Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12623000482662p
Ethics application status
Submitted, not yet approved
Date submitted
2/04/2023
Date registered
12/05/2023
Date last updated
12/05/2023
Date data sharing statement initially provided
12/05/2023
Type of registration
Prospectively registered

Titles & IDs
Public title
Effect of an Augmented Psychological Treatment on Posttraumatic Stress Disorder (PTSD) in Emergency Service Personnel
Scientific title
Randomised Controlled Trial of a Standard Cognitive Behavioural Treatment versus Augmented Cognitive Behavioural Treatment on PTSD in Emergency Service Personnel
Secondary ID [1] 309369 0
Nil
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Posttraumatic stress disorder 329587 0
Condition category
Condition code
Mental Health 326511 326511 0 0
Anxiety
Mental Health 326512 326512 0 0
Depression
Mental Health 326513 326513 0 0
Other mental health disorders

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
There are two arms to this trial that were designed specifically for this trial. Arm 1 (intervention): Augmented Cognitive Behaviour Therapy. Arm 2 (comparator): Cognitive Behaviour Therapy. Augmented Cognitive Behaviour Therapy is administered on an individual basis on a once-weekly basis by a clinical psychologist either face-to-face or remotely via Zoom. Therapy comprises individual 60-minute sessions administered over 12 weeks. The intervention instructs participants on the following stress coping strategies: psychoeducation, anxiety reduction, exposure to trauma memories, and discussion of trauma memories, and relapse prevention. In the first 4 sessions of treatment, participants will also complete a 10-minute computer task in which they use their mouse to indicate the position of threat or neutral stimuli on the computer screen. Treatment adherence will be assessed by checklist completed by therapists. The duration of the study for any participant will conclude after a 2-year follow-up assessment, resulting in participation duration of 125 weeks.
Intervention code [1] 325802 0
Behaviour
Intervention code [2] 325803 0
Treatment: Other
Comparator / control treatment
Cognitive Behaviour Therapy is administered on an individual basis on a once-weekly basis by a clinical psychologist either face-to-face or remotely via Zoom. Therapy comprises individual 60-minute sessions administered over 12 weeks. The intervention instructs participants on the following stress coping strategies: psychoeducation, anxiety reduction, exposure to trauma memories, and discussion of trauma memories, and relapse prevention. In the first 4 sessions of treatment, participants will also complete a 10-minute computer task in which they use their mouse to indicate the position of neutral or neutral stimuli on the computer screen. This arm differs from the Augmented Cognitive Behaviour Therapy treatment by having participants complete a computer task in which they locate neutral or neutral stimuli rather than threat or neutral stimuli. This task is done to serve as a control task to match the computer task in the Augmented Cognitive Behaviour Therapy condition. Treatment adherence will be assessed by checklist completed by therapists. The duration of the study for any participant will conclude after a 2-year follow-up assessment, resulting in participation duration of 125 weeks.
Control group
Active

Outcomes
Primary outcome [1] 334354 0
Posttraumatic stress disorder as measured by the Clinician Administered PTSD Scale.
Timepoint [1] 334354 0
Pretreatment (week 0), posttreatment (week 13 post-baseline), primary follow-up (week 39 post-baseline, primary endpoint), additional follow-up (week 121, post-baseline).
Secondary outcome [1] 420370 0
Depression as measured by the Beck Depression Inventory.
Timepoint [1] 420370 0
Pretreatment (week 0), posttreatment (week 13 post-baseline), primary follow-up (week 39 post-baseline), additional follow-up (week 121, post-baseline).
Secondary outcome [2] 420371 0
Maladaptive appraisals as measured by the Posttraumatic Cognitive Inventory.
Timepoint [2] 420371 0
Pretreatment (week 0), posttreatment (week 13 post-baseline), primary follow-up (week 39 post-baseline), additional follow-up (week 121, post-baseline).
Secondary outcome [3] 420372 0
Quality of life as measured by the Australian Quality of Life scale.
Timepoint [3] 420372 0
Pretreatment (week 0), posttreatment (week 13 post-baseline), primary follow-up (week 39 post-baseline), additional follow-up (week 121, post-baseline).

Eligibility
Key inclusion criteria
Meet criteria for PTSD as defined by DSM-5
Aged at least 18 years
Current or former member of Emergency Service Personnel
Sufficient English proficiency
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
Current psychosis
Imminent suicidal risk
Current substance dependence

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Participants will be adults meeting criteria for PTSD. Participants wishing to participate will be randomly allocated according to a random numbers system administered by an individual who independent of the trial and who works at a site that is independent from the trial centre.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software (i.e. computerised sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?


The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
NA
Phase
Not Applicable
Type of endpoint/s
Efficacy
Statistical methods / analysis
Analyses will focus primarily on intent-to-treat analysis. Using SPSS version 24, hierarchical linear mixed models (HLM) will be used to study differential effects of each treatment condition because this method effectively handles missing data by calculating estimates of trajectories. For the follow-up analyses between the two conditions, analyses will focus on linear time effects, treatment conditions, and interactions. Fixed effects parameters were tested with the Wald test (t-test, p <.05, two-sided) and 95% confidence intervals. Cohen’s (d) effect size was calculated for all analyses. The primary outcome measure will be the Clinician Administered PTSD Scale (CAPS). The primary outcome timepoint will be the 6 months assessment.

Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
22/05/2023
Actual
Date of last participant enrolment
Anticipated
22/04/2026
Actual
Date of last data collection
Anticipated
26/07/2028
Actual
Sample size
Target
100
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC

Funding & Sponsors
Funding source category [1] 313566 0
Government body
Name [1] 313566 0
National Health and Medical Research Council (NHMRC)
Country [1] 313566 0
Australia
Primary sponsor type
University
Name
UNSW Sydney
Address
Anzac Pde, Kensington, NSW, 2052
Country
Australia
Secondary sponsor category [1] 315348 0
None
Name [1] 315348 0
Address [1] 315348 0
Country [1] 315348 0

Ethics approval
Ethics application status
Submitted, not yet approved
Ethics committee name [1] 312745 0
UNSW Human Research Ethics Committee
Ethics committee address [1] 312745 0
UNSW Sydney, Anzac Pde, Kensington, NSW, 2052
Ethics committee country [1] 312745 0
Australia
Date submitted for ethics approval [1] 312745 0
17/04/2023
Approval date [1] 312745 0
Ethics approval number [1] 312745 0

Summary
Brief summary
People in high-risk occupations, such as those in emergency service organizations, are at high risk of psychological disorders. Posttraumatic stress disorder (PTSD) is the most common psychiatric disorder that develops following exposure to a traumatic event, and emergency service personnel have markedly higher rates of PTSD. PTSD is characterised by severe and persistent stress reactions including: intrusive memories and nightmares of the trauma, hypervigilance, difficulty sleeping, emotional withdrawal, pervasive negative emotions, and avoidance of places, activities, and situations that are reminiscent of their trauma. The treatment of choice for posttraumatic stress disorder (PTSD) is trauma-focused psychotherapy. Trauma-focused psychotherapy typically commences with psychoeducation about the trauma responses, and then focuses on three major strategies: anxiety management, exposure, and cognitive restructuring. Despite support for this therapeutic approach, meta-analyses indicate that at least one-third of patients do not respond to this treatment. This situation is also evidence in treatment of PTSD in emergency service personnel. One recent advance has shown that training people to focus attention in a more controlled way can promote reduction of PTSD symptoms. Accordingly, this trial aims to augment TF-CBT for PTSD by comparing standard TF-CBT with TF-CBT combined with attention training. It is hypothesized that the augmented TF-CBT that includes attention training will result in greater reduction of PTSD than standard TF-CBT.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 125758 0
Prof Richard Bryant
Address 125758 0
School of Psychology
Matthews Building
Anzac Pde, Kensington
University of New South Wales
NSW 2052
Country 125758 0
Australia
Phone 125758 0
+61405375874
Fax 125758 0
Email 125758 0
r.bryant@unsw.edu.au
Contact person for public queries
Name 125759 0
Prof Richard Bryant
Address 125759 0
School of Psychology
Matthews Building
Anzac Pde, Kensington
University of New South Wales
NSW 2052
Country 125759 0
Australia
Phone 125759 0
+61405375874
Fax 125759 0
Email 125759 0
r.bryant@unsw.edu.au
Contact person for scientific queries
Name 125760 0
Prof Richard Bryant
Address 125760 0
School of Psychology
Matthews Building
Anzac Pde, Kensington
University of New South Wales
NSW 2052
Country 125760 0
Australia
Phone 125760 0
+61405375874
Fax 125760 0
Email 125760 0
r.bryant@unsw.edu.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
What data in particular will be shared?
All of the de-identified individual participant data and related data dictionaries are available
When will data be available (start and end dates)?
Data will be available following publication of the study outcomes. There is no end date for when this data will be available.
Available to whom?
Researchers wishing to conduct re-analyses of the data after approval from the Chief Investigator
Available for what types of analyses?
Meta-analyses or re-analyses of subgroups
How or where can data be obtained?
By emailing the Principal Investigator (email: r.bryant@unsw.edu.au).


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
No additional documents have been identified.