# Randomized Trial of Prolonged Exposure (PE) vs. PE with PE Coach Among Veterans with PTSD

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2022 · —

## Abstract

Veterans are at increased risk of posttraumatic stress disorder (PTSD), which negatively impacts social and
occupational functioning and quality of life. Prolonged exposure (PE) is an evidence-based psychotherapy for
PTSD that is effective in the treatment of Veterans. However, many Veterans drop out of psychotherapy for
PTSD and many of those who complete PE still meet criteria for PTSD or do not achieve clinically meaningful
change. The vast majority of Veterans with PTSD report neurobehavioral cognitive symptoms and may be at
particular risk given that problems with executive functioning and prospective memory are related to PTSD
treatment drop out and poorer treatment outcomes. [The mechanisms of functioning and symptom change in
PE include emotional activation during exposure, between-session habituation, and changes in PTSD-related
negative cognitions. These mechanisms occur via verbally recounting and processing trauma memories
(imaginal exposure) and approaching anxiety provoking situations in day-to-day life (in vivo exposure) and are
achieved by daily homework exercises.] Increased homework adherence predicts improved PTSD symptoms
and functioning. To support patients participating in PE, the DoD/VA developed the mobile application (app)
‘PE Coach’. The features of PE Coach were designed to enhance patients’ ability to adhere with the homework
critical to recovery. PE Coach may provide the cognitive and organizational support that Veterans with PTSD
need to successfully complete treatment and maximize outcomes. However, little is known about the
effectiveness of most mental health technology augmentations and this is true of PE Coach as well. Although
the app is used in routine VA care and the VA recently invested in the software development required for an
updated version of the app, no study has evaluated the impact of PE Coach on clinically relevant treatment
outcomes. This study will conduct a randomized, controlled clinical trial to determine the efficacy of PE Coach
and its impact on PTSD-related social and occupational functioning, PTSD symptoms, and homework
adherence and dropout. The project will randomize [124] Veterans with PTSD to either PE +PE Coach or
Usual PE (without PE Coach). [Participants in both conditions will have identical homework activities assigned,
but those with PE + PE Coach will receive all of their homework activities through the PE Coach app, while
those in Usual PE will receive their homework through separate, standard workbook handouts and digital audio
recording device.] Veterans will participate in 8-15 weekly individual PE psychotherapy sessions, based on
defined termination criteria and delivered consistent with the published treatment manual. Outcome
assessments will be conducted at baseline, half-way through treatment, post-treatment, and at 1- and 4- month
follow-ups. The primary outcome measure will be the Posttraumatic Stress Related Functioning Inventory
(PRFI). PTSD symptoms will be assessed ...

## Key facts

- **NIH application ID:** 10507779
- **Project number:** 5I01RX003503-02
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Greg Reger
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2021-10-01 → 2026-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10507779

## Citation

> US National Institutes of Health, RePORTER application 10507779, Randomized Trial of Prolonged Exposure (PE) vs. PE with PE Coach Among Veterans with PTSD (5I01RX003503-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10507779. Licensed CC0.

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