February 16, 2010 / 7:23 PM / 8 years ago

Videoconferencing could help vets manage anger

NEW YORK (Reuters Health) - Anger management group therapy can be just as effective over video hookup as in person, according to a new Veterans Administration (VA) study.

If the study’s conclusions hold up in further research, the findings may go a long way toward answering a growing concern at the VA: how to get effective mental health care to the large number of troops who leave active duty to come home to rural or remote areas in the U.S.

“This concern has become a priority for the VA,” study lead author Leslie Morland, of the VA’s National Center for PTSD - Pacific Islands Division, told Reuters Health in a telephone interview.

An estimated 40 percent of today’s combat veterans come from remote or rural areas of the US. Many of them - up to one in six -- return home with combat-related posttraumatic stress disorder (PTSD).

Morland and her group wanted to know if a treatment that had already been shown to be effective for PTSD-related issues when administered in-person could be as effectively managed and as beneficial for participants if delivered via videoconferencing.

Over a four-year period, the team enrolled 125 male combat veterans diagnosed with PTSD-related anger difficulties in the trial. Participants took a 12-session program, which included homework assignments, developed by the National Institute on Drug Abuse Behavioral Therapies Development Program. They were randomly selected to receive group therapy either in person or through a video hookup.

Therapy sessions were conducted in groups of 6 to 8 participants. Every effort was made to make the conduct of the in-person and video-conference sessions the same, , Morland said. In both instances, the group was arranged in a circle with the therapist - whether the therapist was there in person or being transmitted closed-circuit to a video monitor -- in the same location.

The researchers found that after six months, the video group demonstrated a reduction in anger symptoms similar to the in-person group. That led the authors to conclude that “group psychotherapy video teleconferencing not only is feasible but also produces outcomes that are as good as in-person treatment.”

The study also showed that anger management problems could be safely managed remotely.

“We were able to address the question, ‘can you provide services to a rather complex population with anger problems?’ -- we had no difficulties,” Morland said.

Other studies are underway, she added, to look at the feasibility of using videoconferencing to treat PTSD itself, which is a more complex and potentially more volatile process.

Morland believes these findings could be important for the new crop of combat veterans coming home from the wars in Iraq and Afghanistan. While three-quarters of the participants in her study were Vietnam vets, younger vets are more tech savvy.

“I would think it would be even more appropriate for the new generation, who would be even more comfortable getting care through a technological mechanism.” she said

But, she cautions, great care must be taken to protect patient confidentiality before the internet, iPhones, and newer technologies are employed. They must be safe, confidential and unhackable.

Some consider the way the study was designed -- to demonstrate whether one way of delivering therapy delivery was as effective as the other, rather than whether it was better - a weakness.

“We were very aware of how many studies have not used the design appropriately in mental health,” Morland said. However, based on the size and design, she said her team can say, “with confidence, that our findings are accurate.”

SOURCE: Journal of Clinical Psychiatry, online January 26, 2010.

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