Open Trial of Behavioral Activation and Social Engagement (BASE) for Posttraumatic Stress Disorder (PTSD)

Study Overview
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Brief Summary
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The purpose of the study is to see if Behavioral Activation and Social Engagement for PTSD (BASE for PTSD), an individual therapy for PTSD, will help Veterans with PTSD 1) through improved understanding of how PTSD affects them, 2) by reducing ways in which they avoid meaningful activity due to PTSD, 3) by enabling them to do more of the things they really care about, and 4) by improving, strengthening, and building up their social supports.

Detailed Description
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Posttraumatic stress disorder (PTSD) is a mental health condition that some people develop following exposure to a traumatic event. PTSD often results in a reduction in feelings of connection to other people and changes in views about others, as well as reduced participation in valued activities. Many veterans with PTSD do not seek treatment offered in specialty mental health settings and may forgo treatment of any kind. This study is an open-trial format (no comparison condition) of U.S. military veterans who will participate in a brief psychotherapy treatment for PTSD offered in a Primary Care setting. This is a pilot trial to see if the treatment is effective at reducing symptoms of PTSD and increasing feelings of social support, and an exploratory aim is to see if veterans engage in additional treatment after completing this treatment.

Official Title
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Open Trial of Behavioral Activation and Social Engagement (BASE) for Posttraumatic Stress Disorder (PTSD)

Conditions
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Post-Traumatic Stress Disorder

Intervention / Treatment
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* Behavioral: Behavioral Activation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veterans who: are currently enrolled in either of the Primary Care Clinics (including Women's Clinic) or Primary Care Mental Health Integration clinic at VA Puget Sound Health Care System - Seattle Division meet criteria for clinical or subclinical PTSD are willing to have therapy sessions audiotaped for the purposes of supervision plan to live in the Seattle area for 6 months following entry into the study Exclusion Criteria: Veterans who: exhibit the presence of severe mental illness diagnosis (e.g., active psychosis and/or uncontrolled bipolar disorder) have been a psychiatric in-patient admission in the past 30 days have had a suicide attempt in the last 60 days have had a plan or intent to harm self or others in the last 30 days have a behavioral flag in their medical record have had a psychiatric medication dosing or receipt that has changed in the last 30 days are unwilling to provide at least 1 collateral contact have impaired decision making capacity (as measured by evidence in the Computerized Patient Record System record of moderate-severe Traumatic Brain Injury, uncontrolled psychosis, dementia, communication flag, or by clinical judgment in speaking with the participant are prisoners are illiterate or have limited or no English proficiency are terminally ill are currently participating in Cognitive Processing Therapy (CPT) or Prolonged Exposure Therapy (PE)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Behavioral Activation and Social Engagement<br>Participants will attend 6 in-person or phone-mediated therapy sessions lasting approximately 45 minutes per session, held in Primary Care settings. Content of therapy sessions includes education about PTSD symptoms, discussion of the role of avoidance in maintaining PTSD symptoms, self-monitoring homework to identify links between activity level and emotions, and homework designed to increase engagement in valued activities, with a focus on increasing social contact and support. If relevant, participants will be instructed in basic communication skills, social skills, and relaxation skills. We have modified the standard Behavioral Activation intervention by reducing the number and length of sessions to accommodate the Primary Care setting. In addition, there will be a stronger emphasis on social engagement in BASE then in standard BA and social contact and support will be addressed during each treatment session. | Behavioral: Behavioral Activation<br>* Participants will be asked to attend 6 in-person or phone-mediated therapy sessions lasting approximately 45 minutes per session, to be held in Primary Care settings. Content of therapy sessions includes education about PTSD symptoms, discussion of the role of avoidance in maintaining PTSD symptoms, self-monitoring homework to identify links between activity level and emotions, and homework designed to increase engagement in valued activities, with a focus on increasing social contact and support. If relevant, participants will be instructed in basic communication skills, social skills, and relaxation skills.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PTSD Checklist-Military Version | Change in PTSD symptoms | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 
| Medical Outcomes Study Social Support Survey Form and Social Connectedness Scale - Revised | Change in social support | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 
| Patient Health Questionnaire-9 | Change in Depression symptoms | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 
| Network Orientation Scale | Change in social network orientation | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 
| Behavioral Activation for Depression Scale | Change in activity level | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Qualitative assessment | Participants' reactions to the treatment will be gathered in qualitative interviews assessing treatment experience, perceptions of treatment focus, engagement with valued activities, social support, therapeutic relationship | 12 weeks | 
| Additional treatment engagement | measured via medical record review | 16 weeks | 
| Brief COPE | Change in coping strategies | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 
| Social Connectedness Scale - Revised (SCS-R) | Change in the level of interpersonal closeness related to participants' social environment and the degree of difficulty experienced by participants in sustaining the sense of closeness | baseline to 4 weeks, 4 weeks to 8 weeks, 8 weeks to 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Posttraumatic Stress Disorder, Social Support, Primary Care