Stepped Care for Posttraumatic Stress Disorder Study

Adaptive Interventions to Improve Posttraumatic Stress Disorder (PTSD) Treatment Access, Engagement, and Effectiveness in Routine Care

Less than 20% of people with PTSD receive any treatment. This study extends a program of research by the investigator focused on developing adaptive (stepped) interventions for PTSD. The adaptive intervention sequences a digital mental health intervention (DMHI) and brief trauma- and skills-focused treatments for PTSD. The selected treatments are brief and scalable and less burdensome to systems of care. These treatments are: web-administered Skills Training in Affective and Interpersonal Regulation (webSTAIR), Brief STAIR, and Written Exposure Therapy (WET).

This study uses a Sequential, Multiple Assignment, Randomized Trial (SMART) design.

At baseline, participants are randomized to Stage 1 Treatments, either webSTAIR (self-managed) or webSTAIR plus community health worker coaching. At 8 weeks, stage 1 nonresponders are re-randomized to Stage 2 clinician-administered treatments, either Brief STAIR or WET.

Nonresponse is defined as less than a 15-point decrease in PTSD symptom severity from baseline, as measured by the PTSD Checklist for DSM-5 (PCL-5).

The objectives of this study are to:

• examine the main effects of stage 1 treatments, stage 2 treatments, and embedded
• adaptive interventions on PTSD symptom severity.
• confirm mechanisms of change established in the extant PTSD literature
• identify patient-level moderators of change in PTSD symptoms severity at 18 weeks

Inclusion criteria:

Assessed at pre-screening

• Boston Medical Center primary care patient
• At least 18 years of age
• Access to computer or mobile device
• Able to receive treatments in English or Spanish
• Able to read at 4th grade level

Assessed at baseline

• Endorsement of Criterion A trauma using the Life Events Checklist for the DSM-5 (LEC-5), assessed at baseline

• PTSD diagnosis, confirmed by the Clinician-Administered PTSD Scale for the DSM-5 (CAPS-5) assessed at baseline

  - Concordance between CAPS-5 and PCL-5 at baseline

• Clinically appropriate for outpatient level of care

• Stable on psychotropic medication for >4 weeks

Exclusion criteria:

Assessed at pre-screening

• Patient is currently engaged in clinician-administered therapy

Assessed at baseline (clinician interview)

• Patient is not clinically appropriate for outpatient level of care.
• Acute risk for suicidal thoughts or behaviors, assessed by the Columbia Suicide Severity Rating Scale, administered by research clinician at baseline.