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Symposium

Interventions and Care Delivery Models in the Context of Resource Limitations

Comparing Effectiveness Engagement Strategies, and Treatment Fidelity for Two Culturally Informed, Asynchronous Messaging- based Therapies for Posttraumatic Stress Disorder

1 - (SYM 3) A Hybrid Randomized Comparison of Asynchronous Messaging-based , Culturally Informed Cognitive Processing Therapy and Treatment as Usual for PTSD

Thursday, June 25, 2026
9:35 AM - 9:56 AM PDT
Location: Yerba Buena Salon 1, B3 Level
Keywords: PTSD Posttraumatic Stress Disorder, Psychotherapy Outcome, Telehealth/m-Health
Abstract Body

Posttraumatic stress disorder (PTSD) affects an estimated 6.8% of the U.S. population and is associated with substantial distress, impairment, and societal costs. Trauma‑focused cognitive behavioral therapies, including Cognitive Processing Therapy (CPT), are highly effective across diverse populations. However, access to these interventions remains limited due to shortages of trained providers and persistent barriers to traditional and telehealth‑based psychotherapy, such as time, cost, stigma, and competing responsibilities. Scalable, acceptable, and effective alternatives are urgently needed, particularly for individuals less likely to engage in conventional care. Therapist‑delivered messaging offers a promising approach that may enhance accessibility and engagement relative to unsupported digital tools.


This Hybrid Type 1 effectiveness‑implementation trial (n=378) evaluated messaging‑based CPT (CPT‑Text) compared with culturally informed text‑based treatment as usual (CI‑TAU) delivered via a HIPAA‑compliant secure platform. Using a 2×2 factorial design, participants were randomized to treatment condition (CPT‑Text vs. CI‑TAU) and to an engagement strategy: standard reminders (RAU) or reminders plus retention incentives (RAU+I).


Both CPT‑Text and CI‑TAU produced large reductions in PTSD and depression symptoms. Moderation analyses indicated that CPT‑Text may be particularly beneficial for individuals with lower baseline PTSD severity, those who did not identify as heterosexual, and those without prior therapy experience, whereas individuals with lower educational attainment appeared to benefit more from CI‑TAU. The incentive condition yielded a small but significant improvement in depression outcomes and was most advantageous for participants with annual incomes above $50,000.


These findings suggest that culturally responsive, therapist‑delivered messaging‑based therapy can meaningfully reduce PTSD and depression symptoms. Pairing such interventions with altruistic engagement incentives may further enhance outcomes. This work highlights the potential of messaging‑based delivery to expand access to trauma‑focused care and underscores the importance of tailoring approaches to individual characteristics and contextual needs.