Financial Incentives for PTSD

Recruiting at 2 trial locations

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Christopher Cronin

Disqualifiers: Not interested, No consent, Suicide risk

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 20

Duration: 18 sessions (approximately 18 weeks)

600 Participants Needed

Trial Summary

What is the purpose of this trial?

Recovery Resource Council (RRC) is one of the largest and most comprehensive non-profit mental and behavioral healthcare providers in North Texas. Accredited by the Joint Commission in Behavioral Health and licensed by the State of Texas as an Outpatient Treatment Center, RRC strives to promote wellness and recovery through a variety of services and programming. An important component of RRC programming is providing free counseling services to hundreds of U.S. veterans annually. While RRC observes great success for veterans who complete counseling, attendance can be a major obstacle. Veterans who approach RRC for individual counseling services and consent to participate will be randomly assigned to the treatment or control group. The control group will receive counseling as usual. The treatment group will receive $500 gift card payments upon completing their 6th, 12th, and 18th counseling sessions, i.e., $1,500 in gift cards for completing all 18 sessions, the usual prescribed length of therapy. Our primary focus is to examine the impact of the financial incentives on therapy attendance and attrition. In addition, the investigators will estimate the impact on mental health using mental health inventories collected over the course of therapy sessions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Financial Incentive, Monetary Incentive, Financial Reward, Economic Motivation for PTSD?

Research shows that financial incentives can improve treatment engagement, such as therapy attendance and medication adherence, which can lead to better clinical outcomes. This approach has been successfully used in other psychiatric treatments, suggesting it could be effective for PTSD as well. ^{1 2 3 4 5}

Is the use of financial incentives for PTSD treatment generally safe for humans?

There is no specific safety data available for financial incentives as a treatment for PTSD or other conditions, but general safety concerns about psychological interventions suggest the need for careful monitoring of any adverse events (unintended negative effects) that may occur. ^{6 7 8 9 10}

How does the Financial Incentives treatment for PTSD differ from other treatments?

The Financial Incentives treatment for PTSD is unique because it uses financial rewards to encourage therapy attendance and adherence, which can lead to improved clinical outcomes. This approach is different from traditional PTSD treatments that do not typically involve financial motivation as a component of the therapy process. ^{1 2 11 12 13}

Research Team

Meghan Skira, PhD

Principal Investigator

University of Georgia

Christopher Cronin, PhD

Principal Investigator

University of Notre Dame

Ethan Lieber, PhD

Principal Investigator

University of Notre Dame

Eligibility Criteria

This trial is for U.S. veterans dealing with mental health issues like depression or PTSD, who are seeking counseling at the Recovery Resource Council. Participants must be willing to potentially receive financial incentives and complete various therapy sessions.

Inclusion Criteria

Holds veteran status

Possesses and is willing to share SSN

Voluntarily agree to participation requirements outlined in the informed consent form

Exclusion Criteria

Individuals who do not consent

I am interested in participating in the trial.

Individuals posing a significant suicide risk

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (phone)

Intake and Randomization

Participants complete intake forms, initial mental health assessment, and are randomized into treatment or control groups

1 week

1 visit (in-person)

Treatment

Participants receive counseling sessions in 6-session blocks, with financial incentives for the treatment group

18 sessions (approximately 18 weeks)

18 visits (in-person)

Follow-up

Participants are monitored for therapy completion and mental health outcomes

1 year following randomization

Treatment Details

Interventions

• Financial Incentive

Trial Overview The study tests if giving $500 gift cards after certain numbers of counseling sessions can help veterans attend and complete their therapy. Veterans will either get usual counseling (control group) or counseling plus financial rewards (treatment group).

Participant Groups

Group I: Treatment Experimental Treatment 1 Intervention

The treatment group will be offered a $500 gift card for completing 6, 12, and 18 counseling sessions; up to $1,500 in total. Because RRC's typical practice involves prescribing and scheduling counseling in 6-session blocks, the financial awards are revealed to veterans in the treatment group in stages. After intake, treatment group individuals are told that they will receive a $500 gift card for completing the first 6 sessions; later sessions and awards are not mentioned. If the counselor decides that another 6-session block should be prescribed, then at the completion of the 5th session (i) the next 6 sessions are scheduled (i.e., sessions 7 through 12) and (ii) the counselor reveals that the participant can earn another $500 for completing the 12th session. The same process takes place during session 11. As part of RRC's typical practice, no veterans are offered more than 18 sessions.

Group II: Control Active Control 1 Intervention

The control group will have access to the normal counseling services provided by RRC staff. Those in the control group will receive "business as usual" services offered by the RRC, which includes the same counseling services and evaluation of how many sessions an individual is recommended to receive.

Who Is Running the Clinical Trial?

Christopher Cronin

Lead Sponsor

Trials

1

Recruited

600+

University of Georgia

Collaborator

Trials

109

Recruited

43,500+

Findings from Research

A study involving stakeholder input identified increasing combination treatment rates (antidepressants plus psychotherapy) as a key goal for improving depression care in a managed behavioral healthcare organization.

The feasibility test of an incentive-based program showed that while it raised awareness among clinicians, challenges such as administrative barriers and limited clinical data may hinder widespread adoption of these strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A collaborative approach to identifying effective incentives for mental health clinicians to improve depression care in a large managed behavioral healthcare organization. Meredith, LS., Branstrom, RB., Azocar, F., et al.[2021]

The safety of psychological interventions is critical, as adverse events (AEs) can occur and must be carefully evaluated to ensure that these interventions do not cause harm before being deemed beneficial.

There is a pressing need for standardized protocols for assessing and reporting AEs in psychological interventions to improve transparency, consistency, and ultimately enhance clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial: Primum non nocere - are adverse events accurately reported in studies on psychological interventions for children? Purgato, M., Cortese, S.[2023]

The implementation of the Psychiatry Morbidity and Mortality Incident Reporting Tool (PMIRT) led to psychiatrists filing 65 reports over one year, indicating increased engagement in reporting adverse events (AEs).

Following the introduction of PMIRT, the average number of AEs reported in the hospital's formal event reporting system significantly increased, demonstrating that targeted tools can enhance safety reporting practices among psychiatrists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Psychiatry Morbidity and Mortality Incident Reporting Tool Increases Psychiatrist Participation in Reporting Adverse Events. Kroll, DS., Shellman, AD., Gitlin, DF.[2019]

A systematic review of 85 randomized controlled trials involving 14,420 participants found that adverse events (AEs) from psychotherapy can affect more than 10% of participants, with serious AEs occurring in more than 1 in 21 participants.

The study highlighted that the reporting and recording of AEs were inconsistent across trials, suggesting a need for standardized harm monitoring to better evaluate the risks and benefits of psychotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events in psychotherapy randomized controlled trials: A systematic review. Klatte, R., Strauss, B., Flückiger, C., et al.[2023]

In a study of 1324 discharged patients, 10.88% experienced adverse events (AEs), with medication-related AEs occurring in 90% of those affected, highlighting the significant risk of harm from neuropsychiatric treatments.

The neuropsychiatry trigger tool (NPTT) was highly effective, identifying 30 times more AEs than traditional reporting methods, suggesting it could be a valuable tool for improving patient safety and reducing harm in hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of a Trigger Tool to Identify Adverse Events and Harm in a Neuropsychiatry Setting. Sharma, S., Kapoor, K., Nasare, N., et al.[2023]

In a study of 110 military personnel and veterans, higher PTSD severity was linked to lower availability of environmental and hedonic rewards, suggesting that individuals with PTSD may struggle to find positive reinforcement in their lives.

The research supports a behavioral economic model of PTSD, indicating that those with the disorder may have a short-sighted focus on immediate rewards rather than future benefits, which could contribute to their symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model. Olin, CC., McDevitt-Murphy, ME., Murphy, JG., et al.[2022]

In a study of 105 veterans undergoing Cognitive Processing Therapy (CPT) for PTSD, those seeking compensation showed significantly less improvement in symptoms compared to non-compensation seekers, even after adjusting for initial PTSD severity.

66.7% of non-compensation seeking veterans experienced clinically significant symptom improvement, while only 40.1% of those seeking compensation did, suggesting that the compensation-seeking process may negatively impact treatment outcomes in residential settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment. Rodriguez, JL., Hale, AC., Marston, HN., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effects of compensation-seeking on treatment outcomes among veterans with posttraumatic stress disorder. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Improved Clinical Functioning for Patients Receiving Fee Discounts That Reward Treatment Engagement. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

A collaborative approach to identifying effective incentives for mental health clinicians to improve depression care in a large managed behavioral healthcare organization. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Incentivizing attendance to prolonged exposure for PTSD with opioid use disorder patients: A randomized controlled trial. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Increasing the Impact of Interventions Incentivizing Psychiatric Treatment Engagement: Challenges and Opportunities. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Editorial: Primum non nocere - are adverse events accurately reported in studies on psychological interventions for children? [2023]

7. United States pubmed.ncbi.nlm.nih.gov

The Psychiatry Morbidity and Mortality Incident Reporting Tool Increases Psychiatrist Participation in Reporting Adverse Events. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Pharmaceuticals as a market for "lemons": Theory and practice. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Adverse events in psychotherapy randomized controlled trials: A systematic review. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Development of a Trigger Tool to Identify Adverse Events and Harm in a Neuropsychiatry Setting. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

The associations between posttraumatic stress disorder and delay discounting, future orientation, and reward availability: A behavioral economic model. [2022]

12. Netherlands pubmed.ncbi.nlm.nih.gov

Delayed reward discounting and increased risk for suicide attempts among U.S. adults with probable PTSD. [2021]

13. United States pubmed.ncbi.nlm.nih.gov

The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment. [2022]