TY  - JOUR
AU  - Jones, Chelsea
AU  - Miguel-Cruz, Antonio
AU  - Smith-MacDonald, Lorraine
AU  - Cruikshank, Emily
AU  - Baghoori, Delaram
AU  - Kaur Chohan, Avneet
AU  - Laidlaw, Alexa
AU  - White, Allison
AU  - Cao, Bo
AU  - Agyapong, Vincent
AU  - Burback, Lisa
AU  - Winkler, Olga
AU  - Sevigny, Phillip R
AU  - Dennett, Liz
AU  - Ferguson-Pell, Martin
AU  - Greenshaw, Andrew
AU  - Brémault-Phillips, Suzette
PY  - 2020
DA  - 2020/9/21
TI  - Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review
JO  - JMIR Mhealth Uhealth
SP  - e22079
VL  - 8
IS  - 9
KW  - trauma
KW  - mental health
KW  - telemedicine
KW  - therapy
KW  - rehabilitation
KW  - digital health
KW  - psychotherapy
KW  - military
KW  - veteran
KW  - first responder
KW  - public safety personnel
KW  - teletherapy
KW  - telepsychiatry
KW  - mobile phone
AB  - Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted. 
SN  - 2291-5222
UR  - http://mhealth.jmir.org/2020/9/e22079/
UR  - https://doi.org/10.2196/22079
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32955456
DO  - 10.2196/22079
ID  - info:doi/10.2196/22079
ER  -