Cited by 274Telemedicine and Telehealth ImplementationPosttraumatic Stress Disorder ResearchPsychotherapy Techniques and Applications

Telemedicine for Anger Management Therapy in a Rural Population of Combat Veterans With Posttraumatic Stress Disorder: A Randomized Noninferiority Trial

Morland, Leslie A., Greene, Carolyn J., Rosen, Craig S., Foy, David, Reilly, Patrick, Shore, Jay, He, Qimei, Frueh, Christopher·2010·The Journal of Clinical Psychiatry

Abstract

Article AbstractObjective: To demonstrate the noninferiority of a telemedicine modality, videoteleconferencing, compared to traditional in-person service delivery of a group psychotherapy intervention for rural combat veterans with posttraumatic stress disorder (PTSD).Method: A randomized controlled noninferiority trial of 125 male veterans with PTSD (according to DSM criteria on the Clinician-Administered PTSD Scale) and anger difficulties was conducted at 3 Veterans Affairs outpatient clinics. Participants were randomly assigned to receive anger management therapy delivered in a group setting with the therapist either in-person (n†‰=†‰64) or via videoteleconferencing (n†‰=†‰61). Participants were assessed at baseline, midtreatment (3 weeks), posttreatment (6 weeks), and 3 and 6 months posttreatment. The primary clinical outcome was reduction of anger difficulties, as measured by the anger expression and trait anger subscales of the State-Trait Anger Expression Inventory-2 (STAXI-2) and by the Novaco Anger Scale total score (NAS-T). Data were collected from August 2005 to October 2008.Results: Participants in both groups showed significant and clinically meaningful reductions in anger symptoms, with posttreatment and 3 and 6 months posttreatment effect sizes ranging from .12 to .63. Using a noninferiority margin of 2 points for STAXI-2 subscales anger expression and trait anger and 4 points for NAS-T outcomes, participants in the videoteleconferencing condition demonstrated a reduction in anger symptoms similar ("non-inferior") to symptom reductions in the in-person groups. Additionally, no significant between-group differences were found on process variables, including attrition, adherence, satisfaction, and treatment expectancy. Participants in the in-person condition reported significantly higher group therapy alliance.Conclusions: Clinical and process outcomes indicate delivering cognitive-behavioral group treatment for PTSD-related anger problems via videoteleconferencing is an effective and feasible way to increase access to evidence-based care for veterans residing in rural or remote locations.Trial Registration: clinicaltrials.gov Identifier: NCT00122109J Clin Psychiatry 2010;71(7):855-863Submitted: August 11, 2009; accepted September 28, 2009.Online ahead of print: January 26, 2010 (doi:10.4088/JCP.09m05604blu).Corresponding author: Leslie A. Morland, PsyD, National Center for PTSD-Pacific Islands Division, Department of Veterans Affairs Pacific Islands Healthcare System, 3375 Koapaka St, Suite I-560, Honolulu, HI 96819 (Leslie.Morland@va.gov).

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Crossref · 10.4088/jcp.09m05604blu

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Authors
Morland, L. A., Greene, C. J., Rosen, C. S., Foy, D., Reilly, P., Shore, J., He, Q., & Frueh, C.
Affiliations
  • National Center for PTSD (US)
  • United States Department of Veterans Affairs (US)
  • Pepperdine University (US)
  • University of Colorado Denver (US)
  • Houston Methodist (US)
Corresponding author
Morland, Leslie A.
Venue
The Journal of Clinical Psychiatry
Published
2010-01-26
Volume
71
Issue
07
Pages
855-863
ISSN
0160-6689 (ISSN-L)
OpenAlex
W2056579935
Cited by
274
References
29
Citations by year
2026: 6 · 2025: 6 · 2024: 12 · 2023: 10 · 2022: 13 · 2021: 18 · 2020: 21 · 2019: 15 · 2018: 14 · 2017: 18 · 2016: 24 · 2015: 31 · 2014: 22 · 2013: 22 · 2012: 26
FWCI
20.28
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
telemedicine, post-traumatic stress disorder, combat veterans, rural veterans, group therapy, cognitive behavioral therapy, non-inferiority, access to mental health care, treatment alliance, anger expression, trait anger, Veterans Affairs clinics, treatment satisfaction, treatment expectancy
MeSH terms
Adult, Aged, Anger, Combat Disorders, Humans, Male, Middle Aged, Personality Assessment, Psychometrics, Rural Population, Stress Disorders, Post-Traumatic, Veterans, Cohort Studies, Cognitive Behavioral Therapy, Remote Consultation, Evidence-Based Medicine, Vietnam Conflict, Gulf War, Videoconferencing

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