Brief Peer Supported webSTAIR Compared to Enhanced Wait List
Condition: Post Traumatic Stress Disorder; Depression; Emotion Regulation
MeSH terms: Depression; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      This study will enroll 180 Veterans at a 2:1 ratio where 120 Veterans will be enrolled into a
      brief transdiagnostic peer supported webSTAIR (BPS webSTAIR) and 60 will be supported into
      Waitlist. The purpose of the study is to assess the efficacy BPS webSTAIR in regard to four
      outcomes: reduction in PTSD and depression symptoms (measured by the PCL-5 and PHQ-8,
      respectively) and improvement in emotion regulation and work and social adjustment (measured
      by the DERS-16 and WSAS, respectively). The active treatment is a 6-session modular treatment
      that focuses on learning emotion management skills where Particpants will have 10 weeks to
      complete the treatment. Assessments will occur three times for those in webSTAIR: baseline,
      post-treatment (10 weeks after randomization) and 8-week follow-up and twice for those on
      waitlist (baseline and 10 weeks after randomization). It is hypothesized that BPS WebSTAIR
      will be superior to the Waitlist condition on all four outcomes. Mixed Effects Models will be
      used to evaluate the outcomes.
    

Detailed description: 
      The purpose of this randomized controlled trial is to assess the efficacy of a brief version
      of webSTAIR (BPS webSTAIR) supported by peers compared to a waitlist condition (WL). Brief
      peer supported (BPS) webSTAIR is a 6-module web-based transdiagnostic program that provides
      skills training in emotion regulation; participants in this condition will be able to contact
      a Veteran peer trained in the program to obtain general support plus guidance about program
      use and application of skills.

      An 11-module version of webSTAIR with therapist coaching has provided pilot data that the
      program is effective in reducing symptoms of posttraumatic stress disorder (PTSD) and
      depression as well as improving emotion regulation and work and social adjustment. Pilot data
      indicate that initial gains are made in the first 6 sessions. In addition, qualitative
      interviews with Veterans who have completed the program indicate high satisfaction with these
      modules. This study will assess whether a shorter version of the treatment (6 rather than 11
      modules) and with peer rather than professional coaching will be effective compared to a
      waitlist condition. The BPS webSTAIR program was developed with the aim of providing a
      treatment for trauma-related symptoms that is effective, brief, engaging and likely to be
      completed by the user. The reduction of the number of modules creates a briefer treatment
      than the investigators current web-based program. In addition, data indicated that
      integrating Veteran peers into mental health programs leads to better engagement and greater
      retention providing the rationale for including Veteran peers rather than therapists (e.g.,
      psychologists, social workers). Given the absence of findings that a brief, peer-supported
      version of webSTAIR provides improvement in the above symptoms, the research team followed
      recommendations for the development and testing of psychotherapies and used a waitlist
      control as an initial test of efficacy.

      The aim is to establish the efficacy of BPS webSTAIR in improving symptoms of PTSD and
      depression, emotion regulation problems and work and social adjustment compared to a Waitlist
      Control.

      Hypothesis 1a: Compared to WL, BPS webSTAIR will provide greater improvement in PTSD symptoms
      as measured by the PCL5 and depression as measured by the PHQ-8 (secondary outcome).
      Assessments will be made at pre-treatment, post-treatment, and 8-week follow-up for webSTAIR
      participants and pre and post-treatment (or 10 weeks from randomization) for WL.

      Hypothesis 1b: Compared to WL, BPS webSTAIR will provide greater improvement in emotion
      regulation as measured by the DERS-16 and overall functioning as measured by the work and
      social adjustment scale (WSAS) (secondary outcomes). Assessments will be made at
      pre-treatment, post-treatment and 8-week follow-up for webSTAIR participants and pre and
      post-treatment (or 10 weeks after randomization) for WL.

      In the BPS webSTAIR condition, participants will first complete a welcome module to orient
      them to the program. After randomization, participants will have 10 weeks to complete the 6
      modules. Every time the Veteran logs on they will have the opportunity to engage with a
      Veteran peer for support through the web program. Contacts can last for up to an hour.
      Veterans will receive a series of automated reminders and engagement emails that the Vets
      Prevail program sends at various points in the program.

      The equivalence of the treatment conditions on baseline variables demographics and
      psychological variables) will be assessed and controlled (if necessary) in the final
      analyses. Other preliminary analyses will include examination of distributional properties of
      the measures. Transformations will be used to improve distributions when necessary. Missing
      data patterns (from missed assessments and from dropout) will be examined and compared
      between conditions. Mixed Effects Models (MEMs) will be used to evaluate differences between
      the two treatments over time with time as a main effect and treatment-by-time as an
      interaction term.
    

Intervention name(s): Brief Peer Supported webSTAIR
Intervention type(s): Other
Intervention description(s): The BPS webSTAIR program is an online platform where individuals are taught skills in emotion regulation. In this program they will learn how to recognize the emotions they are feeling by assessing their own body language, being attentive to their thought processes, and attempting to replace negative behaviors with positive. Throughout the platform they will engage in written exercises to help them solidify the lessons with their own life experiencing. They will also have the support of peers throughout the program to help them when they need clarification or having a difficult time applying the lesson(s).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: PTSD; Post Traumatic Stress Disorder; Depression; Emotion Regulation; Skills Building; Peer; Coaching; Online