Adaptive Decision-making And Personalized Treatment for PTSD (ADAPT-PTSD)

NCT ID: NCT07176273

Last Updated: 2025-12-19

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

302 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-12-12

Study Completion Date

2028-08-14

Brief Summary

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By doing this research project, the investigators hope to learn which strategies work best to help veterans who are not benefiting from their first PTSD treatment or not completing between-session homework assignments regularly that might improve treatment response. The investigators also want to learn how best to match the right type and amount of treatment to each individual veteran. By conducting this research project, they hope to:

* See if trying a different treatment strategy for veterans not responding to their first PTSD treatment would be more helpful
* See if sending text message prompts between sessions encourages more completion of between-session homework

Detailed Description

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This study is designed to assist the investigators in answering the clinical question of how to address non-response to first line PTSD treatments. Utilizing an innovative Hybrid Experimental Design (HED), the proposed study involves multiple, sequential randomizations to both therapist-delivered and digital interventions operating on short and long timescales to determine the optimal combination and sequencing of evidence-based interventions to maximize response. This will result in actionable data and, consistent with a personalized medicine approach, an implementable, adaptive treatment regimen that optimizes clinical resource allocation. By recruiting and providing treatment in routine care settings serving veterans with PTSD, the study design maximizes generalizability, relevance to the VA mission, and implementation potential.

Conditions

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Posttraumatic Stress Disorder PTSD

Keywords

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Veterans

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

This study is a randomized controlled effectiveness trial utilizing a Hybrid Experimental Design (HED) comprised of a Sequential Multiple Assignment Randomized Trial (SMART) and Micro-Randomized Trial (MRT)
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Early CPT Non-Responders Switch (Group A)

Early NON-RESPONDERS to CPT will SWITCH to PE

Group Type ACTIVE_COMPARATOR

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Cognitive Processing Therapy (CPT)

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Prolonged Exposure (PE)

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Early CPT Non-Responders Modular (Group B)

Early NON-RESPONDERS to CPT will transition to MODULAR CPT

Group Type ACTIVE_COMPARATOR

Modular Cognitive Processing Therapy

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of Contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need. Modular CPT contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need.

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Cognitive Processing Therapy (CPT)

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Early CPT Responders Continue (Group C)

Early RESPONDERS to CPT will CONTINUE in their CPT treatment

Group Type ACTIVE_COMPARATOR

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Cognitive Processing Therapy (CPT)

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Early CPT Responders Step Down (Group D)

Early RESPONDERS to CPT will STEP DOWN to self-managed CPT

Group Type ACTIVE_COMPARATOR

Step Down Treatment

Intervention Type BEHAVIORAL

Self-managed treatment will involve receiving a self-help version of the remaining treatment materials and ongoing use of the intervention companion app (CPT Coach or PE Coach).

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Cognitive Processing Therapy (CPT)

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Early PE Non-Responsers Switch (Group E)

Early NON-RESPONDERS to PE will SWITCH to CPT

Group Type ACTIVE_COMPARATOR

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Cognitive Processing Therapy (CPT)

Intervention Type BEHAVIORAL

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Prolonged Exposure (PE)

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Early PE Non-Responders Modular (Group F)

Early NON-RESPONDERS to PE will transition to MODULAR PE

Group Type ACTIVE_COMPARATOR

Modular Prolonged Exposure Therapy

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. Modular PE is comprised of the same elements of standard PE, but clinicians select and dose modules (i.e., imaginal exposure, in vivo exposure) based on individual patient need.

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Prolonged Exposure (PE)

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Early PE Responders Continue (Group G)

Early RESPONDERS will CONTINUE in their PE treatment

Group Type ACTIVE_COMPARATOR

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Prolonged Exposure (PE)

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Early PE Responders Step Down (Group H)

Early RESPONDERS to PE will STEP DOWN to self-managed PE

Group Type ACTIVE_COMPARATOR

Step Down Treatment

Intervention Type BEHAVIORAL

Self-managed treatment will involve receiving a self-help version of the remaining treatment materials and ongoing use of the intervention companion app (CPT Coach or PE Coach).

Digital Interventions

Intervention Type BEHAVIORAL

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Prolonged Exposure (PE)

Intervention Type BEHAVIORAL

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Interventions

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Modular Cognitive Processing Therapy

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of Contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need. Modular CPT contains the same core elements of CPT, but content is repackaged into modules instead of sessions so that clinicians can select and dose treatment elements according to patient need.

Intervention Type BEHAVIORAL

Modular Prolonged Exposure Therapy

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. Modular PE is comprised of the same elements of standard PE, but clinicians select and dose modules (i.e., imaginal exposure, in vivo exposure) based on individual patient need.

Intervention Type BEHAVIORAL

Step Down Treatment

Self-managed treatment will involve receiving a self-help version of the remaining treatment materials and ongoing use of the intervention companion app (CPT Coach or PE Coach).

Intervention Type BEHAVIORAL

Digital Interventions

The prompt will be a text message delivered through VA-approved technology (e.g., PETALS).

Intervention Type BEHAVIORAL

Cognitive Processing Therapy (CPT)

CPT is a first-line treatment for PTSD that includes the following core elements: (a) identification of "stuck points" in thinking that interfere with recovery and (b) using Socratic questioning and a series of progressive worksheets to examine stuck points, develop balanced beliefs, and facilitate the experience of natural emotions.

Intervention Type BEHAVIORAL

Prolonged Exposure (PE)

PE is a first-line treatment for PTSD that includes the following core elements: (a) in vivo exposure and (b) imaginal exposure to the trauma memory. In imaginal exposure, participants repeatedly, systematically approach their trauma memory and related thoughts and feelings. In in vivo exposure, participants repeatedly, systematically approach objectively safe people, places, objects, and situations that they avoid because these stimuli remind them of their trauma.

Intervention Type BEHAVIORAL

Other Intervention Names

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Modular CPT Modular PE Step Down Daily Digital Prompts CPT PE

Eligibility Criteria

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Inclusion Criteria

1. Veterans eligible for PE and CPT at the participating PTSD treatment-providing clinic who are
2. At least 18 years or older
3. Score ≥ 31 on the PCL-5 secondary to a Criterion A traumatic event
4. Own a mobile device that can be used for the therapy companion mobile app (Prolonged Exposure (PE) coach or Cognitive Processing Therapy (CPT) coach).

Exclusion Criteria

1. Acute suicide risk requiring clinical intervention
2. Need for detoxification
3. Unmanaged psychosis or bipolar disorder
4. Severe cognitive impairment that makes it unlikely that participants 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)
5. Current or past 12-month engagement in PE or CPT.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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United States Department of Defense

FED

Sponsor Role collaborator

The University of Texas Health Science Center at San Antonio

OTHER

Sponsor Role lead

Responsible Party

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Stefanie LoSavio

Assistant Professor of Psychiatry & Behavioral Sciences

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Stefanie LoSavio, PhD

Role: PRINCIPAL_INVESTIGATOR

The University of Texas Health Science Center at San Antonio

Rebecca Sripada, PhD

Role: PRINCIPAL_INVESTIGATOR

VA Ann Arbor-506

Locations

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Augusta VA

Augusta, Georgia, United States

Site Status RECRUITING

Ann Arbor VA

Ann Arbor, Michigan, United States

Site Status RECRUITING

Battle Creek VA

Battle Creek, Michigan, United States

Site Status NOT_YET_RECRUITING

Salt Lake City VA

Salt Lake City, Utah, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Stefanie LoSavio, PhD

Role: CONTACT

Phone: 210-562-6700

Email: [email protected]

Rebecca Sripada, PhD

Role: CONTACT

Phone: 734-222-7432

Email: [email protected]

Facility Contacts

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J. Richard Monroe

Role: primary

Rebecca Sripada, PhD

Role: primary

Rebecca Sripada, PhD

Role: primary

Erika Roberge

Role: primary

Other Identifiers

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HT9425-24-1-1026

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

STUDY00001551

Identifier Type: -

Identifier Source: org_study_id