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SMART: Self-Management Audio for Recovery from Trauma

15 Feb

Jennifer Strauss PhD and her team at Duke Medical Center & the Durham V.A.M.C. have conducted one survey and 3 studies assessing SMART (Self-Management Audio for Recovery from Trauma) on soldiers and veterans with posttraumatic stress.  The results have exceeded expectations, and compare with far more expensive, time-consuming, and hard-to-implement best practices currently in use for PTSD.

  1. The 1st study was a survey of VA clinic users, showing that over 70% of active miitary & vets prefer help via audio downloads. (Similar findings were just reported in a recent Phoenix V.A. survey.)

  2. The 2nd study was a small pilot (no controls) that looked at imagery’s impact on 15 women with PTSD from Military Sexual Trauma, mostly from the Vietnam era, to see if it worked, if the women liked it and would stay with it. They listened 5x/wk for 12 weeks.  There were large, significant effect sizes - steep drops in symptoms, as measured by 2 gold-standard measures: the CAPS (Clinician Administered PTSD Scale) and the PCL (PTSD Check List), as well as the Well-Being Scale – scores comparable to individual therapy and to CBT/prolonged exposure therapy.

  3. The 3rd study is an ongoing randomized controlled trial funded by the Dept. of Defense through the Samueli Institute, with 28 women enrolled to date, 14 in each group (the intervention group receives SMART; controls get music only).  The population is mostly older but 25% are OIF/OEF.  This study yields the same results: large, significant effect sizes, consistent with best outcomes from individual therapy with prolonged exposure. (Thanks to an NIH grant, this study will be over-enrolled to 50 subjects.)  From this study, we found that 80% of change occurs by week #6 and that by week #8, subjects drop out due to feeling better.  In addition to drops in PTSD, the Well- Being Scale data reveals improved social efficacy & relationships and better positive self-regard. This study will finish by June, then rolled out on a larger scale.

  4. The 4th study is an open trial with male vets - to date, 14 with combat-related PTSD (14% OIF/OEF) – aiming for 20 to complete the pilot.  The intervention is framed as “skills training”, not “therapy”; the program was shortened to 8 weeks; and changes were made to the audio content, based on previous feedback. There is unusually high retention (only one dropout so far), very positive feedback and the same outcomes: large effect sizes on all clusters, comparable to individual therapy.  The team is now proposing a randomized controlled trial with 162 (the minimal number needed for statistical purposes) soldiers, to begin next year.


Implications:  Although the numbers are small, they are compelling & consistent.  It is likely that SMART can reduce mild or moderate PTS symptoms on its own; or it may be a useful adjunct to prolonged exposure therapy, to add to the potency of that therapy and to help manage or reduce the distress it can generate; and it might even be helpful in pre-deployment training, to help inoculate against the later acquisition of PTS symptoms or reduce their severity. It is highly practical, because it is cost-effective, self-administered, user-friendly, non-threatening, framed as a training tool and entirely portable.
 

Belleruth Naparstek

Psychotherapist, author and guided imagery pioneer Belleruth Naparstek is the creator of the popular Health Journeys guided imagery audio series. Her latest book on imagery and posttraumatic stress, Invisible Heroes: Survivors of Trauma and How They Heal (Bantam Dell), won the Spirituality & Health Top 50 Books Award