Financial Incentives for PTSD

Enrolling by invitation 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)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if gift cards encourage veterans to attend more counseling sessions for PTSD. Researchers divide veterans into two groups: one receives regular counseling, while the other receives up to $1,500 in gift cards as financial incentives for attending specific sessions. The main goal is to discover if financial incentives help veterans maintain their therapy and improve mental health. Veterans seeking counseling and willing to share their email and Social Security number might be suitable candidates for this study. As an unphased trial, this study offers veterans a unique opportunity to contribute to research that could enhance counseling attendance and mental health outcomes.

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 prior data suggests that financial incentives are safe for improving therapy attendance?

Research has shown no specific safety data for using financial incentives as a treatment for PTSD or other conditions. However, this method is generally considered safe, as it involves giving participants gift cards rather than new drugs or medical procedures.

The trial aims to encourage veterans to attend therapy sessions by offering financial rewards. Thus, typical safety concerns like side effects or adverse reactions are not present. The main goal is to determine if these incentives improve attendance and mental health outcomes.

Overall, financial incentives are viewed as a safe way to increase participation in therapy, with no known direct safety risks. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using financial incentives for PTSD treatment because this approach tackles the challenge of therapy adherence in a novel way. Unlike traditional PTSD treatments, such as cognitive behavioral therapy or medications like SSRIs, this method incentivizes patients with gift cards for completing counseling sessions, potentially increasing their motivation to stick with the therapy. By offering tangible rewards, this strategy aims to improve completion rates of counseling sessions, which is critical for achieving better mental health outcomes. This approach could pave the way for a new dimension of behavioral health interventions that prioritize patient engagement and consistent treatment adherence.

What evidence suggests that financial incentives could be effective for improving therapy attendance in PTSD treatment?

This trial will compare the effects of financial incentives with standard counseling services for individuals with PTSD. Research has shown that offering money can help people attend therapy and take their medication regularly. Studies have found that people with PTSD may react differently to rewards like money. Thus, financial incentives, as offered in the treatment arm of this trial, might encourage more frequent therapy attendance. Attending more sessions can lead to better mental health. Early findings suggest that these incentives are practical and welcomed by participants. This approach could help people with PTSD stay engaged and succeed in their treatment. ^{3 4 6 7 8}

Who Is on the Research Team?

Christopher Cronin, PhD

Principal Investigator

University of Notre Dame

Ethan Lieber, PhD

Principal Investigator

University of Notre Dame

Meghan Skira, PhD

Principal Investigator

University of Georgia

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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).

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

Citations

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The Reward System and Post-Traumatic Stress Disorder Posttraumatic stress disorder is associated with altered reward mechanisms during the anticipation and the outcome of monetary incentive cues.

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Financial Incentives for PTSD · Info for Participants Research shows that financial incentives can improve treatment engagement, such as therapy attendance and medication adherence, which can lead to better ...

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Posttraumatic Stress Disorder is associated with altered ... For the first time, functional brain activation during both the anticipation and the outcome of monetary rewards is reported altered in PTSD patients.

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Feasibility and acceptability of two incentive-based ... Financial incentives assume that variation in clinician performance is caused by variability in motivation and that financial incentives will ...

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Posttraumatic Stress Disorder is associated with altered ... Posttraumatic Stress Disorder is associated with altered reward mechanisms during the anticipation and the outcome of monetary incentive cues.

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Posttraumatic Stress Disorder is associated with altered ... Posttraumatic Stress Disorder is associated with altered reward mechanisms during the anticipation and the outcome of monetary incentive cues - ScienceDirect.

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Reward Ameliorates Posttraumatic Stress Disorder- ... A recent meta-analysis found that PTSD is characterized by deficits in multiple aspects of reward sensitivity, including “wanting” or incentive motivation, and ...

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0022395607001811

Probing reward function in posttraumatic stress disorder PTSD participants reported both lower expectancy of reward and lower satisfaction with reward when it was received. The latter result was manifest in a failure ...