Creative Art Teletherapy for Veterans With PTSD

The primary goal of this proposal is to evaluate a promising teletherapy for Veterans with posttraumatic stress disorder, ART-VET. Problem: Current treatments for posttraumatic stress disorder (PTSD) face considerable challenges including high dropout rates and insufficient remission rates. First line pharmacotherapy using selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), or psychotherapeutic methods such as prolonged exposure therapy result in remission rates between 20 and 50%, though this estimate is confounded by high dropout rates. Furthermore, gold-standard therapies such as trauma-focused cognitive behavior therapy (CBT), i.e. prolonged exposure and Cognitive Processing Therapy (CPT), face higher dropout rates in Veteran populations than civilian, and the proportion which receive an "adequate dose" of therapy is low due to poor compliance. These factors contribute to the chronicity of PTSD and concomitant declines in health and reduced quality of life for the estimated 23% of Veterans who served in recent conflicts, as well as their families and communities. Furthermore, access to care is restricted, particularly in the rural context. Approximately 4.4 million United States Veterans reside in rural communities, and 61% percent of rural Veterans are enrolled in the VA health care system, significantly higher than the 41% enrollment rate of urban Veterans. Rural health care challenges related to access to specialty care are intensified by combat-related injuries and illnesses such as PTSD. Thus, it is critical that the investigators develop alternative treatments while simultaneously improving our understanding of the mechanistic basis of PTSD. Art-therapy Remote Treatment for Veterans Experiencing Trauma (ART-VET) shows promise as a tool to treat PTSD. ART-VET incorporates elements of other empirically supported psychotherapeutic methods, for example exposure therapy. While art therapy is already in use in the VA, there are fewer than 50 Art Therapists in the Veterans Health Administration (VHA) system, and expanded access is held back in part by the lack of robust clinical trial data. The proposed research builds on a successful pilot study whose results strongly supported further research on ART-VET. Research Design and Methods: This research will determine if Creative Art Teletherapy reduces symptoms of PTSD as assessed by commonly used and validated clinical PTSD scales as well as a broad set of measures of domains frequently impacted by PTSD including sleep, depression, anxiety, and quality of life. Furthermore, the research will expand our understanding of the mechanistic basis of PTSD and the impact of Creative Art Teletherapy on those measures. The overall design is a wait-list control randomized clinical trial with partial cross-over, which allows the assessment of the impact of therapy for all participants as well as estimation of the symptom stability without treatment. The proposed research will also use functional magnetic resonance imaging measures to assess brain activity associated with PTSD symptoms during emotional image viewing and memory tasks. These will be combined to evaluate the relationships, patterns and clustering features of PTSD symptoms, comorbidities, psychosocial wellbeing, sleep quality, self-efficacy, functional brain measures, and quality of life measures as well as patterns of association with qualitative measures of art therapy and patient outcomes including imagery, self-report measures, narrative response themes and features, and clinical notes.