Testing Adaptive Interventions to Improve Posttraumatic Stress Disorder Treatment Outcomes in Federally Qualified Health Centers

NCT ID: NCT05457985

Last Updated: 2025-08-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

430 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-23

Study Completion Date

2026-05-31

Brief Summary

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This trial is being completed to develop a stepped-care talk therapy model for patients with PTSD. Specifically, this study is testing whether beginning with one type of therapy is better than beginning with another type of therapy, and whether moving to a different therapy after four sessions is more helpful than staying with the same therapy, depending on how well it is working.

The central hypothesis is that beginning with a low- or medium-intensity PTSD intervention and then titrating intensity based on early indications of response will result in clinically significant PTSD symptom reduction with parsimony of resources.

Detailed Description

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Conditions

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PTSD

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

All eligible participants will initially be randomized to one of the two first-stage options, either PE-PC or PTSD coach with clinician support. Participants that have experienced less than a 15-point reduction, have a PCL score of greater than 60 ("very severe"), or cannot be reached for assessment will be classified as slow responders and will be re-randomized to one of two second-stage tactics, either (a) continue in their first-stage treatment strategy, or (b) step up to full PE. Participants who have experienced at least a 15-point symptom reduction or have a PCL score of less than 29 will be classified as early responders and will step down to a lower intensity of their current treatment strategy (i.e., early responders will not be re-randomized).
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The primary outcome, the Clinician-Administered PTSD Scale (CAP-5), will be administered by a blinded study team member.

Study Groups

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Prolonged Exposure for Primary Care (PE-PC) then continue as early responder

PE-PC consists of four weekly 30-minute sessions. At the 4th session or 9-week assessment point (whichever comes first), early responders will step down to every-other-week sessions for the duration of the second stage (for 8 weeks).

Group Type EXPERIMENTAL

Prolonged Exposure for Primary Care (PE-PC)

Intervention Type BEHAVIORAL

Treatment follows the standardized PE-PC manual and workbook.PE-PC consists of four weekly 30-minute sessions. In vivo and imaginal exposure are introduced at the first session and reviewed at Sessions 2-4. To conduct in vivo exposure, participants repeatedly and systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma. At the 4th session or 9-week assessment point (whichever comes first), early responders will step down to every-other-week sessions for the duration of the second stage.

Clinician Supported (CS) PTSD Coach App then continue as early responder

During the first stage of treatment, participants will receive four weekly clinician support sessions or 9 weeks (whichever occurs first). Early responders will be encouraged to continue app use but will discontinue clinician support sessions for the remaining 8 weeks.

Group Type EXPERIMENTAL

Clinician Supported PTSD Coach App

Intervention Type BEHAVIORAL

This is a brief psychotherapy that uses the PTSD Coach mobile app developed by the study team. The PTSD Coach app incorporates evidence-based assessment, psychoeducation, and cognitive behavioral therapy and self-management strategies that are customizable to the user.

Prolonged Exposure for Primary Care (PE-PC) then full PE

PE-PC consists of four weekly 30-minute sessions. At the 4th session or 9-week assessment point (whichever comes first), slow responders that are then randomized to full PE and will have sessions once a week for eight weeks. During these 60-minute sessions, participants will practice in vivo and imaginal exposure and continue these exposure exercises every day at home.

Group Type EXPERIMENTAL

Prolonged Exposure for Primary Care (PE-PC)

Intervention Type BEHAVIORAL

Treatment follows the standardized PE-PC manual and workbook.PE-PC consists of four weekly 30-minute sessions. In vivo and imaginal exposure are introduced at the first session and reviewed at Sessions 2-4. To conduct in vivo exposure, participants repeatedly and systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma. At the 4th session or 9-week assessment point (whichever comes first), early responders will step down to every-other-week sessions for the duration of the second stage.

Full Prolonged Exposure

Intervention Type BEHAVIORAL

Treatment will follow the standardized PE manual. Participants will have 60 minute sessions once a week for eight weeks During these sessions, participants will practice in vivo, imaginal, and emotional exposure as well as continue these exposure exercises every day at home.

Clinician Supported PTSD Coach App then full PE

During the first stage of treatment, participants will receive four weekly clinician support sessions or 9 weeks (whichever occurs first), slow responders that are then randomized to full PE will have sessions once a week for eight weeks. During these 60 minute sessions, participants will practice in vivo and imaginal exposure and continue these exposure exercises every day at home.

Group Type EXPERIMENTAL

Full Prolonged Exposure

Intervention Type BEHAVIORAL

Treatment will follow the standardized PE manual. Participants will have 60 minute sessions once a week for eight weeks During these sessions, participants will practice in vivo, imaginal, and emotional exposure as well as continue these exposure exercises every day at home.

Clinician Supported PTSD Coach App

Intervention Type BEHAVIORAL

This is a brief psychotherapy that uses the PTSD Coach mobile app developed by the study team. The PTSD Coach app incorporates evidence-based assessment, psychoeducation, and cognitive behavioral therapy and self-management strategies that are customizable to the user.

Prolonged Exposure for Primary Care (PE-PC) then continued PE-PC

PE-PC consists of four weekly 30-minute sessions. At the 4th session or 9-week assessment point (whichever comes first), slow responders that are then randomized to continue with PE-PC (medium intensity) will continue weekly sessions for 8 weeks.

Group Type EXPERIMENTAL

Prolonged Exposure for Primary Care (PE-PC)

Intervention Type BEHAVIORAL

Treatment follows the standardized PE-PC manual and workbook.PE-PC consists of four weekly 30-minute sessions. In vivo and imaginal exposure are introduced at the first session and reviewed at Sessions 2-4. To conduct in vivo exposure, participants repeatedly and systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma. At the 4th session or 9-week assessment point (whichever comes first), early responders will step down to every-other-week sessions for the duration of the second stage.

Clinician Supported PTSD Coach App then continued CS PTSD Coach App

During the first stage of treatment, participants will receive four weekly clinician support sessions or 9 weeks (whichever occurs first), slow responders that are then randomized to continue this treatment will have the frequency reduced to twice monthly.

Group Type EXPERIMENTAL

Clinician Supported PTSD Coach App

Intervention Type BEHAVIORAL

This is a brief psychotherapy that uses the PTSD Coach mobile app developed by the study team. The PTSD Coach app incorporates evidence-based assessment, psychoeducation, and cognitive behavioral therapy and self-management strategies that are customizable to the user.

Interventions

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Prolonged Exposure for Primary Care (PE-PC)

Treatment follows the standardized PE-PC manual and workbook.PE-PC consists of four weekly 30-minute sessions. In vivo and imaginal exposure are introduced at the first session and reviewed at Sessions 2-4. To conduct in vivo exposure, participants repeatedly and systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma. At the 4th session or 9-week assessment point (whichever comes first), early responders will step down to every-other-week sessions for the duration of the second stage.

Intervention Type BEHAVIORAL

Full Prolonged Exposure

Treatment will follow the standardized PE manual. Participants will have 60 minute sessions once a week for eight weeks During these sessions, participants will practice in vivo, imaginal, and emotional exposure as well as continue these exposure exercises every day at home.

Intervention Type BEHAVIORAL

Clinician Supported PTSD Coach App

This is a brief psychotherapy that uses the PTSD Coach mobile app developed by the study team. The PTSD Coach app incorporates evidence-based assessment, psychoeducation, and cognitive behavioral therapy and self-management strategies that are customizable to the user.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Receive care at a participating federally qualified health center (FQHC)
* Have a Posttraumatic Stress Disorder checklist (PCL-5) score greater or equal (≥) to 33
* Own a mobile device that can be used for the PTSD Coach App
* Have had psychotropic medication stability for at least 4 weeks

Exclusion Criteria

* Severe cognitive impairment that in the judgment of the investigators makes it unlikely that the participant can adhere to the study regimen (as evidenced by confusion, inability to track discussion or answer questions, or other clear and significant indicators of cognitive impairment)
* High risk of suicide (defined as meeting criteria for Action Step 3 on the Participant Suicide Risk Screening form
* Severe alcohol or substance use disorder (moderate-severe alcohol use disorder on Alcohol Use Disorders Identification Test (AUDIT) (scores ≥ 15) or high risk on National Institute on Drug Abuse Quick Screen (scores ≥ 27))
* Active psychosis or unmanaged bipolar disorder
* Unstable housing
* Current engagement in a trauma-focused behavioral treatment (such as Prolonged Exposure or Cognitive Processing Therapy).
* Patients who do not speak English will be excluded for logistical reasons.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role lead

Responsible Party

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Rebecca Sripada

Associate Professor of Psychiatry

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Family Health Care

Baldwin, Michigan, United States

Site Status TERMINATED

Grace Health

Battle Creek, Michigan, United States

Site Status RECRUITING

Genesee Community Health Center

Flint, Michigan, United States

Site Status RECRUITING

Hamilton Community Health Network

Flint, Michigan, United States

Site Status RECRUITING

Cherry Health

Grand Rapids, Michigan, United States

Site Status RECRUITING

MidMichigan Community Health Services

Houghton Lake, Michigan, United States

Site Status RECRUITING

Upper Great Lakes Family Health Care Center

Menominee, Michigan, United States

Site Status RECRUITING

Family Medical Center of Michigan

Monroe, Michigan, United States

Site Status RECRUITING

Sterling Area Health Center

Sterling, Michigan, United States

Site Status RECRUITING

Family Care Health Centers

St Louis, Missouri, United States

Site Status RECRUITING

Western North Carolina Community Health Services

Asheville, North Carolina, United States

Site Status RECRUITING

CommUnityCare Health Centers

Austin, Texas, United States

Site Status RECRUITING

Unity Care NW

Bellingham, Washington, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Kayla Longuski, MS

Role: CONTACT

734-647-6258

Heather Walters

Role: CONTACT

734-845-3650

Facility Contacts

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Eric Macleod

Role: primary

Brian Nicholson

Role: primary

Albert Ujkaj

Role: primary

Lindsey Metts

Role: primary

Stacey Gedeon

Role: primary

Savanna Weber

Role: primary

Erica Keith

Role: primary

Linda LaTulip

Role: primary

Jordanna Riebel

Role: primary

Jessica Parsil

Role: primary

Heather Gause

Role: primary

Beth Williams

Role: primary

Other Identifiers

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1R01MH125857-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HUM00203165

Identifier Type: -

Identifier Source: org_study_id

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