Symposium 3 - Comparing Effectiveness Engagement Strategies, and Treatment Fidelity for Two Culturally Informed, Asynchronous Messaging- based Therapies for Posttraumatic Stress Disorder

Chair(s)

• 

  Shannon Wiltsey Stirman, Ph.D. (she/her/hers)

  Associate Professor/Acting Deputy Director
  National Center for PTSD and Stanford University
  Menlo Park, California, United States

Discussant(s)

• 

  Debra Kaysen, ABPP, Ph.D.

  Professor
  Stanford University
  Palo Alto, California, United States

Presenter(s)

• 

  Shannon Wiltsey Stirman, Ph.D. (she/her/hers)

  Associate Professor/Acting Deputy Director
  National Center for PTSD and Stanford University
  Menlo Park, California, United States
• AP

  Aarthi Padmanabhan, Ph.D. (she/her/hers)

  Head of Research
  Talkspace
  Los Angeles, California, United States
• KD

  Katy Dondanville, PsyD, ABPP

  Associate Professor
  The University of Texas Health Science Center at San Antonio
  San Antonio, TX, United States
• 

  Elizabeth Stade, PhD (she/her/hers)

  Postdoctoral fellow
  Stanford University
  PALO ALTO, California, United States

Many individuals with PTSD lack access to, or do not wish to pursue traditional forms of psychotherapy. Additionally, engagement in treatment, including digital mental health strategies, is often low, and engagement typically drops off before symptom improvement can occur. Asynchronous texting‑based therapy may offer a more acceptable, flexible, and accessible format for individuals who are less likely to engage in in‑person or web‑based programs. Recent research has found that asynchronous messaging therapy can be effective for depressed individuals and suggest promising results for PTSD, but prior to this study, there have been no adequately powered studies for PTSD.

This symposium presents a Hybrid Type 1 effectiveness‑implementation trial (n=378) designed to compare CPT‑Text with text‑based TAU using a HIPAA‑compliant secure messaging platform. This pragmatic, hybrid type 1 implementation-effectiveness randomized controlled trial used a 2×2 factorial design to evaluate (1) messaging-based cognitive processing therapy (CPT-Text) versus culturally informed treatment as usual (CI-TAU), and (2) standard reminders (RAU) versus reminders plus retention incentives (RAU+I), delivered via the HIPAA-compliant Talkspace platform. The study examines treatment outcomes, engagement patterns, moderators, and mechanisms—including motivation—and evaluates a novel Artificial Intelligence (AI)-based approach to assessing fidelity in messaging‑based interventions.

The first presentation provides an overview of the study design and reports main clinical outcomes and moderators by treatment condition. The second presentation focuses on engagement strategies, comparing RAU and RI on engagement trajectories, treatment response, and motivational processes. The third presentation examines therapy content and fidelity across both treatment conditions, highlighting how therapists deliver CPT‑Text and TAU in asynchronous formats. The fourth presentation introduces an emerging large language model (LLM)–based fidelity assessment approach, demonstrating how automated methods may support scalable quality monitoring in DMH interventions.

The discussant will focus on implications for providing scalable, innovative models of care for individuals who don’t access therapy.
Together, these presentations offer the first comprehensive evaluation of text‑based PTSD treatment at scale, advancing understanding of how to promote sustained engagement, ensure fidelity, and expand access to evidence‑based care through secure messaging platforms.

Presentations:

• 9:35 AM - 9:56 AM PDT

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

  Speaker: Shannon L. Wiltsey Stirman, Ph.D. (she/her/hers) – National Center for PTSD and Stanford University

  Co-Author: Amber Calloway, Ph.D. (she/her/hers) – University of Pennsylvania

  Co-Author: Sohayla Elhusseini, B.A. – University of Kentucky

  Co-Author: Booil Jo, PhD (she/her/hers) – Stanford University

  Co-Author: Aarthi Padmanabhan, Ph.D. (she/her/hers) – Talkspace

  Co-Author: Stefanie LoSavio, ABPP, Ph.D. – The University of Texas Health Science Center at San Antonio

  Co-Author: Brittany Hall Clark, PhD (she/her/hers) – University of Texas Health Sciences Center for San Antonio

  Co-Author: Derrick Hull, PhD (he/him/his) – Slingshot AI

  Co-Author: Emily Peake, M.A. (she/her/hers) – Talkspace

  Co-Author: Szu-Chi Huang, PhD – Stanford Graduate School of Business

  Co-Author: Elizabeth Stade, PhD (she/her/hers) – Stanford University

  Co-Author: Bailee Schuhmann, PhD (she/her/hers) – University of Texas Health Sciences Center for San Antonio

  Co-Author: Katy Dondanville, PsyD, ABPP – The University of Texas Health Science Center at San Antonio
• 9:56 AM - 10:17 AM PDT

  (SYM 3) Evaluating a "pay-it-forward" Incentive Model to Enhance Engagement and Clinical Outcomes in PTSD Treatment
  

  Speaker: Christine Bird, Ph.D. – Stanford University

  Co-Author: Aarthi Padmanabhan, Ph.D. (she/her/hers) – Talkspace

  Co-Author: Booil Jo, PhD (she/her/hers) – Stanford University

  Co-Author: Sohayla Elhusseini, B.A. – University of Kentucky

  Co-Author: Emily Peake, M.A. (she/her/hers) – Talkspace

  Co-Author: Szu-Chi Huang, PhD – Stanford Graduate School of Business

  Co-Author: Katy Dondanville, PsyD, ABPP – The University of Texas Health Science Center at San Antonio

  Co-Author: Shannon L. Wiltsey Stirman, Ph.D. (she/her/hers) – National Center for PTSD and Stanford University
• 10:17 AM - 10:38 AM PDT

  (SYM 3) Therapy by Text: Training, Fidelity, and What's Actually Being Delivered
  

  Speaker: Katy Dondanville, PsyD, ABPP – The University of Texas Health Science Center at San Antonio

  Co-Author: Amber Calloway, Ph.D. (she/her/hers) – University of Pennsylvania

  Co-Author: Stefanie LoSavio, ABPP, Ph.D. – The University of Texas Health Science Center at San Antonio

  Co-Author: Bailee Schuhmann, PhD (she/her/hers) – University of Texas Health Sciences Center for San Antonio

  Co-Author: Brittany Hall Clark, PhD (she/her/hers) – University of Texas Health Sciences Center for San Antonio

  Co-Author: Christine Bird, Ph.D. – Stanford University

  Co-Author: Shannon L. Wiltsey Stirman, Ph.D. (she/her/hers) – National Center for PTSD and Stanford University
• 10:38 AM - 11:00 AM PDT

  (SYM 3) Development of an Automated, Scalable Method for Assessing Fidelity to Cognitive Processing Therapy
  

  Speaker: Elizabeth Stade, PhD (she/her/hers) – Stanford University

  Co-Author: Samuel Campione, M.A. (he/him/his) – Stanford University

  Co-Author: Sohayla Elhusseini, B.A. – University of Kentucky

  Co-Author: Katy Dondanville, PsyD, ABPP – The University of Texas Health Science Center at San Antonio

  Co-Author: Stefanie LoSavio, ABPP, Ph.D. – The University of Texas Health Science Center at San Antonio

  Co-Author: H. Andrew Schwartz, PhD – Vanderbilt University

  Co-Author: Johannes Eichstaedt, Ph.D. (he/him/his) – Stanford University

  Co-Author: Shannon L. Wiltsey Stirman, Ph.D. (she/her/hers) – National Center for PTSD and Stanford University