A pragmatic randomized trial of brief clinician- and web-administered skills training in affective and interpersonal regulation (STAIR) for posttraumatic stress disorder in safety net primary care.

Brief, effective treatments for posttraumatic stress disorder (PTSD) may broaden access to treatment. Brief treatments may fit well within stepped care approaches to treatment, reserving more intensive therapies for those who need them. To assess a first step option for PTSD treatment, we randomized primary care patients to one of two brief formats of Skills Training in Affective and Interpersonal Regulation (STAIR), a psychoeducation and coping skills treatment. Participants were randomized to a clinician (Brief STAIR) or web (webSTAIR) administered version of the treatment. Patients were recruited from primary care clinics that primarily serve low income, publicly insured, and racial and ethnic-minoritized patients. The primary clinical outcome, change in PTSD symptom severity, was assessed using the PTSD Checklist for the DSM-5 (PCL-5) administered at 0, 3, and 9 months. We used linear mixed models for intent to treat analysis (N = 60), imputing missing data with most recent available values. ANCOVA was used to analyze the main effects of treatment. Participants reported significant improvements in PTSD symptoms with large effect sizes (partial η2) at 3 (0.57) and 9 months (0.56), as well as large effect sizes for improvements in overall mental functioning (0.19) and depression (0.18) at 9 months, measured by the Brief Symptom Inventory (BSI-18). There was a large effect for group differences in retention (Brief STAIR [73%] > webSTAIR [30%]; η2 = 0.28). Though inferior to Brief STAIR retention, webSTAIR retention was higher than most digital mental health interventions. Treatments may be suitable early step treatments.