy sessions. The comparison condition will be assigned
      to a Prolonged Exposure (PE) condition without the attendance incentives intervention. The PE
      sessions will be scheduled once per week for 12 weeks, with a 12-week follow-up. Groups will
      be compared primarily on adherence to the PE schedule, improvement in PTSD symptoms, and
      rates of drug use (urine specimens, self-reported use). The study's three primary aims are to
      1) Evaluate the efficacy of adding voucher-based attendance incentives to PE for PTSD to
      increase adherence in SUD patients in a methadone treatment program; 2) Evaluate the efficacy
      of adding voucher-based attendance incentives to PE for PTSD to reduce PTSD symptoms in SUD
      patients; and 3) Evaluate the effect of PE for PTSD on rates of drug use in SUD patients.
    


Intervention name(s): Prolonged Exposure Therapy; Voucher-Based Reinforcement
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Prolonged Exposure Therapy is considered the "gold standard" treatment for PTSD in psychiatry. It uses a cognitive-behavioral approach that repeatedly and systematically exposes patients to memories of their traumatic events to reduce fear and arousal. The PE therapy offered in this study will be based on procedures used by Foa and colleagues, described in their book-length treatment manual (Foa, Hembree, & Rothbaum, 2007).; Those in the PE+CM condition will also be able to earn voucher-based incentives for each therapy session that they attend as scheduled, with a maximum of $480 for full adherence to all sessions. Specifically, participants will earn $30 for attending Session 1, $40 for attending Session 2, $50 for attending Session 3, and $60 for attending Sessions 4 through 9. There will be no payment for Sessions 10 through 12. Because it is very important that participants attend sessions on schedule, voucher values will be reset starting from $30 if participants miss a scheduled session. Vouchers can be exchanged for goods and services in the community (e.g., gift cards to local retailers).
Other intervention name(s): PE Therapy; Vouchers
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: PTSD; Prolonged Exposure; Comorbidity; Treatment; Methadone Maintenance; Substance Use Disorder