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Telemedicine for Anger Management Therapy in a Rural Population of Combat Veterans With Posttraumatic Stress Disorder: A Randomized Noninferiority Trial
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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“Moreover, a handful of studies have documented the non-inferiority of VCP when compared to gold-standard treatments [34,35,36,37,38].”
In the citing paper
“Videoconferencing is an efficacious mode of delivering treatment for a wide range of mental and physical conditions, and a variety of different interventions have been delivered including cognitive behavioral, supportive, and educational [41–45].”
In the citing paper
“One-on-one videoconferencing (a single client and clinician) is comparable with face-to-face interventions in terms of effectiveness, client ratings of the therapeutic relationship, client satisfaction [25, 29] and treatment retention [30] for a variety of psychological conditions [29].”
In the citing paper
“Studies have reported equivalent outcomes to those found in face-to-face groups for 125 clients with posttraumatic stress disorder [25, 29, 30] and seven clients with traumatic brain injury [28].”
In the citing paper
“However, similar to studies with videoconferencing group participants located in health care centers [17,77], there is a clear trend for improving mental health outcomes such as depression, self-efficacy, stress and anxiety, and overcoming a fear of meeting new people.”
From Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review (2018) · cites this paper as [17]
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Self-citation
Metadata
- 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
- Publisher
- Physicians Postgraduate Press, Inc
- 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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