The COVID-19 pandemic had exacerbated mental health challenges for trauma-exposed individuals due to increased isolation, insufficient capacity in the mental health workforce, and a predicted fourth wave of mental health impacts of the pandemic itself. There had been a pressing need to increase treatment capacity for individuals with trauma-related mental health problems directly related to or exacerbated by the pandemic.
Digital mental health (DMH) interventions for post-traumatic stress disorder (PTSD) addressed well-documented barriers to traditional in-person psychotherapy or telehealth delivery of evidence-based treatments (EBTs) for PTSD, but many consumers did not remain engaged. Thus, acceptable, efficient, and engaging forms of EBTs were sorely needed, particularly for those who were less likely to access traditional psychotherapy or use online programs.
Asynchronous texting therapy platforms could facilitate treatment engagement among those who sought discrete, convenient, and affordable support. In a pilot of a texting-based format of an EBT for PTSD, Cognitive Processing Therapy (CPT-Text), the team found that CPT-Text was feasible to deliver, and clients showed substantially greater PTSD symptom improvement over a shorter time compared to text therapy as usual (TAU). A larger-scale, more rigorous test had been necessary. Additional refinement was also needed to address challenges to sustained engagement that had been identified both in the pilot and more broadly in other DMH interventions.
The project used a randomized, Hybrid Type 1, implementation-effectiveness trial with a factorial design to compare text-based therapies for PTSD utilizing the HIPAA-compliant secure texting platform of the DMH partner, Talkspace. Participants (N=400) who had PTSD that was related to or had been exacerbated by the COVID-19 pandemic were randomized into CPT-Text or text-based TAU. Participants were also randomized into one of two engagement strategies: therapist reminder as usual (RAU) or RAU + incentive (RI).
