Stepped Care for Posttraumatic Stress Disorder: An Open Trial Feasibility Study

Objective: There is a need to evaluate stepped care approaches for individuals with posttraumatic stress disorder (PTSD). This pilot study tested the efficacy of combining a low-intensity program (This Way Up [TWU]) with the option to step up to an established higher intensity therapy (Cognitive Processing Therapy [CPT]). Method: This study was an open trial with participants with predominantly interpersonal trauma (N = 38). PTSD diagnosis and self-reported PTSD, depression symptoms, and quality of life were assessed at pretreatment, posttreatment, and 3-month follow-up for all participants (with TWU-only participants also assessed at 6 months). Results: Among the intent-to-treat sample, 24 participants only required TWU (21 completers), with 14 participants stepped up to CPT (TWU + CPT; nine completers). Significant improvements in PTSD, depression, and quality of life were observed for TWU and TWU + CPT participants, with gains maintained at follow-up. Effect sizes for PTSD outcomes (clinician- and participant-rated) ranged from medium to large, with larger reductions generally in the TWU group (e.g., PTSD gs: 1.96-3.54, vs. gs: 0.48-1.14 for TWU + CPT). Of the participants available at 3-month follow-up, 73% (n = 19/26) met good-end-state functioning for PTSD (TWU: 70.6%; TWU + CPT: 77.8%). Those who stepped up reported significantly greater symptoms at pretreatment than TWU-only participants. Conclusions: This stepped care approach appeared credible and feasible and demonstrated meaningful impact on mental health for participants who had predominately experienced interpersonal trauma.